The four stages of mesothelioma describe the development of stage 1 tumors, where the cancer cells are at a place in stage 4, where the cancer cells have spread to the chest or abdominal cavity. Prognosis, survival rates and life expectancy decrease with increasing number of steps.
Staging of cancer is a key element in the diagnosis and treatment of mesothelioma. Doctors rely on the cancer stage to determine whether it is likely that a patient will benefit from treatments such as surgery.
The goal of treatment at all stages of mesothelioma is to improve quality of life and prolong survival.
Stages of Mesothelioma
The cancer cells are in the same place. Surgery is an option.
The cancer cells enter the lymph nodes. Surgery remains an option.
The cancer cells spread to nearby organs and distant lymph nodes. Surgery can be an option. Chemotherapy is more common at this stage.
The cancer cells extend beyond the chest or abdominal cavity. Surgery is no longer an option. Chemotherapy can improve life expectancy and relieve symptoms.
As the symptoms develop later mesothelioma stages, most patients are diagnosed only at stages 3 or 4. The type of cancer cell and the overall health of the patient also affects the treatment options.
The most common treatment for mesothelioma is chemotherapy. Some patients are diagnosed early enough to be operated on. Surgical procedures are often associated with chemotherapy and radiation therapy to kill more cancer cells. Meanwhile, clinical trials continue to test new treatments such as immunotherapy.
The stages of peritoneal and pleural mesothelioma depend on the size of the tumors and their extent. The location and size of the tumors have a direct impact on the symptoms a person may feel.
The size and location of the tumor also determine whether a person can be operated on. Unfortunately, surgery is no longer an option when tumors get too big or spread too far.
People often wonder if they can determine their stage based on their symptoms. Unfortunately, the symptoms of mesothelioma are not strongly connected with the stages.
One of the reasons why Mesothelioma tends to be diagnosed at an advanced stage is, the fact that the early stages of Mesothelioma cause no symptoms. The cancer is small in the beginning and does not affect the body as do the larger, late tumors.
Stage 1- Symptoms
Most patients with mesothelioma d not experience stage 1 symptoms. At this stage, the tumors are too small to cause pain or difficulty breathing.
Most cases of stage 1 mesothelioma are accidentally found on routine radiography in a separate condition.
Stage 1 – Treatment
Mesothelioma stage 1 is treated by surgery, chemotherapy, and radiotherapy. This approach is called multimodal therapy. Major surgery to eliminate cancer is usually the first line of treatment.
Different surgeries, chemotherapy drugs, and radiation types are selected on an individual basis. Clinical trials provide stage 1 patients with new approaches to multimodal therapy. Some of them include immunotherapy.
Step 1 – Life expectancy
Some patients can survive mesothelioma stage 1 for years beyond the average prognosis. Those who respond well to multimodal therapy have lived three to five or even ten years.
People diagnosed at this stage have the greatest chance of living longer with mesothelioma. The median life expectancy at stage 1 is 22.2 months with surgery.
Stage 2 – Mesothelioma
- Stage 2 indicates that tumors begin to spread beyond the mesothelial lining and into the lymph nodes.
- Tumors remain small enough to be removed by surgery, which positively impacts life expectancy.
Stage 2- Symptoms
Stage 2 pleural mesothelioma symptoms may be similar to colds such as breathing difficulties during physical activity or mild cough.
Peritoneal patients may lose weight or feel bloated.
It is usually rare for symptoms to appear in stage 2. Symptoms usually appear on stage 3.
Stage 2- Treatment
Mesothelioma stage 2 is treated by surgery, chemotherapy, and radiotherapy. The same multimodal approach to treatment used in Stage 1 is also used in Stage 2.
The treatment is adapted to the patient. Aggressive options are used to eliminate or kill as many cancers as possible.
Step 2 – Life expectancy
Some stage 2 patients can survive for years with mesothelioma. Overall survival for all stages is about one year, but stage 2 patients can live beyond the years.
Those who respond well to aggressive treatment can live more than three to five years. The median life expectancy at stage 2 is 20 months with surgery.
Step 3 mesothelioma
Once cancer has reached stage 3, it may have spread to many tissues, organs and lymph nodes in the same area of the body where it was formed.
Some stage 3 patients may be eligible for surgery depending on the size and location of the tumors.
Stage 3 – Symptoms
Stage 3 symptoms include breathing difficulties, dry cough, wheezing, and chest pain. Patients with pleural mesothelioma may have difficulty breathing and chest pain, even at rest. Discomfort can also be felt in other parts of the body.
