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AJCC Stages

Stages

T

N

M

I

T1

N0

M0

IA

T1a

N0

M0

IB

T1b

N0

M0

II

T2

N0

M0

III

T1, T2

N1

M0

T1, T2

N2

M0

T3

N0, N1, N2

M0

IV

T4

Any N

M0

Any T

N3

M0

Any T

Any N

M1

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Tumor limited to the ipsilateral parietal pleura with or without mediastinal pleura with or without diaphragmatic pleural involvement

T1a

No involvement of the visceral pleura

T1b

Tumor also involving the visceral pleura

T2

Tumor involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with ≥ 1 of the following: Involvement of diaphragmatic muscle; extension of tumor from visceral pleura into the underlying pulmonary parenchyma

T3

Locally advanced but potentially resectable tumor

Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with ≥ 1 of the following: Involvement of the endothoracic fascia; extension into the mediastinal fat; solitary, completely resectable focus of tumor extending into the soft tissues of the chest wall; nontransmural involvement of the pericardium

T4

Locally advanced technically unresectable tumor

Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with ≥ 1 of the following: Diffuse extension or multifocal masses of tumor in the chest wall, with or without associated rib destruction; direct transdiaphragmatic extension of tumor to the peritoneum; direct extension of tumor to the contralateral pleura; direct extension of tumor to mediastinal organs; direct extension of tumor into the spine; tumor extending through to the internal surface of the pericardium with or without a pericardial effusion or tumor involving the myocardium

(N) Regional Lymph Nodes

NX

Regional nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastases in the ipsilateral bronchopulmonary or hilar lymph nodes

N2

Metastases in the subcarinal or the ipsilateral mediastinal lymph nodes, including the ipsilateral internal mammary and peridiaphragmatic nodes

N3

Metastases in the contralateral mediastinal, contralateral internal mammary, ipsilateral or contralateral supraclavicular lymph nodes

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

(G) Histologic Grade

GX

Grade cannot be assessed

G1

Well differentiated

G2

Moderately differentiated

G3

Poorly differentiated

G4

Undifferentiated

Χαρακτηριστικά Επέκτασης

Local spread

• Malignant pleural mesothelioma (MPM) usually grows diffusely around and within pleural cavity
  • Localized MPM is rare
• Local invasion of adjacent structures common
  • Chest wall
  • Diaphragm
  • Interlobar fissure
  • Pericardium
  • Abdominal organs
• Seeding across tracts resulting from pleural interventions is common

Nodal spread

• Poor prognostic sign
• Regional lymph nodes include
  • Intrathoracic
  • Scalene
  • Internal mammary
  • Peridiaphragmatic

Distant metastasis

• Rare hematogenous spread
• Common sites include
  • Contralateral lung
  • Contralateral pleura
  • Peritoneum
  • Liver
  • Bone
  • Adrenal gland

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

• Epithelioid (55-65%) (Best prognosis)
• Sarcomatoid (10-15%)

• Biphasic (20-35%)
• Desmoplastic (10%)