Mesothelioma staging

• T1a – Tumor involves the ipsilateral parietal pleura and may also be in the pleura lining the diaphragm or the mediastinum. There is no tumor in the visceral pleura.
• T1b – Tumor involves both the ipsilateral parietal pleura and the visceral pleura.

• Tumor in the visceral pleura, including the fissures of the lung
• Invasion of the diaphragm
• Invasion of the lung parenchyma

• Invasion of the endothoracic fascia
• Invasion into mediastinal fat
• Solitary tumor invading soft tissues of the chest wall
• Non-transmural involvement of the pericardium
  

_{T3 describes mesothelioma that is locally advanced, but potentially resectable}

• Diffuse or multifocal invasion of soft tissues of the chest wall
• Rib involvement
• Invasion through the diaphragm and into the peritoneum
• Invasion of any organ in the mediastinum
• Extension to the contralateral pleura
• Invasion into the spine
• Extension to the internal surface of the pericardium
• Pericardial effusion with positive cytology
• Invasion of myocardium
• Invasion of nerves of the brachial plexus
  

_{T4 describes mesothelioma that is locally advanced, but unresectable}

• Bronchopulmonary lymph nodes are within the lungs.
• Hilar lymph nodes are near where the bronchus enters the lung.

OR
Metastasis in subcarinal lymph nodes or in either the internal mammary lymph nodes or mediastinal lymph nodes on the same side of the chest as cancer.

• Subcarinal lymph nodes are below the trachea.
• Internal mammary lymph nodes are around the sternum.
• Mediastinal lymph nodes are in the mediastinum.

OR
Metastasis in the contralateral mediastinal, internal mammary, or hilar lymph nodes or in either the supraclavicular or scalene lymph nodes on the ipsilateral or contralateral side.

• Supraclavicular lymph nodes are located above the clavicle.
• Scalene lymph nodes are located at the base of the neck.

It does not involve the visceral pleura. It has not spread to lymph nodes or distant organs.

It has not spread to lymph nodes or distant organs.

• the visceral pleura that covers the fissures of the lung
• the diaphragm
• the lung itself It has not spread to lymph nodes or distant organs
  

It has not spread to lymph nodes or distant organs.

• the diaphragm
• the lung itself
  

It has spread to the lymph nodes on the same side of the chest as the mesothelioma. These lymph nodes that contain cancer may be:

• bronchopulmonary lymph nodes
• hilar lymph nodes
• in both locations
  

It has not spread to distant organs.

T2

• the diaphragm
• the lung itself
  

It has spread to the lymph nodes on the same side of the chest as the mesothelioma. The lymph nodes that contain cancer may be:

• subcarinal lymph nodes
• internal mammary lymph nodes
• mediastinal lymph nodes
• subcarinal lymph nodes and internal mammary lymph nodes or mediastinal lymph nodes
  

It has not spread to distant organs.

N1,
N2

• endothoracic fascia
• the fatty part of the mediastinum
• a single area of soft tissue of the chest wall, such as muscle or fat
• pericardium
  

It may or may not have spread to lymph nodes closest to the ipsilateral lung, trachea, sternum, or mediastinum.
It has not spread to distant organs.

• several areas of soft tissue of the chest wall
• rib
• the diaphragm and into the peritoneum
• mediastinum
• contralateral pleura
• spine
• pericardium
• pericardial effusion positive for cancer cells
• myocardium
• brachial plexus
  

It may or may not have spread to lymph nodes. It has not spread to distant organs.

It has spread to lymph nodes in one of the following locations:

• contralateral mediastinal, internal mammary, or hilar lymph nodes
• ipsilateral or contralateral supraclavicular or scalene lymph nodes
• contralateral mediastinal, internal mammary, or hilar lymph nodes and to supraclavicular or scalene lymph nodes on either side
  

It has not spread to distant organs.

It may or may not have spread to the lymph nodes.
It has spread to distant organs.