Resources for Patients and their Families

Mesothelioma Staging

Mesothelioma Stages

The four stages of mesothelioma allow doctors to identify and classify the severity and progression of the cancer at diagnosis. Stage 1 offers the most hopeful prognosis, while a Stage 4 diagnosis often means the patient is limited to palliative care.

How Mesothelioma Is Staged

Mesothelioma staging refers to the process of categorizing mesothelioma according to the extent of the disease in a patient’s body. Staging is actually a process common to all types of cancer, although specific staging systems are often developed based on characteristics of specific cancers, like mesothelioma.

Mesothelioma has four stages that doctors can use to determine extent of the cancer within the body. Upon being diagnosed, the diagnosing doctor will identify the stage with a number between 1 and 4, with Stage 4 being the most severe and deadliest form.

The Four Stages of Mesothelioma
Stage 1 Mesothelioma Stage 2 Mesothelioma Stage 3 Mesothelioma Stage 4 Mesothelioma

Staging only occurs at diagnosis. While the cancer may progress or recede, the stage of mesothelioma at diagnosis will not change. For example, if a Stage 1 mesothelioma tumor spreads to other parts of the body, it is called Stage 1 with metastasis. Likewise, if a Stage 4 mesothelioma tumor reduces in size or goes into remission, the stage will not change. While the initial treatment program may depend on the mesothelioma stage, actual treatment may vary depending on how the disease progresses.

Generally, staging requires a number of diagnostic tests to determine the tumor location, size, and whether it has spread beyond the initial site.

Mesothelioma Staging by Type

Given the rarity of mesothelioma, a formal staging classification exists only for pleural mesothelioma, the most common variety. No formal staging systems are defined for peritoneal, pericardial, or testicular mesothelioma.

Although there are no staging systems for less common forms of mesothelioma, the American Joint Committee on Cancer (AJCC) has published general guidelines for staging cancer in its AJCC Cancer Staging Manual. Therefore, even when doctors do not have guidelines for a specific form of cancer, they can still refer to the general guidelines to help determine the stages of extremely rare cancers like peritoneal mesothelioma and pericardial mesothelioma.

Stages of Mesothelioma

The four stages of mesothelioma vary slightly within each system, but they can be generalized as indicated below. Please click into the individual pages to get more information about each stage.

Stage 1

In Stage 1, the mesothelioma tumor is in one location, and the cancer has not spread to lymph nodes or other organs or tissues. In general, surgery may be an option for removing the tumor.

Stage 2

In Stage 2, the mesothelioma tumor is larger and has invaded nearby organs, such as the lung or diaphragm. Lymph nodes may also be involved. In this case, surgical resection may still be possible, though more difficult depending on the extent of the growth.

Stage 3

In Stage 3, mesothelioma has invaded a region or area, such as the chest wall, esophagus, or lymph nodes. Surgery is generally not an option as a curative treatment, though other treatments may be tried.

Stage 4

In Stage 4, the mesothelioma has spread to multiple areas, such as other organs and tissues throughout the body. Surgery is not an option, and most treatments at this stage focus on reducing pain and discomfort.

Pleural Mesothelioma Staging Systems

Over the years, different systems have been developed to stage mesothelioma. The three most commonly used systems are very similar, although they vary slightly. Learn more about each staging system for mesothelioma by selecting the appropriate link below.

Note that mesothelioma-specific staging systems only exist for pleural mesothelioma. Other types of mesothelioma do not have their own staging systems.

Butchart Staging System

The Butchart staging system is the oldest and most commonly used staging system for mesothelioma. This system focuses on defining the location of the primary tumor mass in the body for each stage. The system doesn’t address how many cancer cells are present, how big the tumor is, or the overall amount of cancer present in the body.

TNM Staging System

The TNM Staging System, developed by the American Joint Committee on Cancer (AJCC), is a staging system used for many different types of cancer. The current version of the TNM Staging System is detailed in the AJCC Cancer Staging Manual (7th ed., 2009). It considers the characteristics of the tumor (T), involvement of the lymph nodes (N), and whether the cancer has metastasized (M) to other locations within the body.

Brigham Staging System

The Brigham Staging System also has four stages of progression. The primary difference of the Brigham System from the others is that, in addition to identifying tumor characteristics and metastasis, the Brigham System assesses the likely success of surgical intervention at each stage.

