T0: There is no evidence of a primary tumour. T1a The tumour is limited to the ipsilateral parietal pleura as well as the mediastinal and diaphragmatic pleura. However, there is no involvement of the visceral pleura. T1b The tumour has involved the ipsilateral parietal and visceral pleura along with the mediastinal and diaphragmatic pleura. T2 The ipsilateral pleural surfaces, which include the parietal, mediastinal, diaphragmatic and visceral pleura, have been invaded by the tumours. At least one of the following features is also included in this stage: The diaphragmatic muscle is involved. The tumour has extended into the visceral pleura and the underlying pulmonary parenchyma. T3 The tumour has expanded locally, but is potentially resectable. It has invaded all of the ipsilateral pleural surfaces, which include the parietal, mediastinal, diaphragmatic and visceral pleura. One or more of the following features will be displayed: The endothoracic fascia is involved. Extension into the mediastinal fat. The tumour has extended into the soft tissues of the chest wall and is solitary and completely resectable. Nontrasmural involvement of the pericardium. T4 The tumour is locally advanced and is unresectable. It has involved all of the ipsilateral pleural surfaces including the parietal, mediastinal, diaphragmatic and visceral pleura. These tumours will also display at least one of the following features: A di ff use extension or multifocal masses into the chest wall, with or without rib destruction. The tumour has direct transdiaphragmatic extension into the peritoneum. A direct extension of the tumour into the contralateral pleura. The tumour has directly extended into one or more of the mediastinal organs. The spine has experienced a direct extension of the tumour. The tumour has extended through the internal surface of the pericardium with or without a pericardial e ff usion. The tumour has involved the myocardium.
National Guidelines for Cancer Management Kenya 158 MX The presence of metastasis cannot be assessed. M0 The tumour has not metastasized to other parts of the body. M1 The presence of metastasis into other parts of the body. Table 57: Stage grouping for Malignant Pleural Mesothelioma STAGE PRIMARY TUMOUR (T) REGIONAL LYMPH METASTASIS NO DES (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 Table 58: Stage grouping and TNM for Malignant Pleural Methosilioma Stage IA T1a N0 M0 Stage IB T1b N0 M0 Stage II Stage III Stage IV Completely resected within the capsule of the parietal pleura without adenopathy (ie, ipsilateral pleura, lung, pericardium, diaphragm, or chest wall disease limited to previous biopsy sites) All stage I characteristics, with positive resection margins, intrapleural adenopathy, or a combination T2 N0 M0 T4 Any N M0 Any T N3 M0 Any T Any N M1 T1, T2 N1 M0 T1, T2 N2 M0 T3 N0, N1, N2 M0 Local extension of disease into the chest wall or mediastinum, into the heart, through the diaphragm or peritoneum, or extrapleurally to involve the lymph nodes Distant metastatic disease
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