The Four Stages Of Mesothelioma
Doctors use the four stages of mesothelioma to determine where the tumor is located and if it has begun to spread to other areas of the body. Once they determine the stage of mesothelioma, they can begin to create a plan for the best course of treatment.
Stage 1 mesothelioma is considered to be the stage with a better prognosis than the other three stages. Symptoms aren’t as noticeable during stage 1 and stage 2; they only begin to really show up in stage 3. However, stage 4 mesothelioma, aka end-stage mesothelioma, will have the shortest estimated life expectancy.
Details About the Four Stages of Mesothelioma
When doctors evaluate the size of mesothelioma tumors and determine whether they have spread, they can establish the stage of cancer and begin the planning process for the treatments available. Symptoms are also dependent on the size of the tumor and where it is located in the body.
Many people want to assume they know what stage they are in, but only after a medical professional has determined both the size and location of the mesothelioma tumor will they be able to tell what stage it is in.
Since the early stage of mesothelioma rarely shows any symptoms due to the small size of the tumor, it generally is diagnosed in a late stage. The beginning stage starts with a small-sized tumor and typically has no symptoms, whereas the late-stage tumor is usually larger and affects the patient’s body in noticeable ways.
The methods used to determine the stage of malignant mesothelioma are critical to the diagnosis process and the course of treatment. Biopsy samples will be taken by a pathologist to complete the tumor grading and differentiation. Once the sample results are given to the oncologist, they will perform imaging scans to determine the mesothelioma stage. They will also recommend surgery if the patient qualifies based on these results.
Four Stages of Pleural Mesothelioma
Stage 1 – Pleural Mesothelioma
This is the earliest stage of mesothelioma. Normally, it is determined that the early-stage mesothelioma tumor growth is still located within a single area and has not begun to spread beyond the lining of the patient’s lungs. Stage 1 has the most treatment options available to the patient.
Stage 1 mesothelioma is the most challenging stage to catch because patients rarely, if ever, show any symptoms.
- Symptoms – There are usually zero symptoms with stage 1 mesothelioma due to the small size of the tumor. Patients with stage 1 mesothelioma won’t experience the known symptoms such as breathing difficulties or pain in the tumor’s location; therefore, it is very difficult to diagnose stage 1 mesothelioma.
- Treatments – Surgery, then chemotherapy followed by radiation therapy is the standard treatment plan for stage 1 mesothelioma. This is known as multimodal therapy, and the main goal is first to remove the tumor with surgery and continue with the treatment plan.
- Life Expectancy – Patients who respond well to the aggressive treatments may live longer than the average life expectancy for stage 1 mesothelioma, which is 22.2 months when opting for the recommended surgery. Patients who are diagnosed at this stage have the best chances of living longer with mesothelioma.
Stage 2 – Pleural Mesothelioma
Typically, all the same treatments are available to patients diagnosed as stage 2 as it was for stage 1. However, patients with stage 2 mesothelioma might begin to experience some symptoms.
Being diagnosed with stage 2 means that the tumors have begun spreading beyond the mesothelioma lining and could be entering the lymph nodes (N1 lymph nodes). The tumors are usually small enough to be removed through surgery, which increases the life expectancy rate immensely.
- Symptoms – Patients with stage 2 mesothelioma might begin to experience symptoms similar to the common cold, or have difficulty breathing when exercising, or may just have a mild cough. They could also feel bloated or notice some weight loss; however, it is not common for patients with stage 2 mesothelioma to show symptoms that would alarm them enough to seek medical attention. This is one of the primary reasons that mesothelioma is usually diagnosed in the later stages.
- Treatments – Surgery, chemotherapy followed by radiation therapy is the standard treatment plan for stage 2 mesothelioma. The same treatment course used with stage 1, multimodal therapy, is also used for patients diagnosed as stage 2. The goal also remains the same, to first remove the tumor with surgery and continue with the treatment plan.
- Life Expectancy – Patients who respond well to the aggressive treatments may live longer than the average life expectancy for stage 2 mesothelioma, which is 20 months when opting for the recommended surgery. Patients diagnosed at this stage have better chances of living longer with mesothelioma than those diagnosed in the later stages.
Stage 3 – Pleural Mesothelioma
When diagnosed with stage 3 mesothelioma, the symptoms will begin to worsen, and treatment options can be limited compared to stages 1 and 2. But, there are different types of therapies that a patient diagnosed as stage 3 might benefit from and improve their survival rate.
Although, there is a chance that stage 3 mesothelioma has spread to other organs, the lymph nodes, and even some tissues near the region of the initial tumor location as it progresses.
