The stage of cancer at diagnosis is one of the most important factors affecting cancer treatment plans. In most cases, early-stage cancers have more treatment options, and later-stage cancers have fewer options.
Patients often find disheartening messages that offer little hope for late-stage diagnoses. In many cases, these messages aren’t accurate or helpful. This negative information is too general and doesn’t account for all the factors at play. And it doesn’t recognize that treatment recommendations can change as needed.
Understanding how and why cancer stage affects treatment can offer hope by shedding light on these bleak half-truths. Having medically accurate information may also help patients feel more empowered and supported at a challenging time.
Cancer stage is a rough measure of the size, location and number of tumors in a patient’s body. Not all cancers use the same staging system. Many indicate how far a cancer has progressed on a scale of 1 to 4. Establishing a stage can help doctors understand if a specific therapy will help.
According to one mesothelioma specialist, surgeons need to answer these questions when making treatment recommendations:
The patient’s cancer stage factors into how surgeons answer these questions. Let’s walk through a couple of examples to see how this plays out in the real world.
The above examples are highly simplified. Doctors consider many factors that are not part of the staging system when recommending treatment. For example, age and overall health can also affect treatment options. This is why patients should not focus too narrowly on stage when thinking about treatment outcomes.
In official guidelines, treatment decisions can seem black and white. But these are guidelines, not rules. You can keep the following in mind when receiving recommendations:
For stages 1 – 2 pleural mesothelioma, treatment is often a surgery-based combination. By using different therapy types, doctors can fight cancer in more than one way. This approach (multimodal treatment) may be the most effective in extending mesothelioma survival.
Many stage 1 and 2 patients undergo surgery followed by some form of chemotherapy. Pleural mesothelioma survivor Heather Von St. James had surgery then 2 kinds of chemo:
She also underwent radiation therapy. Patients diagnosed at an earlier stage commonly qualify for treatments similar to Heather’s.
But surgery-based combinations can come with serious side effects, and recovery is not easy. Patients must have certain characteristics, including:
If a patient lacks these characteristics, surgery-based treatment may be more harmful than beneficial. Patients who do not qualify for surgery-based approaches still have good treatment options available. And many can receive 2 or more types of non-surgical therapy.
The Role of Palliative Care
Palliative therapy helps maximize quality of life for patients of all cancer stages. It can extend to end-of-life care, but that is not its sole purpose. Palliative therapies can help patients manage treatment side effects and mental health setbacks. This approach can also extend survival.
Learn More About the Benefits of Palliative CareTreatment options for stages 3 – 4 pleural mesothelioma vary. At these stages, some patients qualify for surgery-based options and others do not. Regardless of surgery eligibility, treatment can extend survival and boost quality of life. So patients should discuss their options with a mesothelioma specialist.
Stage 3 patients generally have either operable or inoperable tumors. Operable tumors can be treated with surgery-based combination therapies. Inoperable tumors generally qualify for chemotherapy or immunotherapy.
For patients who do not qualify for surgery, immunotherapy may change their eligibility. In a recent inoperable stage 3 case, doctors treated the patient with immune checkpoint inhibitors. This treatment shrunk the tumors enough for the patient to become eligible for surgery. This case shows how helpful non-surgical treatment can be.
Stage 4 pleural mesothelioma usually does not qualify for surgery. The tumors are so big and numerous that they likely could not be safely and fully removed. But many patients still undergo combination treatment without surgery. In the past, chemotherapy followed by radiation was a common approach.
In recent years, the combo of Opdivo® (nivolumab) and Yervoy® (ipilimumab) has become a standard option. This regimen of immune checkpoint inhibitors may improve quality of life better than chemo. Many patients also have the option to undergo other therapies after Opdivo and Yervoy.
Even though stage 4 patients may not qualify for surgery, they still have good treatment options. These may include:
Research and drug development advances continue opening new possibilities for treating late-stage pleural mesothelioma.
Peritoneal and pleural mesothelioma patients have similar treatment options. But peritoneal mesothelioma has a different staging system. Still, treatment recommendations are based on similar factors. Doctors consider whether a surgery-based approach is likely to extend survival better than immunotherapy or chemo.
Many peritoneal mesothelioma patients undergo surgery plus heated chemo in the belly (HIPEC). But immunotherapy is also an option.
Learn More About Peritoneal Mesothelioma TreatmentMany factors go into mesothelioma treatment recommendations. Doctors weigh the cancer stage heavily in these decisions. But stage alone does not determine a patient’s treatment options or prognosis. And surgery-based approaches are not the only effective treatments.
Aziz T, Jilaihawi A, Prakash D. The management of malignant pleural mesothelioma; single centre experience in 10 years. Eur J Cardiothorac Surg. 2002 Aug;22(2):298–305.
Baas P, Scherpereel A, Nowak AK, Fujimoto N, Peters S, Tsao AS, et al. First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743): a multicentre, randomised, open-label, phase 3 trial. Lancet. 2021 Jan 30;397(10272):375–86.
Enewold L, Sharon E, Thomas A. Patterns of care and survival among patients with malignant mesothelioma in the United States. Lung Cancer. 2017 Oct;112:102–8.
Kajiyama K, Taira A, Takenaka M, Kuroda K, Kusano M, Nawata A, et al. Salvage pleurectomy/decortication after immunotherapy for sarcomatoid malignant pleural mesothelioma. Annals of Thoracic Surgery Short Reports. 2023 Mar;1(1):121–3.
Kindler HL, Ismaila N, Armato SG, Bueno R, Hesdorffer M, Jahan T, et al. Treatment of malignant pleural mesothelioma: american society of clinical oncology clinical practice guideline. J Clin Oncol. 2018 May 1;36(13):1343–73.
Peters S, Scherpereel A, Cornelissen R, Oulkhouir Y, Greillier L, Kaplan MA, et al. First-line nivolumab plus ipilimumab versus chemotherapy in patients with unresectable malignant pleural mesothelioma: 3-year outcomes from CheckMate 743. Ann Oncol. 2022 May;33(5):488–99.
Takenaka M, Kuroda K, Yoshimatsu K, Mori M, Kanayama M, Taira A, et al. Salvage pleurectomy/decortication following immunotherapy for malignant pleural mesothelioma. Interdiscip Cardiovasc Thorac Surg. 2024 Feb 2;38(2):ivad173.
Katy Moncivais, Ph.D., has more than 15 years of experience as a medical communicator. As the Medical Editor at Mesothelioma.com, she ensures our pages and posts present accurate, helpful information.
