Brigham Staging System

Brigham staging system, developed at the Dana Farber Cancer Institute/Brigham and Women’s Hospital Thoracic Oncology Program in Boston, Massachusetts,  is based on four stages of cancer. It also considers such variables as lymph node involvement and tumor resectability – or the ability to surgically remove the tumor.

One of the important steps in diagnosing and treating any form of cancer is staging. Determining the stage of the cancer helps doctors and patients understand how far it has spread and what parts of the body are affected – which, in turn, can determine what sort of treatment may be most effective in eradicating the cancer and improving the patient’s quality of life.

There are three methods of staging mesothelioma, the cancer that affects the lining of the lungs, heart or stomach. These are the Butchart staging system, the TNM staging system, and the newest staging system, the Brigham staging system. Developed at the Dana Farber Cancer Institute/Brigham and Women’s Hospital Thoracic Oncology Program in Boston, Massachusetts, the Brigham staging system is based on four stages of cancer. It also considers such variables as lymph node involvement and tumor resectability – or the ability to surgically remove the tumor.

Stage I

The mesothelioma is still resectable and the lymph nodes have not been affected.

Stage II

The mesothelioma is still resectable; however, the body’s lymph nodes are involved.

Stage III

The mesothelioma tumor is not resectable. It may have penetrated the abdominal cavity, chest wall, heart or diaphragm. The lymph nodes may or may not be affected in Stage III.

Stage IV

The mesothelioma has completely metastasized, or spread beyond its original location.

Several medical procedures and tests may be employed in order to help the oncologist stage a case of mesothelioma. Imaging techniques such as chest x-ray, CT scan, magnetic resonance imaging (MRI) and endoscopic ultrasound are all commonly used to determine the type of mesothelioma – pleural (lung), peritoneal (stomach) or pericardial (heart). Biopsies are also frequently taken, whether through a thin needle or more invasive methods such as endoscopy, thoracoscopy or mediastinoscopy.

Mesothelioma has a long latency period – it can take up to 40 years for the cancer to develop to the point where it is symptomatic – and therefore few cases are diagnosed in Stage I. Stage II is less rare, but most patients with mesothelioma are diagnosed in Stage III or Stage IV. At this point, it is difficult to treat mesothelioma with surgery. Depending on the cancer’s location, it may also be inadvisable to treat it with radiation or chemotherapy. Some late-stage patients are deemed too weak to undergo these aggressive forms of treatment, and therefore choose to manage their pain and try to remain as comfortable as possible during their remaining days.

There are also some experimental therapies which patients may pursue, including immunotherapy, gene therapy and photodynamic therapy. Alternative methods of treating mesothelioma are increasing in popularity as well. These include such approaches as nutritional supplements, a whole-foods diet or herbal products; homeopathic or naturopathic medicine; acupuncture; Eastern medicine such as Traditional Chinese Medicine (TCM); massage therapy; and hypnosis or meditation.

Many physicians will use a combination of staging systems, or will even stage each patient according to the Brigham system, the Butchart system and the TNM system, in order to provide themselves with the most complete and accurate picture possible of the mesothelioma’s development and metastasis.

The Butchart system, developed in the 1970s and named for cardiothoracic surgeon Eric. G. Butchart, is based on the magnitude of the primary tumor. The TNM system stands for Tumor, (Lymph) Nodes and Metastasis, and was developed by the American Joint Committee on Cancer (AJCC). Considered the major staging system, the TNM system is also the most complicated, with a variety of categories and levels by which to classify the cancer.

The staging process, in combination with an assessment of the patient’s overall health and strength, as well as his or her wishes, can help the doctor formulate a treatment plan that will optimize the patient’s comfort and decrease their pain and other symptoms.