The Butchart Staging System

Malignant mesothelioma is an aggressive cancer caused primarily by exposure to asbestos. It occurs in the mesothelium, most commonly in the pleura lining the chest cavity, less frequently in the peritoneal surrounding the organs in the abdomen, and rarely, in the pericardium surrounding the heart. Treatments are devised based on the stage of the cancer. Staging is determined by the extent the cancer has spread and is essential for developing the most effective treatment plan.

The Butchart Staging System

Three different systems of determining the stages of malignant mesothelioma are in use – the Brigham Staging System, the TNM Staging system, and the Butchart Staging System. The Butchart system is the oldest of these, devised by Dr. Eric G. Butchart in the 1970s. Despite its age, it is currently used for its simplicity and usefulness for choosing therapeutic options.

Stage 1 is the earliest stage of mesothelioma. The cancer is present in the left or right pleura surrounding the lung. At this stage, the cancer may also be present in the lung, the pericardium, or the muscle of the diaphragm. The cancer is present only on one side of the body.

In Stage 2, the cancer has spread to the chest wall or into the esophagus. It may also be present on both sides of the chest and the heart. Some patients have cancer in the lymph nodes in the chest.

Stage 3 occurs when the cancerous growth has penetrated the diaphragm and spread into the peritoneum, the lining of the abdominal cavity. Lymph nodes may be involved both in the chest and outside.

In Stage 4, the cancer has metastasized to distant parts of the body. It may be found in other organs and in areas distant from the point of origin.

Testing to Determine the Butchart Stage

A complete chest X-ray gives an accurate view of all the bones and organs within the chest. Computerized tomography, CT or CAT scan, reveals details of different tissues. The CT scan uses low levels of X-rays. As the scanner rotates around the body, a computer records the levels of energy absorbed. A cross section through the body is composed of many layers of X-ray scans. Dye is sometimes utilized during a CT scan to improve the image. Magnetic resonance imaging (MRI) is used to produce detailed images. Endoscopic ultrasound (EUS) in conjunction with a biopsy may also be performed.

Treatment Options

Once the stage and general health of the patient have been assessed, a treatment plan is developed. Traditional treatments use surgerychemotherapy, and radiation, often in combination. New treatments include various new chemotherapy medications, intensity modulated radiation therapy (IMRT), interferon and interleukin therapies, gene therapy, immunotherapy, and others. Clinical trials testing new treatments may be an option. In addition, many complementary and alternative medical (CAM) treatments exist including special diets, herbs, acupuncture, massage, and vitamin therapies. Eastern medicines include traditional Chinese and ayurvedic systems.


Doherty, Gerard M. (2010). Current Diagnosis and Treatment Surgery. 13th ed.