NCCN Guidelines for Patients
Malignant Pleural Mesothelioma, Version 1.2016
What are the 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 (
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
Your state of general health will be rated using a
performance status scale. A commonly used scale is
the ECOG (
Performance Scale. The PS (
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
Details of that stage
The tumor hasn’t grown beyond the pleura where it started.
The tumor has grown into the diaphragm or the lung, or both.
• 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
• 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.