- Symptoms – Patients with stage 3 mesothelioma typically experience symptoms that include dry cough, wheezing, difficulty breathing, and chest pain. They will also have some abdominal pain, feelings of being bloated, and develop constipation or diarrhea. Other symptoms for patients with stage 3 mesothelioma could be experiencing fever, night sweats, and weight loss.
- Treatments – Chemotherapy is the usual treatment plan for stage 3 mesothelioma because most patients at this stage do not qualify for surgery. At this stage, the main goal is to control the pain while improving the quality of life with palliative options. There might be clinical trials available to patients with stage 3 for immunotherapies or new to the market chemotherapy drugs.
- Life Expectancy – Patients who can qualify for surgery to remove the tumors may live longer with stage 3 mesothelioma. The average life expectancy for stage 3 mesothelioma is 17.9 months when having surgery.
Stage 4 – Pleural Mesothelioma
The final stage of mesothelioma is stage 4 and it has now been determined that cancer has probably spread into multiple areas of the body. Most of the treatments are currently not possible to undergo. The main goal is to reduce the severity of the different symptoms patient with stage 4 mesothelioma are now experiencing.
- Symptoms – Patients with stage 4 pleural mesothelioma commonly experience symptoms that include severe chest pain, difficulty breathing, and trouble swallowing. Those that have been diagnosed with peritoneal mesothelioma can experience symptoms such as swelling in the abdomen, constant digestive issues, difficulty swallowing and breathing, along with bowel obstruction.
Both types of stage 4 mesothelioma could also experience the following symptoms: fever, night sweats, loss of appetite, weight loss, weakness in the muscles, and fatigue.
- Treatments – Chemotherapy is the usual treatment plan for stage 4 mesothelioma. The main goal at this stage is to control the pain while improving the quality of life with palliative options. There might be clinical trials available to patients with stage 4 for immunotherapies or new chemotherapy drugs.
- Life Expectancy – There have been some patients diagnosed with stage 4 mesothelioma who live past a year. However, stage 4 mesothelioma’s average life expectancy is 14.9 months or less regardless of having surgery.
The Final Stage of Mesothelioma with Metastasis
In most cases, this will only happen during the 4th and final stage of mesothelioma. This type of cancer stays typically local to the region it developed and affects the abdominal cavity or the chest cavity.
It is not normal for mesothelioma to travel to other body parts, such as the brain. Most of the metastasis with mesothelioma stays within the body’s local region where the cancer was first discovered.
Staging Systems – Pleural Mesothelioma
Pleural mesothelioma is separated into three different staging categories, TNM, which is also known as AJCC (American Joint Committee on Cancer), Brigham, and Butchart.
TNM (AJCC) – This is the most widely accepted and used system for staging malignant pleural mesothelioma. Staging in this system is indicated as either pathological or clinical by the attending doctor. The clinical-stage is determined by physical examinations of the patient and reviewing the results from the imaging tests. The pathological stage is solely based on the surgery results.
Brigham – Dr. David Sugarbaker developed the Brigham system while working at Brigham and Women’s Hospital in Boston, Massachusetts. It was designed to help doctors identify the patients with pleural that they felt qualified and would respond best to mesothelioma surgery.
Butchart – This staging system was created to help physicians identify the patients with pleural mesothelioma that will be able to tolerate surgery with aggressive treatments. Dr. Eric Butchart introduced this system in the late ‘70s.
Staging for Peritoneal, Pericardial and Testicular Mesothelioma
However, a TNM staging system is being developed for peritoneal mesothelioma, but it will not be official until more data has been collected.
Some doctors are already adopting this system to stage peritoneal mesothelioma in patients. Other doctors use an approach that is similar but only defines either early or late stages of cancer. The Peritoneal Cancer Index (PCI) is a system used for abdominal cancers and can assign a stage based on certain factors, including tumor size.
As for both pericardial and testicular mesothelioma, there is currently no staging system available. Pericardial has only been reported in less than 150 cases and is considered to be very rare. There just isn’t enough data to support the creation of a staging system. Testicular mesothelioma has only been reported in less than 100 cases. Again, not enough data to support a staging system.
When doctors are creating a treatment plan for patients with mesothelioma, the staging process plays a significant role. They are able to monitor cancer as it progresses and re-stage when necessary. The staging systems also assist with prognosis and determining the likelihood of available treatments being successful and which course of action to take.
When doctors can use a staging system for patients with mesothelioma, they can determine which avenues of treatment are available for that patient. Some of these treatments may include:
- Surgery (Stages 1 & 2)
- Radiation therapy
- Clinical trials
Depending on the mesothelioma stage, some or all of these treatments might be available to the patient. Surgery is usually only recommended for stages 1 and 2 of mesothelioma; however, some patients diagnosed in stage 3 qualify for surgery based on the size and location of the tumor.