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Mesothelioma has four stages, which can be determined by physicians through X-rays, CT scans and MRI scans.

Up until now, doctors still use the Butchart System in grading the different stages of mesothelioma. It is regarded as the oldest system, and a trusted method at that.
Developed by Dr. Eric Butchart, the Butchart System has four levels that classify the extent of mesothelioma. Stages I and II are identified as the early stages wherein the malignant cells are localized only on the lining of the internal organs, such as the lungs and kidney. In the advanced stages of III and IV, the tumor has already spread outside the membrane surface and on to the other parts of the body.
The Butchart System focuses only on the main disease, which is mesothelioma. It largely disregards other secondary tumors and complications caused by the cancer.

Stage I

In the first stage of mesothelioma, malignant cells start to build up in membranes that enclose the lungs and lining of the chest cavity. In some instances, these cancer cells may also develop in the membrane that covers the heart. Usually, cancer cell growth is restricted only to one side of the body. So the primary tumor may either be on the right or left side of the chest.

Stage II

During the second stage, the tumor has extended beyond both sides of the chest area, and invades the regions of the esophagus and the heart. In addition, the lubricating fluid, which is normally produced by the pleura, builds up in the lungs and the chest wall; thus, resulting to pleural effusion. Symptoms like shortness of breath and chest pains are usually manifest during this stage of mesothelioma. Other patients may also have cough.

Stage III

At this point, the primary tumor has extended into the bounds of the diaphragm and abdominal cavity. In addition, the malignant cells may develop into the first layer of the chest wall or on the outer layer of the heart. Also, cancer may build up on the lymph nodes on one part of the chest. Severe pain in the affected parts of the body may be experienced by a Stage III patient. Immediate treatment and medication is advised; otherwise, the cancer may progress to Stage IV.

Stage IV

Known as the “distant metastatic cancer,” the malignant cells have entered into the bloodstream, and invaded the other organs. During this stage, it is possible that the patient may experience the collapsing of the lungs. In addition, pain and swelling of the neck and face may also exhibit as its symptoms. In severe instances, the tumor could reach the brain.

Recently, the International Mesothelioma Interest Group developed a new system, which is more or less similar to the Butchart System.  The TNM System, which stands for tumor, nodes (as in lymph nodes), and metastasis, is the new system that is being adopted by the American Joint Committee on Cancer.  More cancer centers are now adopting this new system in account of its accuracy in determining the extent of the tumor. 

Like the Butchart System, the TNM System also has four stages:

In the first stage, malignant cells are either on the right or left side of the chest.  At most, these cancer cells may spread and manifest in small spots to the outer lining of one lung.  At this early stage, the tumor has not yet reached the lymph nodes.

In Stage II, the malignant cells have extended to the diaphragm and the lungs.

During the third stage, mesothelioma has invaded the first layer of the chest wall and the outer covering layer of the heart.  Also, the tumor has reached the lymph nodes in the same side of the chest.

At the last stage, the malignant cells have entered the bloodstream, and overrun the chest wall, the ribs and the diaphragm.  Moreover, the cancer has also reached the esophagus, trachea and the blood vessels.  The complications will also involve the spine, the heart, brachial plexus and the other organs of the body.