Mesothelioma Prognosis

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James Stevenson, M.D. Thoracic Medical Oncologist

Mesothelioma prognosis is a forecast for the likely progression of a patient’s cancer. Doctors can estimate survival time and provide treatments to improve prognosis. Many mesothelioma patients live 18 – 31 months. Patient health, tumor type, nutrition and other factors can affect prognosis.

Note: This page contains statistics gleaned from large groups of patients. These statistics cannot forecast a single patient’s risk, cancer experience or the success of any given treatment. Patients should discuss all cancer screening and treatment decisions with an experienced oncologist.

01. What Is Prognosis?

What Is Mesothelioma Prognosis?

A person’s mesothelioma prognosis generally describes how a doctor expects the cancer to progress over time. A prognosis estimates the life expectancy and the quality of life a patient may have. Historically, mesothelioma has had a poor prognosis, but research is changing that. Newer mesothelioma treatment options have extended survival. Currently, malignant mesothelioma patients have an average life expectancy of 18 – 31 months.

Malignant mesothelioma is an aggressive cancer that can take years to develop. As a result, it may not be detected until it has reached an advanced stage. Data shows that earlier stages of mesothelioma can have a better prognosis. Other factors, such as location of tumors, mesothelioma cell type and a patient’s age, also impact prognosis.

Although there is no cure for mesothelioma, the prognosis has been improving in recent years. This is because of new experimental treatments and diagnostic methods that have been developed and recent advancements in clinical trials.

Mesothelioma 3-Year Survival Rates

Looking at long-term survival rates may help some patients understand their prognoses. For example, the list below shows the 3-year relative survival rate over the last 20 years. The data suggests the rate is improving.

Mesothelioma 3-year relative survival rates from 2000 to 2013 include:

  • 2000: 11%
  • 2005: 13%
  • 2009: 16%
  • 2013: 19%

During these years, the 3-year relative survival rate improved by 8%.

Terms Related to Prognosis

With a mesothelioma diagnosis, patients may start hearing a lot of new terms they don’t understand. Understanding key terms can make things easier for patients and their loved ones. They may hear the following terms during conversations with their doctors.

Life Expectancy

Life expectancy is an estimate of the amount of time a person in a given situation will live.

In regard to medical diagnoses, mesothelioma patients may understand life expectancy as an estimate of the amount of time they will live after diagnosis.

Survival Rate

Survival rate is the percentage of people in a certain group who are still alive at a specific point in time.

Mesothelioma studies often report survival rates as 1- or 2-year survival. This shows the percentage of patients alive one or two years after diagnosis.

Death Rate

A cancer death rate reports the number of cancer deaths per 100,000 people in a single year. Doctors may also refer to death rate as mortality rate.

Because mesothelioma is so rare, it would be difficult to find a true death rate for it. However, cancer organizations often report death rates for the country as a whole.

02. Improving Prognosis

Improving a Mesothelioma Prognosis

Mesothelioma patients may improve their prognoses through treatment. Researchers have done substantial work to improve mesothelioma prognosis. This includes developing new diagnostic techniques and treatments for the cancer.

Early detection is the best way to improve mesothelioma prognosis. Also, some research suggests palliative care may help extend survival by nearly six months.

Mesothelioma Prognosis Without Treatment

The most important thing a patient can do to improve their prognosis may be to get treatment. Research shows that patients who undergo treatment have a better prognosis than those who do not:

  • Mesothelioma prognosis without treatment: 6 months
  • Mesothelioma prognosis with some form of treatment: 18 – 31 months

Mesothelioma Treatments That Improve Prognosis

Treatment is the best way to improve the prognosis for mesothelioma cancer. Some treatments have proven to be more effective in improving prognosis than others.

Mesothelioma Prognosis After Multimodal Treatment

Multimodal treatments combine more than one cancer therapy in one treatment program. Research shows this approach may be most effective in improving prognosis.

Research shows patients who receive a multimodal treatment live about 2 – 6 years. These treatments may include different combinations of chemotherapy, immunotherapy, radiation or surgery.

For pleural mesothelioma, a particularly effective multimodal treatment combination is extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) surgery followed by hyperthermic intrathoracic chemotherapy (HITHOC). In one study, patients who received this therapy regimen lived about 3.5 years.

For peritoneal mesothelioma, the combination of cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) extended survival. In one study, patients who received this therapy had a median survival ​​ranging from 2 to more than 6.5 years.

Mesothelioma Prognosis After Chemotherapy

Studies show pleural mesothelioma patients treated with chemotherapy live about 14 months after diagnosis.

