The prognosis for patients with malignant mesothelioma is hard to pinpoint because many variables go into a determination. Overall, patients diagnosed with the disease are expected to live six months to two years following diagnosis. However, there are many elements, including age, overall health, histology and stage of the disease, that play major parts in individual patient prognoses.
Mesothelioma is a rare disease that is primarily caused by exposure to asbestos. The most prevalent subtype — pleural mesothelioma — accounts for 80% of all diagnosed cases in the United States. Researchers have found that some of the factors that contribute to improved survival rates include being female, under age 45 and an epithelioid histological subtype.
Since treatments for mesothelioma can vary based on the location, stage and histology of the disease, doctors review all the contributing factors to find the best treatment. There are some actions patients can take to improve their prognosis.
Understanding a Prognosis
When a physician provides a prognosis, the goal is to give the patient an estimate of the chances of recovery based on medical and historical evidence from the general population. Several factors affect a prognosis, including:
- General health – People who are healthy can withstand the rigors of treatment.
- Age – Younger patients are better able to tolerate treatments. However, most patients are diagnosed in their 60s or 70s due to the long disease latency.
- Cell type – Each of the three main cell types —epithelioid, sarcomatoid and biphasic — can impact how the disease is treated. Epithelial mesothelioma has the best survival rate.
- Disease type – Of the three main types of mesothelioma —pleural, peritoneal and pericardial — pleural mesothelioma is the most common.
- Disease stage – Like other cancers, mesothelioma is classified by stage, with Stage 1 being the most treatable and Stage 4 having the fewest treatment options.
- Sex – Men make up more than 80% of all pleural mesothelioma cases.
- Work history – Those diagnosed with mesothelioma have usually been exposed to asbestos on the job or during military service.
- Treatments – Patients who are eligible for aggressive treatments that include surgery typically fare better than those who are not eligible.
In addition to prognosis, doctors use other terminology in relation to the disease outcome:
A survival rate is based on the percent of people with a similar diagnosis who are alive after a set period of time (usually five years). Survival rates are estimates based on historical information and do not provide information specific to individuals.
In general, cancer survival rate information comes from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database, which collects information from regional cancer registries.
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Life expectancy is used to describe how long a patient is expected to live following a diagnosis. For a malignant mesothelioma diagnosis, each disease stage presents different life expectancies:
- Stage I – 21 months
- Stage II — 19 months
- Stage III — 16 months
- Stage IV — 12 months
In addition to the stage of the disease, other factors that determine life expectancy include the type of treatment available, the patient’s general health and the physician’s experience treating the disease.
Despite the grim outlook for some patients, some factors can improve a prognosis:
Early detection dramatically increases a patient’s outcome because the disease can be caught in the early stages. New tools, including the Mesomark assay, measure the number of mesothelioma cells in the bloodstream, possibly detecting the presence of disease long before symptoms begin.
Physical activity and good nutritional habits
Physical activity and diet alone will not cure mesothelioma. However, patients who receive proper nutrition and begin physical activity following (or during) treatment may undergo fewer complications.
Treatments that kill cancer cells, including chemotherapy, radiation and surgery, work to eliminate the disease. This multimodal approach is considered the gold standard in mesothelioma treatment.
Specialized medical care
Mesothelioma specialists help patients improve their prognosis by utilizing the most advanced treatments and technologies to fight the disease. The average cancer doctor (oncologist) does not have experience with mesothelioma and will only offer standard cancer treatments. Because mesothelioma is so rare, only mesothelioma specialists know the best tools to fight the disease.
Diagnostic testing, also called medical testing, is used to verify or rule out the presence of disease. Once a diagnosis is confirmed, physicians use additional testing to determine specific information about the disease, including cell type, disease stage and location.
Many people who have mesothelioma are initially diagnosed with other types of cancers or diseases. A wrong diagnosis can waste precious time for medical management of the disease. A correct diagnosis is vital for the best treatment and access to trust fund compensation that helps pay for treatments.
Mesothelioma specialists use physical exams and blood tests to initially confirm a diagnosis. From there, they use a variety of procedures for additional information. Patients who suspect they might be misdiagnosed are urged to contact a mesothelioma cancer specialist for an accurate diagnosis.
Steps to Getting a Diagnosis
The process of getting a diagnosis can be challenging, depending on the situation. Patients who seek immediate attention from an asbestos cancer specialist have an easier time getting an accurate diagnosis quickly. The steps to a diagnosis are as follows:
- Since the onset of mesothelioma symptoms are similar to a cold or the flu, patients usually put off seeking medical attention. When they finally do see a doctor, the first step is their primary care physician, urgent care or hospital emergency room. With little information about the patient’s work history or asbestos exposure, general doctors listen to the patient’s lungs and typically diagnose a common illness. Patients are given a prescription for antibiotics and sent home to rest.
