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19

NCCN Guidelines for Patients

®

:

Malignant Pleural Mesothelioma, Version 1.2016

3

Treatment planning

What are the stages?

Clinical stages

The recommended treatment for mesothelioma is

based on where the cancer is located. The clinical

stage is a rating of the extent of the cancer based on

tests before treatment. The AJCC (

A

merican

J

oint

C

ommittee on

C

ancer) staging system is most often

used for mesothelioma. In this system, there are four

cancer stages based on the growth and spread of the

cancer. Stages III and IV have more than one place

of cancer growth. These stages are described in

Guide 4.

Performance status

Your state of general health will be rated using a

performance status scale. A commonly used scale is

the ECOG (

E

astern

C

ooperative

O

ncology

G

roup)

Performance Scale. The PS (

p

erformance

s

tatus)

indicates a person’s general level of fitness.

For mesothelioma, a PS of 0–4 is considered when

planning treatment. With 0 meaning you are fully

active, 1 means you do light activity, 2 means you

care for youself but are not active, 3 means you are

limited to the chair or bed half of the time, and 4

means you need someone to care for you. With a PS

4, you are fully limited to a chair or bed.

This status helps doctors decide whether to watch

you closely and wait to start treatment, begin

treatment, or offer supportive care. Supportive

care is given to help ease your pain or discomfort.

Supportive care is also known as palliative care. See

Part 5 for more information on supportive care.

What are the stages?

Guide 4. Stages of mesothelioma

Stage

Details of that stage

Stage I

The tumor hasn’t grown beyond the pleura where it started.

Stage II

The tumor has grown into the diaphragm or the lung, or both.

Stage III

• The tumor has grown into 1) the first layer of the chest wall or a confined area of the

other layers, 2) the fat between the lungs, or 3) the pericardium.

• The cancer has spread to nearby lymph nodes or the nodes at the base of the breast

bone.

Stage IV

• The tumor has grown into 1) a wide area of the chest wall, 2) the peritoneum, 3) an organ

between the lungs, 4) the spine, or 5) the pleura around the other lung.

• The cancer has spread to the lymph nodes near the other lung or near the collarbone.

• The cancer has spread to distant sites.