Chemotherapy may prove most beneficial for patients with inoperable tumors. Chemotherapy can also be helpful as part of a multimodal treatment plan. Peritoneal mesothelioma patients receive chemotherapy during HIPEC procedures. This approach can give some patients five or more years to live.

Mesothelioma Prognosis After Immunotherapy

In studies, the prognosis for patients receiving immunotherapy treatments ranges from 18 to 24 months. Thus far, these studies have mostly focused on pleural mesothelioma.

Checkpoint inhibitor immunotherapy has helped pleural mesothelioma patients with difficult cases. This includes patients with inoperable tumors or non-epithelial cell types. For patients with non-epithelial cases, these drugs may extend prognosis by up to 100%.

Patients may receive multiple immunotherapies in a single treatment plan. One of the most common immunotherapy treatments for pleural mesothelioma is the FDA-approved combination of Opdivo® and Yervoy®.

Mesothelioma Prognosis After Radiation Therapy

Mesothelioma patients may see improved prognosis following radiation therapy. Pleural mesothelioma patients undergoing radiation combined with other treatments live more than 2 years.

Radiation therapy often precedes or follows other cancer treatments. It is often incorporated into multimodal treatment plans.

Mesothelioma Prognosis After Surgery

In studies, patients who had therapeutic surgery as part of a multimodal treatment plan lived about 2 – 6 years.

Surgery alone has not proven effective in treating mesothelioma. However, surgery within a multimodal plan can improve prognosis for some patients. Chemotherapy or radiation often follow surgery in an effort to kill remaining cancer cells.

Mesothelioma Prognosis With Alternative Treatments

It is difficult to estimate the effect of alternative mesothelioma treatments on prognosis. Some evidence suggests alternate therapies may improve quality of life.

Alternative treatments come in many forms but have not been well studied in mesothelioma. Still, some patients may want to explore improving prognosis with alternative therapies. These patients can discuss their options with an oncologist.

Other Options for Improving Prognosis

Some patients may wonder about other ways to improve their prognoses. A mesothelioma prognosis may be affected by the patient’s overall health and wellness.

Although some factors cannot be changed, patients can follow a healthy lifestyle with a nutritional diet and regular exercise. Quitting smoking may be beneficial, too. Patients may want to speak with their doctors about other options as well.

For example, engaging in holistic practices, like meditation, massage and yoga, can also help ease mental and physical stress. Such activity may positively impact a patient’s quality of life and ability to receive treatment.

Spotlight: Patients Who Improved Their Prognosis

The Exceptional Responders Initiative (ERI) is a program that studies patients who outlive their initial prognosis. By finding common traits among these survivors, the program may help future patients make choices that could extend survival.

The program recently published a study looking at lifestyle traits of exceptional responders. The study included a small number of mesothelioma patients. The authors found several trends among these patients who outlived their prognoses:

  • Half of exceptional responders changed their diet after diagnosis. Among those who did, the majority opted for fewer carbs and meat and more fruit and veggies.
  • A third of exceptional responders started exercising or increased their exercise level. Yoga, Pilates and Tai Chi were the most popular exercise choices.
  • Nearly two thirds of exceptional responders used some form of complementary and alternative medicine. Among those, massage therapy was the most common choice.
  • Two thirds of exceptional responders engaged in some form of prayer.

Patients who made the choices above lived at least three times as long as expected. But this does not necessarily mean patients who make the same choices will have the same results. Still, these activities may help mesothelioma patients hoping to take an active role in improving their prognosis.

Lifestyle changes could have effects on a patient’s treatment plans. So, all cancer patients should discuss exercise, diet and complementary therapies with their oncology teams.

Source: Translational Oncology

Clinical trials may help some patients, especially those who experience cancer progression during regular treatment. Clinical trials can provide access to new treatments, such as photodynamic therapy.

As more treatment options have become available in recent years, malignant mesothelioma prognosis has improved. Some mesothelioma patients have extended their survival years far beyond the initial prognosis. Treatment offers the best odds for improving a mesothelioma prognosis.

Mesothelioma Patients Who Beat Their Prognosis

When pleural mesothelioma patient Heather Von St. James was first diagnosed, she was given 15 months to live. After undergoing surgery, chemotherapy and radiation, Heather has survived more than a decade beyond her prognosis.

Learn MoreRead Heather’s Story

Peritoneal mesothelioma patient Jim Dykstra was diagnosed in 2013. He underwent surgery, radiation and chemotherapy. Jim continues to undergo treatment with immunotherapy and has survived more than six years.