- After several weeks of a persistent cough, feeling rundown and losing weight, patients usually return to their physician. Patients may be asked to undergo a chest X-ray or blood work for a closer look at the causes of disease. If cancer is suspected, the patient will be immediately referred to an oncologist.
- After a complete physical and diagnostic testing, patients who are diagnosed with cancer are fast-tracked to treatment. Most oncologists misdiagnose mesothelioma as lung cancer and provide inadequate care. Patients who suspect they have been exposed to asbestos at any point in their lives should seek immediate assistance from a mesothelioma cancer specialist. When asbestos diseases are suspected, always consult a second-opinion doctor.
Mesothelioma specialists may perform additional diagnostic testing to determine the location of the disease better. The screenings includes:
- Blood tests
Blood tests are useful diagnostic testing tools because they can be the first indicator of abnormalities, including exposing cancer biomarkers. Recently, scientists have developed blood testing specifically for a mesothelioma diagnosis. Doctors use the following as part of a diagnosis routine:
The MESOMARK assay measures the Soluble Mesothelin-Related Peptides (SMRP) in human blood serum. High levels of SMRP may indicate the presence of asbestos cancer.df
- N-ERC/Mesothelin Test
Similar in design to the MESOMARK test, the N-ERC/Mesothelin Test provides more precise results for an accurate mesothelioma diagnosis.
- Fibulin-3 Test
Developed by asbestos-cancer specialist Dr. Harvey Pass, the Fibulin-3 Test detects an overabundance of Fibulin-3 proteins commonly found in mesothelioma patients.
- Imaging tests
Doctors use imaging tests because they are painless and noninvasive but provide an accurate view of abnormalities on internal organs. These testing devices use energy, typically in the form of radioactive particles or electromagnetic waves, to produce high-quality images. Some of the more common imaging tests include:
X-ray exams can be performed as an in-office procedure and are good at showing bone fractures, bone cancer and foreign objects in tissue.
- CT scan
CT scans show detailed cross-sections of the body, including blood vessels, tissue and cancerous masses. CT scans are used to stage cancer.
Ultrasounds provide a clear image of soft tissue, including the movement of blood through the body. In cases of mesothelioma, they can be used to guide biopsy needles. An ultrasound of the heart, called an echocardiogram, is used in suspected pericardial mesothelioma.
MRIs use magnets to take detailed images of internal bodily functions and masses, including tumors. MRIs are used to diagnose cancer.
- PET scan
PET scans react to ingested radioactive materials to show details of cancerous masses. PET scans are often used to observe the progress of cancer treatment.
Doctors rely on biopsies for an accurate assessment of abnormalities and deviations in tissue or fluids. Under a microscope, a biopsy can identify cell types and the category of cancer. Some of the more commonly used biopsy procedures used in mesothelioma include:
- Needle biopsy
Physicians use a long needle to remove small pieces of tumorous tissue for microscopic testing.
- Endoscopic biopsy
Doctors use a long flexible tube with a light and camera, called an endoscope, to remove tissue samples and get a closer look at internal organs. Types of endoscopic biopsies include a thoracoscopy (used to view inside the chest), laparoscopy (used to view inside the abdominal area) and mediastinoscopy (used to view lymph nodes).
- Surgical biopsy
When less-invasive biopsy procedures do not result in adequate information, doctors use surgical biopsies for better tissue and fluid samples. The thoracotomy (chest) or laparotomy (abdomen) procedures are used to remove larger samples or entire tumors.
Types of Mesothelioma
The four main types of mesothelioma are identified by their location in the body and cell type. Both factors affect how the disease is treated and the overall prognosis. Using these findings and patient-specific information such as age and general health, doctors can provide targeted medical care.
Primary types of mesothelioma
- Pleural mesothelioma
Pleural mesothelioma attacks the patient’s lungs and the pleura (space around the lungs). A majority of mesothelioma patients are diagnosed with pleural mesothelioma. Pleural mesothelioma begins forming after asbestos fibers are inhaled and become embedded in lung tissue.
Some of the early symptoms include a persistent cough, chest pains, shortness of breath and difficulty breathing.
- Peritoneal mesothelioma
Peritoneal mesothelioma, which attacks the lining of the abdomen, is the second most common type of asbestos cancer, accounting for about 15% to 20% of cases. Peritoneal mesothelioma forms when inhaled asbestos fibers are coughed up and swallowed.
Early symptoms include gas, bloating, nausea, abnormal vaginal bleeding, rectal bleeding and abdominal pain.
- Pericardial mesothelioma
Pericardial mesothelioma forms in the tissue around the heart and is considered extremely rare. The disease can be diagnosed through an echocardiography, which shows the thickness of heart tissue.
