The Brigham Staging System

Mesothelioma is a rare form of asbestos cancer that advances and spreads through the body’s organs in stages. In order for doctors to determine the best treatment options for a mesothelioma patient, a staging system must be employed to determine the severity of the disease. Several staging systems for mesothelioma are currently used in diagnosis. The Brigham system is the newest.

The Brigham System

The Brigham staging system was introduced after analyzing 52 mesothelioma patients. It is made up of four stages. Staging is determined by whether or not malignancy may be removed surgically and whether the lymph nodes are affected. The Brigham system is similar to the most common staging system, the TNM system.

Stages of the Brigham System

A Brigham system diagnosis of stage I mesothelioma means that the malignancy may be removed surgically and the lymph nodes have not become involved. Stage II indicates that the lymph nodes are affected but that surgery is still a viable option for removal. In Stage III, according to the Brigham staging system, the malignancy is not removable by surgery and has spread into the body cavity, diaphragm, chest wall, or heart. The lymph nodes may or may not be affected. Stage IV mesothelioma means that the disease has metastasized and spread throughout the body.

The Staging Process

A variety of tests may be performed during the staging process in order to accurately diagnose mesothelioma. This may include a chest X-ray, MRI, CAT scan, or endoscopic ultrasound. Sometimes, biopsies are performed in order to determine which organs have been invaded by malignancy. Endoscopic ultrasound may aid in these procedures as well.

Treatment Options for Mesothelioma

Upon completion of the tests involved in the Brigham system, doctors determine the best course of treatment for a patient based on stage assignation and other factors. These factors may include age, overall health, and other medical conditions. Courses of treatment may involve traditional or new procedures.

Traditional treatment involves surgerychemotherapy, and radiation therapy. Surgery may be used to remove infected cells. Chemotherapy refers to the injection of cancer fighting agents directly into the patient. Radiation therapy involves high energy rays that are used to shrink and destroy tumors and cancerous cells. These treatments are used simultaneously in the majority of cancer patients.

Additional Treatment Methods

Other, more radical treatments have been explored to address mesothelioma. Immunotherapy, the introduction of new chemotherapy agents, photodynamic therapy, and intensity modulated radiation therapy are just a few of these treatments. Many other new therapies are constantly being developed and explored as options to treat mesothelioma.

There are some people who believe that alternative and Eastern medicines aid in treatment as well. This may include homeopathic medicine, herbal treatments, and special diets. It is believed that these treatments may be able to assist traditional medicine in treatment.

The Brigham system of staging is an important step in the diagnosis of mesothelioma. It allows doctors to determine how advanced the cancer has become before providing a prognosis and determining the best course of treatment for each patient.


Vanderbilt University Department of Thoracic Surgery