Learn MoreRead Jim’s Story
03. Prognosis by Type

Prognosis by Mesothelioma Type

The type of mesothelioma, or where the cancer develops, affects the prognosis of the disease. For example, peritoneal mesothelioma generally has a more favorable prognosis than pleural. Different treatments may also be more effective against certain types of mesothelioma.

Pleural Mesothelioma Prognosis

Pleural mesothelioma affects the lining of the lungs. Generally, the prognosis for pleural mesothelioma patients who receive some form of treatment is about 18 months after diagnosis. Some treatments have been linked to longer survival times, such as surgery combined with chemotherapy.

Peritoneal Mesothelioma Prognosis

Peritoneal mesothelioma affects the lining of the abdomen. The prognosis for peritoneal mesothelioma is about 2 – 6 years, depending on a number of factors. Patients who undergo surgery and HIPEC have been able to improve prognosis. A 5-year survival rate can be as high as 87% in qualified patients.

Prognosis for Rare Mesothelioma Types

Rare types of mesothelioma can have variable prognoses because of late-stage diagnosis and treatment.

Pericardial mesothelioma occurs in the lining of the heart and is a rare form of the disease. This type has the least favorable prognosis, about six months, with many cases diagnosed posthumously.

Testicular mesothelioma occurs in the lining of the testes, the tunica vaginalis. It is one of the two rarest forms of the disease. Prognosis for testicular mesothelioma is about six years.

04. Prognosis by Stage

Mesothelioma Prognosis by Stage

Stage has a strong relationship with prognosis. Patients diagnosed at an early stage of mesothelioma often have more treatment options and a better prognosis than those diagnosed at a later stage. Once mesothelioma metastasizes (spreads) and reaches a later stage, treatments such as surgery may not be viable.

Stage 1 Mesothelioma Prognosis

Stage 1 mesothelioma patients have an average life expectancy of 21 months or longer.

Stage 2 Mesothelioma Prognosis

Stage 2 mesothelioma patients have an average life expectancy of 19 months or longer.

Stage 3 Mesothelioma Prognosis

Stage 3 mesothelioma patients have an average life expectancy of 16 months or longer.

Stage 4 Mesothelioma Prognosis

Stage 4 mesothelioma patients have an average life expectancy of 12 months or longer.

05. Other Prognosis Factors

What Factors Affect Mesothelioma Prognosis?

Different factors may affect a patient’s prognosis. These factors include the cell type and cancer location. Other factors may include the patient’s age, gender and overall health.

Patients may want to talk to their doctors about how those factors affect their prognoses. The following summarizes the most common factors.

Prognosis by Cell Type

The types of cells that make up a mesothelioma tumor influence prognosis:

  • Epithelioid mesothelioma typically has the best prognosis. Epithelioid cells are more responsive to treatment than other cell types.
  • Sarcomatoid mesothelioma has the least favorable prognosis of the cell types. Sarcomatoid cells behave aggressively and are not as responsive to treatments.
  • Biphasic mesothelioma prognosis varies based on which cell type is dominant. In some cases, patients may be diagnosed with other rare cell types, which have prognoses that vary from a few months to 10 years or longer.


Nutrition plays an important role in a patient’s cancer prognosis. Poor nutrition may negatively affect survival. Patients who prioritize nutrition during mesothelioma treatment may improve their prognoses.

Research indicates the risk of malnutrition increases with the progression of cancer. Higher body mass index (BMI) before treatment is associated with a better prognosis.

Patients may find these nutritional strategies helpful during cancer treatment:

  • Mixing patient-centric smoothies: At-home smoothies can incorporate the best food for mesothelioma patients. Recipes can accommodate the patient’s nutritional needs and food preferences. This may make it easier to get balanced nutrition.
  • Optimizing meals: Patients may find it easier to eat many small meals throughout the day. A mesothelioma treatment diet may be easier to maintain if patients eat on a set schedule or eat more when they are hungry.
  • Snacking with purpose: Patients may gain nutrition and energy from handy, high-calorie snacks. Foods including chocolate milk, fruit in heavy syrup, nuts and peanut butter can provide significant calories with little or no preparation.

Cancer patients should receive nutritional support as soon as they notice weight loss or decreased appetite. Discussing nutritional support with their oncology team is often helpful. Their team can help mesothelioma patients find the best nutritional approach for their unique situation.

Patient Demographics

Some demographic factors that affect prognosis cannot be controlled. These include factors like age, gender, race and a patient’s overall health.

  • Age: Research shows patients over 75 years old have a worse prognosis than those 50 years old or younger.
  • Gender: Research also shows women with mesothelioma tend to have a more favorable prognosis than men.
  • Race: Race may have an impact on prognosis, but not enough research has been done to provide a definitive answer.

