Mesothelioma Diagnosis Staging and Prognosis 2 — Questions and Answers
Question 1: N2 disease in the IMIG TNM system for mesothelioma refers to involvement of which lymph nodes?
- Subcarinal or contralateral mediastinal nodes (Correct answer)
- Ipsilateral bronchopulmonary nodes
- Axillary nodes
- Cervical nodes
Correct answer: Subcarinal or contralateral mediastinal nodes
N2 disease indicates spread to subcarinal or contralateral mediastinal or internal mammary lymph nodes, which typically indicates unresectable disease.
Question 2: Which prognostic scoring system for mesothelioma uses lactate dehydrogenase, age, performance status, and hemoglobin?
- CALGB prognostic score (Correct answer)
- EORTC score
- IMIG TNM
- Brigham staging
Correct answer: CALGB prognostic score
The CALGB (Cancer and Leukemia Group B) prognostic score uses LDH, age, performance status, and hemoglobin to classify patients into good, intermediate, and poor risk groups.
Question 3: What does T4 disease represent in the IMIG staging of pleural mesothelioma?
- Direct extension into contralateral pleura, spine, or heart (Correct answer)
- Invasion of the diaphragm only
- Involvement of the pericardium without cardiac invasion
- Ipsilateral pleural disease with effusion
Correct answer: Direct extension into contralateral pleura, spine, or heart
T4 denotes extension beyond local structures to involve the contralateral pleura, peritoneum, spine, heart, or brachial plexus — all indicating unresectable disease.
Question 4: Which performance status scale is most commonly used to assess mesothelioma patients' fitness for treatment?
- ECOG performance status (Correct answer)
- Karnofsky score only
- WHO disability grade
- NYHA functional class
Correct answer: ECOG performance status
ECOG (Eastern Cooperative Oncology Group) performance status 0–2 is the standard measure used in clinical trials and treatment decisions for mesothelioma.
Question 5: Peritoneal mesothelioma staging uses the Peritoneal Cancer Index (PCI), where a PCI score above what threshold generally predicts incomplete cytoreduction?
- 20 (Correct answer)
- 5
- 50
- 10
Correct answer: 20
A PCI score above approximately 20 is generally associated with inability to achieve complete cytoreduction (CC-0), which is required for optimal survival benefit.
Question 6: Which first-line chemotherapy regimen is FDA-approved and standard of care for unresectable pleural mesothelioma?
- Cisplatin plus pemetrexed (Correct answer)
- Carboplatin plus paclitaxel
- Gemcitabine plus oxaliplatin
- FOLFOX
Correct answer: Cisplatin plus pemetrexed
Cisplatin plus pemetrexed (with folic acid and B12 supplementation) is the approved first-line standard chemotherapy regimen for malignant pleural mesothelioma.
Mesothelioma Diagnosis Staging and Prognosis 2
N2 disease in the IMIG TNM system for mesothelioma refers to involvement of which lymph nodes?