Symptoms include severe chest pains (including heart attack), irregular heartbeat, difficulty breathing and night sweats.
- Testicular mesothelioma
Also extremely rare, testicular mesothelioma attacks the membranous lining that surrounds the testes, called the tunica vaginalis. Tumors can attack the testicles, blood vessels and the spermatic cord.
Symptoms include lumps inside the scrotum and an excess of fluids in the scrotum, called hydrocele.
- Mesothelioma cell types
The three main cell types in mesothelioma also influence treatment success rates because each type responds differently.
Epithelioid cells are the most common and treatable cells involved in a mesothelioma diagnosis. Epithelial cells are commonly found in healthy people. But when exposed to asbestos, epithelial cells mutate, and tumors are fast-growing.
Sarcomatoid cells mutate and spread quicker than other mesothelioma cell types, so they are harder to treat. Because they resemble healthy tissue, they are challenging to identify.
Biphasic cells have elements of sarcomatoid and epithelioid cells, so treatment success depends on the number of sarcomatoid cells to epithelioid cells. Patients who have a higher ratio of epithelioid cells have better success rates.
Stages of Mesothelioma
Like other forms of cancer, mesothelioma is graded, or staged, based on the severity of the disease. Each stage provides important information about the disease:
- Stage I
Stage I is the initial phase of cancer. The cancerous masses are limited to a single area in the body. Stage I mesothelioma is highly treatable. Chemotherapy, surgery and radiation are among the options for treatment.
- Stage II
Stage II mesothelioma contains more extensive tumor coverage but is still contained in a single area. In some cases, Stage II cancer spreads but aggressive treatment options — surgery, chemotherapy and radiation — are available.
- Stage III
In Stage III asbestos cancer, the tumors have spread to nearby tissue and organs. In Stage III, side effects become more severe, including chest pains, difficulty breathing and stomach pains. Early Stage III treatment options include multimodal treatments. As Stage III cancer develops further, palliative care eases associated pain. Stage III mesothelioma patients often take part in clinical trials that can provide pathways to emerging disease treatments.
- Stage IV
In Stage IV mesothelioma, cancer has metastasized throughout the body including the bloodstream, bones and brain. Stage IV patients typically undergo palliative care measures that decrease pain and improve the quality of life.
Mesothelioma Staging Systems
While there are several types of staging systems that have been developed that allow doctors to produce diagnoses across the community of patients, the most common is the TNM system. Developed by the American Joint Committee on Cancer (AJCC), the TNM system uses the following factors to stage cancer:
What are the sizes of the main tumors? Can the tumors be surgically removed?
Ranges from T0 (no main tumor) to T4 (extensive tumors)
Has cancer metastasized (spread) in the body to distant organs like the bones, liver or brain? Has cancer spread to both sides of the body?
Ranges from M0 (no spread) to M1 (disease spread)
In addition, doctors sometimes use other letter/number combinations in the TNM staging process:
Primary tumor cannot be evaluated
No evidence of primary tumor
Lymph nodes cannot be evaluated
Brigham staging system
Developed by asbestos cancer specialist Dr. David Sugarbaker, the Brigham system is primarily used in pleural mesothelioma patients. The main goal of the system is to identify patients who qualify for surgical tumor resection or full-lung removal, called extrapleural pneumonectomy (EPP). Sugarbaker developed the EPP as a curative treatment for pleural mesothelioma.
In Brigham, Stages I and II patients are eligible for surgical resection of tumors or a cancerous lung. Stage III and IV patients do not qualify for surgical treatment.
Butchart staging system
As the oldest mesothelioma staging system (developed in 1976), Butchart is aimed at identifying patients who can undergo aggressive treatment protocols. However, the Butchart system is based on data from 29 EPP patients before advanced imaging testing, like CT and PET scans, was available.
Average Survival Rates
The most recent data from the SEER database shows 43.8% of all asbestos cancer patients survive for a year after a diagnosis.
According to the American Cancer Society, the five-year survival rate for anyone diagnosed with Stage I mesothelioma is 18%. Stage II and early Stage III and late Stage III and Stage IV are 11% and 7% respectively.
The American Cancer Society said the average survival rates by months are as follows:
- Stage I – 21 months
- Stage II – 19 months
- Stage III – 16 months
- Stage IV – 12 months
Research shows that other characteristics regarding mesothelioma cancer patients and survival rates include:
- Caucasian women age 65 and younger live longer with the disease when compared to similarly aged men.
- Women overall outlive men five years past diagnosis (15.4% women vs. 6.5% men).
- Military veterans account for up to 30% of all mesothelioma cases.
- Patients who receive care from a mesothelioma specialist have better access to advanced treatments that can increase survival rates.
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