Patient Health

A patient’s health may have an impact on their prognosis. Some studies show patients under 50 years old have a better prognosis than those over the age of 75. This may also be attributed to the patients’ overall health. Older patients may have pre-existing conditions or may not be able to withstand the side effects of treatment.

For example, heart, liver or kidney disease may affect a patient’s eligibility for chemotherapy with cisplatin. Other conditions may affect eligibility for other treatments. Patients should consult with their doctors to determine eligibility for specific treatments.


Some location factors may have an effect on mesothelioma prognosis. For example, studies have shown a patient’s distance from a hospital or cancer center may affect prognosis. In states that have fewer hospitals, patients often have to travel farther to receive care. These patients may have a worse prognosis than patients who have closer facilities.

It is important for mesothelioma patients to find a cancer center with experience treating mesothelioma. Some cancer centers may help patients find and pay for a place to stay during treatment.

Another potential prognostic factor is air quality. For example, researchers have found air pollution negatively impacts lung cancer survival. Certain types of air pollution also increase a person’s risk of dying from cancer in general.

While specific data on mesothelioma prognosis by state is not available, patients in very rural or very polluted areas may be affected. Patients can help combat these outside factors by seeing a mesothelioma doctor as soon as possible.

06. Remission and Recurrence

Mesothelioma Remission and Recurrence

Some mesothelioma patients have achieved remission and long-term survival. There are two types of mesothelioma remission. Partial remission indicates a decrease in the size of tumors or the extent of mesothelioma in the body. Complete remission indicates the cancer is no longer seen on imaging scans, such as CT scans.

It is important for patients to maintain frequent medical follow-ups and monitoring for recurrence, or the regrowth of tumors, after remission. Recurrence occurs in the majority of patients with mesothelioma.

Because mesothelioma recurrence is unpredictable, all mesothelioma patients should be aware of the risks and receive ongoing medical care throughout remission.

Why Is Mesothelioma So Fatal?

Unfortunately, mesothelioma is fatal for many patients. In part, this is because it is a rare cancer that may be discovered at a later stage of disease progression. Mesothelioma may also be misdiagnosed as other forms of cancer.

Another factor is that there is currently no cure for mesothelioma. But some patients have achieved long-term remission with treatment. Studies show treatment generally improves life expectancy. Research continues to find the best treatment combinations to help patients.

07. Common Questions

Common Questions About Mesothelioma Prognosis

Is mesothelioma always fatal?

Mesothelioma is a deadly disease that currently does not have a cure. However, there are treatment options available that can improve prognosis. Mesothelioma survivors who have undergone treatment have beaten their prognoses, sometimes by years.

How accurate is a mesothelioma prognosis?

A mesothelioma prognosis is a doctor’s estimate for likely patient survival and disease progression. Doctors gauge prognosis using information such as cancer type, stage and other factors. There are patients who have outlived their initial prognosis. A patient’s prognosis may change depending on their response to treatment and changes in overall health.

Can a mesothelioma prognosis be improved?

Mesothelioma prognosis can be improved. Patients may undergo treatments and potentially participate in clinical trials to improve their mesothelioma prognoses.

Can mesothelioma go into remission?

Mesothelioma can go into complete or partial remission with appropriate treatment. Complete remission is when a patient no longer has any signs of cancer. Partial remission is a reduction in the size of the tumor or spread of the cancer. Partial remission would be at least a reduction of 30% or more.

What is the best prognosis for mesothelioma?

Patients typically have the best mesothelioma prognosis after multimodal treatments. In fact, some peritoneal mesothelioma patients had more than six years life expectancy after multimodal treatments. Some pleural mesothelioma patients treated with surgery and heated intrathoracic chemotherapy experienced 42 months life expectancy. There are also long-term survivors, such as Heather Von St. James. Heather continues to celebrate more than 16 years of survival.

What is the average mesothelioma prognosis?

The average prognosis for mesothelioma ranges from 18 to 31 months with treatment. This information comes from published medical studies. These studies may not perfectly reflect the real-world experiences of mesothelioma patients. But they do provide an estimate of average mesothelioma prognosis.

Studies also provide information about the average mesothelioma prognosis after certain treatments.

  • Average pleural mesothelioma prognosis after checkpoint inhibitor treatment: 18 months
  • Average pleural mesothelioma prognosis after chemotherapy: 12 to 14 months
  • Average peritoneal mesothelioma prognosis after surgery + heated chemotherapy: 2 to 5.5 years

Factors like cancer location, stage and patient health may affect prognosis. A mesothelioma specialist can help estimate if a patient will or will not have an average mesothelioma prognosis.