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Butchart Staging System

First proposed in 1976, the Butchart System is the oldest formal system for specifically staging mesothelioma. This system relies on determining the location of the primary tumor mass in the body for each stage. It does not take into account the size of the tumor, how many cancer cells are present, or the level of cancer present in the body overall.

The Butchart System was created before CT scans, and correlations between the stage of mesothelioma and survival rates according to the system may not hold up under later research.

Other systems based on the Butchart system have been proposed over the last 30 years. For example, in 1982, Karin Mattson proposed a variation on the Butchart System that offered more concise and precise descriptions of each stage.

Stages in the Butchart System

The table below describes the Butchart System as it was originally published.

Butchart Staging System
Stage Description
Stage 1 Tumor confined within the “capsule” of the parietal pleura, i.e., involving only ipsilateral pleura, lung, pericardium, and diaphragm
Stage 2
  • Tumor invading chest wall or involving mediastinal structures, e.g., esophagus, heart, opposite pleura
  • Lymph node involvement within the chest
Stage 3
  • Tumor penetrating diaphragm to involve peritoneum; involvement of opposite pleura
  • Lymph node involvement outside the chest
Stage 4 Distant blood-borne metastasis


Butchart EG, Ashcroft T, Barnsley WC, Holden MP. Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura: experience with 29 patients. Thorax. 1976;31:15-24.

Flores RM, Rush VW. Staging of Mesothelioma. In: Pass HI, Vogelzang N, Carbone M, ed. Malignant Mesothelioma: Pathogenesis, Diagnosis, and Translational Therapies. New York, NY: Springer;2005:402-415.

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