Peritoneal patients develop digestive problems (constipation or diarrhea), abdominal pain and bloating. Pleural and peritoneal patients may experience weight loss, fever and night sweats.
Stage 3 – Treatment
Stage 3 mesothelioma is usually treated with chemotherapy. Some patients may be eligible for surgery and radiation therapy.
Some Stage 3 patients are not eligible for surgery or other aggressive treatments. At this point, doctors offer palliative options to control pain and improve quality of life.
Stage 3 patients can participate in clinical trials to try new chemotherapy drugs and new immunotherapies.
Step 3 – Life expectancy
Some patients may survive for several years with stage 3 mesothelioma. Those who respond well to aggressive treatment may live for years beyond their initial prognosis.
The median life expectancy at stage 3 is 17.9 months with surgery.
Mesothelioma- Stage 4
In Stage 4, cancer spread to the area where it first developed, or even to other parts of the body. Cancer could be present in the liver, brain, bones or elsewhere.
Surgery to remove tumors is not used at this stage. Minimally invasive surgeries can be used to control symptoms.
Stage 4- Symptoms
Stage 4 pleural mesothelioma symptoms may include extreme difficulty breathing, difficulty swallowing, and severe chest pain.
Peritoneal symptoms include constant digestive problems, swelling of the abdomen (abdominal distension), bowel obstruction, and difficulty breathing or swallowing.
Pleural and peritoneal patients may experience loss of appetite, weight loss, muscle weakness, nerve pain, night sweats, fever, and fatigue.
Stage 4 – Treatment
Stage 4 mesothelioma is treated with chemotherapy and sometimes radiotherapy. Doctors use palliative treatments designed to relieve pain and control other symptoms.
Most Stage 4 patients are not eligible for aggressive surgery, but they are also eligible for many clinical trials involving chemotherapy and immunotherapy.
Step 4 -Life expectancy
Some patients in stage 4 have lived for more than one year with mesothelioma. Treatments such as chemotherapy, radiation, and immunotherapy help people live longer at this stage.
The median life expectancy at stage 4 is 14.9 months or less with or without surgery.
Staging of different types of mesothelioma
Pleural mesothelioma is the only type of cancer that has an official staging system.
The researchers are working on the formalization of a classification system for peritoneal mesothelioma, which currently has only three stages.
Patients usually have no symptoms at the beginning of peritoneal mesothelioma. During the final stages of cancer, patients may lose weight but feel swollen.
The fourth stage of peritoneal mesothelioma is generally accepted as the stage where cancer has spread to other parts of the body. The reason doctors have not officially defined a fourth step is that the current staging system is based on patients qualified for surgery.
Only early-stage patients are eligible for surgery, which means that researchers have not studied enough advanced patients to define the fourth stage clearly.
There is no staging system for pericardial mesothelioma or testicular mesothelioma.
Methods and classification systems of mesothelioma
There are three systems for determining mesothelioma: TNM, Brigham, and Butchart.
TNM is the most widely used and accepted system for pleural mesothelioma stages. A TNM classification system is in preparation for peritoneal mesothelioma, but it has not yet been formally adopted. There is currently no formal staging system for other types of mesothelioma.
The Brigham system was developed at Boston’s Brigham and Women’s Hospital by Dr. David Sugarbaker. It was created to help identify which pleural patients would respond best to surgery.
The Butchart system was developed in the late 1970s by Dr. Eric Butchart. He created it to help doctors identify which patients of the pleura could withstand aggressive treatment.
4. Seek a second opinion
A person diagnosed with mesothelioma should seek a second opinion to ensure that their cancer has been properly organized. Many oncologists do not have the experience of asbestos-related cancers. Always find a doctor who does.
Improve staging methods
Doctors are working to improve the way they present mesothelioma. The goal is to accurately determine the stage of cancer using minimally invasive procedures.
Now, the most accurate way to treat mesothelioma is surgery.
Doctors do their best to determine the stage without using surgery as a metric. They use imaging scanners, such as CT and PET scanners, and biopsies to estimate the stage. These techniques are less invasive than surgery.
These techniques are close to estimating the actual stage of the patient, but often they outperform or underdeveloped cancer. This inaccurate staging has the consequence that patients do not receive the best treatments for their actual stage.
An improved approach to the estimation stage is under development. Doctors are using new methods to analyze imaging scans.
These new methods measure the volume and thickness of tumors in the images. The measures allow physicians to better understand the progression and spread of cancer, allowing for more accurate staging.
Improvement of staging methods will ensure that patients receive the most effective treatments. This could lead to longer survival rates for people diagnosed with mesothelioma at any stage.