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14.5. TNM-8 klassifisering for malignt mesoteliom

Stadium

Forklaring

T1

Tumor limited to the ipsilateral parietal ± visceral ± mediastinal ± diaphragmatic pleura

T2

Tumor involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features:

•involvement of diaphragmatic muscle

•extension of tumor from visceral pleura into the underlying pulmonary parenchyma

T3

Describes locally advanced but potentially resectable tumor. Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features:

  • 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

Describes locally advanced technically unresectable tumor. Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features:

  • 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

N1

Metastases in the ipsilateral bronchopulmonary, hilar, or mediastinal (including the internal mammary, peridiaphragmatic, pericardial fat pad, or intercostal lymph nodes) lymph nodes

N2

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

M1

Distant metastasis present

Stadium

N0

N1

N2

T1

IA

II

IIIB

T2

IB

II

IIIB

T3

IB

IIIA

IIIB

T4

IIIB

IIIB

IIIB

M1

IV

IV

IV

IASLC/UICC Mesothelioma Staging Manual, 8th edition, 2016 (Rusch et al., 2016).

Anbefaling - utredning av mesoteliom:

  • Malignt pleuralt mesoteliom mistenkes ved pleuraeffusjon, pleural fortykkelse og samtidig brystsmerter (D).
  • Ved sterk mistanke om mesoteliom, ved diagnostisk usikkerhet eller når radikal behandling vurderes, skal pasienten henvises tverrfaglig møte ved universitetssykehus (A).
  • CT toraks med kontrast er basis for diagnostikk og staging (C).
  • For videre cyto-/histologisk diagnostikk gjøres aspirering for cytologi (D), og pleural biopsering (A) (helst torakoskopisk).
  • Histologisk bekreftelse av diagnosen må etterstrebes. Siden negativ cytologi/pleural biopsi ikke utelukker mesoteliom bør videre utredning gjøres (D).
  • Ved vurdering for kurativ behandling skal PET-CT utføres (C). I en ikke-kurativ situasjon er det ikke indikasjon for PET-CT.

Sist faglig oppdatert: 23. desember 2021