Mesothelioma Stages Are Guides – Not Rules!

Although the stage of the mesothelioma can provide guidance about the expected course of the disease (that is, the prognosis) it is important to remember that the staging systems themselves are guides. At every stage, mesothelioma can be deadly – but there can also be some hope as well, no matter what stage you are diagnosed at.

Every patient’s treatment options will depend heavily not only on the stage of the disease, but on the cell type and location of the mesothelioma they have, as well as the patient’s age, gender, and overall health.

If you or a loved one was recently diagnosed with mesothelioma, you may want to talk with someone who can provide explanation and context around your diagnosis. Contact us to connect with an expert who can help you understand what your stage means.

Treatment Options By Mesothelioma Stage

Stage 1 Mesothelioma Treatment

Mesothelioma surgery is the most commonly recommended course of treatment for pleural mesothelioma patients having a Stage 1 diagnosis. The procedures that are likely to be performed are pleurectomy/decortication or extrapleural pneumonectomy. Post surgery, doctors may further evaluate the patient to determine if chemotherapy or radiation treatment is necessary. It is often determined with stage 1 mesothelioma that those adjunct therapies are not required.

Stage 2 Mesothelioma Treatment

Patients diagnosed with Stage II Mesothelioma still have a fairly wide range of treatment options available to them. Chemotherapy and radiation therapy are the most common treatments that will be recommended. Surgery may or may not continue to be a viable treatment option at this stage. There are also a variety of experimental and alternative treatments that may be used to slow the progression of the disease and help manage the pain and stress associated with conventional treatment therapies.

Stage 3 Mesothelioma Treatment

The treatment options for Stage III Mesothelioma patients are fewer than those available for Stage I and II patients as the cancer, in this stage, has typically spread beyond the point of origin to other vital organs in the body or the lymphatic system. Treatments recommended for Stage III patients are primarily focused on providing patient comfort and improving quality of life.

Stage 4 Mesothelioma Treatment

A diagnosis of stage 4 mesothelioma usually indicates a very unfavorable mesothelioma prognosis. At this stage, the cancer has usually metastasized throughout the body to other organs and as with stages 2 and 3, cannot be cured. In this stage, symptoms generally increase in severity and pain management becomes the primary focus of the medical team. Therapies such as chemotherapy and radiation are typically not offered at this stage unless they are needed to support pain management objectives. Oftentimes families find that it is most helpful to seek out additional support through a local Hospice program. Hospice programs focus on providing patient care, developing a pain management protocol and providing support for both the patient and family members at this difficult time. Patients with stage 4 mesothelioma may also be interested in participating in specialized clinical trials offered at leading cancer hospitals and centers.

Financial Assistance for Mesothelioma Treatment

Medical treatment costs can be significant as one progresses through the various stages of a mesothelioma diagnosis. Sometimes insurance companies may not cover the cost of diagnostic tests, clinical trials or other alternative treatments. If you or a loved one is diagnosed, you should strongly consider taking steps to help offset this potential financial burden. Learn more about the financial assistance that is available to you if you or a loved one has been diagnosed with mesothelioma and exposed to asbestos.

View Sources


Heelan RT, Rusch VW, Begg CB, et al. Staging of malignant pleural mesothelioma: comparison of CT and MR imaging. American Journal of Roentgenology. 1999;172: 1039-1047. doi: 10.2214/ajr.172.4.10587144

International Mesothelioma Interest Group. A Proposed New International TNM Staging System for Malignant Pleural Mesothelioma. Chest. 1995;108(4):1122-1128. doi: 10.1378/chest.108.4.1122 Accessed September 7, 2016.

Jett JR. Malignant Pleural Mesothelioma: A Proposed New Staging System. Chest. 1995;108(4):895-897. doi: 10.1378/chest.108.4.895

Richards WG. Recent Advances in Mesothelioma Staging. Seminars in Thoracic and Cardiovascular Surgery. 2009;21(2):105-110. doi: 10.1053/j.semtcvs.2009.07.002

Van Schil P. Malignant pleural mesothelioma: Staging systems. Lung Cancer. 2005;49(Supplement 1):S45-S48. doi: 10.1016/j.lungcan.2005.03.008

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