Dr. James Stevenson, M.D.
Prognosis by Mesothelioma Type
The type of mesothelioma, which is determined by the location where it first develops, has an effect on the prognosis of the disease.
Pleural mesothelioma affects the lung linings and is the most common type of mesothelioma, making up 80 – 90% of all diagnoses. Treatment is typically multimodal, and on average, pleural mesothelioma patients who receive some form of treatment live 6 – 12 months after diagnosis. Some treatments have been linked to longer survival times, such as chemotherapy using pemetrexed (Alimta®), cisplatin and bevacizumab (Avastin).
Peritoneal mesothelioma affects the linings of the abdomen and is the second most common type of mesothelioma, accounting for 15 – 20% of cases. Common treatments often involve surgery and chemotherapy. The median survival period for patients with peritoneal mesothelioma is one year. However, patients who are healthy enough to undergo surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) have been able to improve prognosis, with a 5-year survival rate as high as 67%.
Pericardial mesothelioma is seen in the linings of the heart and is one of the rarest forms of the disease, seen in 1 – 2% of mesothelioma diagnoses. This type has a very poor prognosis of about six months, with many cases not properly diagnosed until an autopsy is performed. With early detection, treatment is typically palliative to improve symptoms and quality of life.
Testicular mesothelioma is seen in the linings of the testes and is the rarest of the four types, seen in only 1% of all diagnosed cases. Prognosis for testicular mesothelioma patients is typically 20 – 23 months, though some have lived much longer. Treatment involves a multimodal approach of surgery, chemotherapy and radiation therapy.
Read Survivor Stories
Despite the poor prognosis of malignant mesothelioma, there is still hope. Mesothelioma survivors are not only a source of inspiration but an excellent source of information as they share their experiences and advocate for an asbestos ban, awareness, treatments and efforts toward finding a cure. Read the stories of mesothelioma survivors.
Speak with a Mesothelioma SurvivorConnect with 13-year pleural mesothelioma survivor Heather Von St. James
What Factors Affect Mesothelioma Prognosis?
There are five primary factors that doctors consider when determining a prognosis for mesothelioma patients. While these factors can help physicians provide patients with a prognosis, the disease progression will still differ on a case-by-case basis.
Stage is the most important factor in determining a patient’s prognosis. Patients diagnosed at an early stage of mesothelioma will have more treatment options and a better prognosis than those diagnosed at a later stage. The life expectancy for stage 1 patients is typically 21 months or longer, and 19 months for stage 2 patients. By stage 3 and stage 4, patients generally only have palliative treatment options available to prolong life and improve quality of life. On average, stage 3 patients have a life expectancy of 16 months, while stage 4 patients survive for about 12 months after diagnosis.
Of the three primary mesothelioma cell types, epithelioid mesothelioma is the most common and also has the best prognosis, as epithelioid cells spread less aggressively and are more responsive to treatment. Biphasic mesothelioma has a worse prognosis due to the presence of sarcomatoid cells. Sarcomatoid mesothelioma has the least favorable prognosis of these cell types, as these cells spread aggressively and are not as responsive to cancer treatments. 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.
Average life expectancy varies for patients diagnosed with pleural, peritoneal, pericardial and testicular mesothelioma. Testicular patients have a favorable prognosis with a median survival of around 20 – 23 months. Peritoneal patients typically survive one year or longer, and pleural mesothelioma patients have an average prognosis of about six months to one year. Pericardial patients have the least favorable prognosis of the types, with many diagnosed posthumously.
If the mesothelioma has spread to other parts of the body from where it originated, the prognosis is much worse. Once the disease begins to spread, it is much harder to remove the cancer through surgery or kill the cancer cells with chemotherapy. Localized mesothelioma can be treated more aggressively with multimodal treatments and lead to a better prognosis and longer lifespan.
Patients who are relatively young and healthy can have a better prognosis because their bodies are better able to handle aggressive treatments. Older patients may not be able to withstand the side effects of surgery, chemotherapy or radiation therapy, and also tend to have other conditions that can worsen the disease or limit treatment options. In general, poor overall health will limit treatment options and lower life expectancy for patients facing a mesothelioma diagnosis.
Resources for Mesothelioma Patients
Improving a Mesothelioma Prognosis
In recent years, research has developed new diagnostic techniques and treatment methods for mesothelioma, which has helped improve prognosis. Early detection is the best way to improve prognosis.
Improving Prognosis Before Diagnosis
The best way to improve a mesothelioma prognosis is to diagnose the disease early. By using blood tests to identify certain biomarkers (high levels of specific substances in the blood) researchers have succeeded in finding new ways to detect mesothelioma early.
The first thing individuals can do is to understand the relationship between mesothelioma and asbestos exposure. If exposed to asbestos in the past, or if symptoms of mesothelioma present themselves, patients should seek professional medical advice.
Improving Prognosis After Diagnosis
After a mesothelioma diagnosis, overall prognosis depends on the cell type, location, and stage of the cancer, as well as the patient’s age, gender and overall health.
Aside from early detection, treatment is the best way to improve survival. Some treatments have proven to be more effective in improving prognosis than others. For example, surgery coupled with HIPEC has significantly improved the prognosis for some patients with peritoneal mesothelioma. At least half of the patients who undergo this treatment survive five years or longer. Patients with tumors that can’t be removed through surgery may benefit from a chemotherapy treatment of pemetrexed, cisplatin and bevacizumab. Immunotherapy treatments have also shown promise in mesothelioma and are now an option for many patients. Radiation therapy may also be used in a multimodal treatment plan.
Clinical trials can provide a final hope for improving prognosis in some patients. These trials offer promising experimental treatments like immunotherapy, gene therapy, and photodynamic therapy, which have shown longer life expectancies in some cases.
While some of these prognostic factors cannot be changed, patients should be sure to follow a healthy lifestyle by eating right and exercising regularly. Engaging in holistic practices such as meditation, massage, and yoga can also help alleviate mental and physical stresses, which may positively impact quality of life and ability to receive treatment as well.
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Mesothelioma Remission and Recurrence
Despite a generally poor prognosis, some mesothelioma patients have been able to achieve remission and long-term survival. There are two types of mesothelioma remission: partial remission and complete remission. Partial remission indicates that the cancer is drastically improving, with at least a 30% reduction in tumor size. Complete remission indicates that the cancer has been completely removed or destroyed and is no longer seen on imaging scans such as CT scans. Complete remission is more likely with patients that had early detection and aggressive treatments.
While remission is a large accomplishment for patients, it’s important to maintain frequent follow-ups and monitoring to recognize any potential recurrence, or the regrowth of tumors after remission.
Recurrence occurs in the majority of patients with mesothelioma, even despite aggressive treatment. The time to recurrence and sites of recurrence depend on a variety of factors, including cell type or previous treatments. For example, local recurrences in the chest are more common after pleurectomy/decortication for pleural mesothelioma while distant recurrence is more likely after extrapleural pneumonectomy. With varying times to and sites of recurrence, all mesothelioma patients should be aware of the risks and receive ongoing professional medical care throughout remission as well as treatment.