The stage of mesothelioma determines a patient's treatment options. The most common type of staging system is the TNM system. The TNM staging system is based on three variables: the size and location of the tumor, the involvement of the lymph nodes, and metastasis. The TNM system is made up of four stages. In Stage I the lymph nodes are not involved and mesothelioma involves either the right or left pleura. In Stage II the lymph nodes are affected on the same side as the mesothelioma on the pleura and/or lung. In Stage III the lymph nodes may or may not be affected but the chest wall, heart, and other organs in the chest are affected by mesothelioma. And in the final stage, Stage IV, mesothelioma has spread throughout the chest and into most of the chest lymph nodes. Distant metastases are also included in this stage.