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Mesothelioma Prognosis

The prognosis for mesothelioma is poor, with most patients living less than one year. The type of mesothelioma, stage of the cancer, and patient health are the three most important factors used to determine prognosis. Mesothelioma prognosis can be improved by receiving treatment as soon as possible and leading a healthy lifestyle.

Malignant mesothelioma is extremely aggressive and has a long latency period, which means it usually remains undetected until the cancer has reached an advanced stage. There is no cure for mesothelioma, though the prognosis has been slowly improving over the years. This improvement in prognosis is due to the development of experimental treatments, new detection and diagnostic methods, and other areas of research in clinical trials.

Defining Terms
Prognosis
Prognosis
How a disease will progress. A prognosis can be good or bad, and may include a life expectancy estimate.
Life Expectancy
Life Expectancy
How long a patient can expect to survive. This may change with treatment and other developments.
Survival Rate
Survival Rate
A statistic (percentage or ratio) indicating how many people live a certain amount of time after diagnosis.

Prognosis by Mesothelioma Type

The type of mesothelioma, which is determined by the location where it first develops, can have a big effect on the prognosis of the disease.

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.

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, disease progression will still differ on a case-by-case basis.

Stage

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 relieve pain and discomfort. On average, stage 3 patients have a life expectancy of 16 months, while stage 4 patients survive for about 12 months after diagnosis.

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Cell Type

Of the three primary mesothelioma cell types, epithelioid mesothelioma is the most common and also has the best prognosis, as epithelial cells spread slower 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.

Location

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.

Metastasis

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 tumors can typically be surgically removed with more targeted, aggressive treatments and lead to a better prognosis and longer mesothelioma lifespan.

Overall Health

Patients who are relatively young and healthy will 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.

Improving a Mesothelioma Prognosis

Early detection is the best way to improve prognosis.

In recent years, research has developed new diagnostic techniques and treatment methods for mesothelioma, which has helped 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 right away.

Resources for Mesothelioma Patients and Their Families

Improving Prognosis After Diagnosis

After a mesothelioma diagnosis, improving prognosis depends on the cell type, location, and metastasis of the tumors, as well as the patient’s age, sex, and overall health. While some of these 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 improve prognosis as well.

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. 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.

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 50% reduction in tumor size. Complete remission indicates that the cancer has been completely removed or destroyed, and is most common 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 return of tumors after remission. Early detection of recurrent tumors is important, and patients with a history of benign mesothelioma should also be aware that tumors have a potential to recur as malignant.

Recurrence rates depend on a variety of factors, including cell type or previous treatments. For example, in a study of patients with cystic mesothelioma, more than half of patients experienced recurrence. Another study notes that recurrence can also be high in patients that undergo aggressive treatments, such as an extrapleural pneumonectomy or pleurectomy decortication. Researchers found local recurrence rates of 41 – 71% and distant recurrence rates of 10 – 65% with both surgeries. With varying rates of recurrence, all mesothelioma patients should be aware of the risks and receive professional medical care throughout remission.

Author: Linda Molinari

Editor in Chief, Mesothelioma Cancer Alliance

Linda Molinari

Reviewer: Annette Charlevois

Patient Support Coordinator

Annette Charlevois
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Sources

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Levy AD, Arnaiz J, et al. From the archives of the AFIP: primary peritoneal tumors: imaging features with pathologic correlation. Radiographics. April 2008;28(2):583-607. doi: 10.1148/rg.282075175

Meyerhoff R, Yang C, et al. Impact of mesothelioma histologic subtype on outcomes in the Surveillance, Epidemiology, and End Results database. Journal of Surgical Resection. June 2015; 196(1):23-32. doi: 10.1016/j.jss.2015.01.043

National Cancer Institute. SEER Cancer Statistics Review (CSR) 1975-2015. Updated September 2018.

Rusch VW, Giroux D, et al. Initial Analysis of the International Association For the Study of Lung Cancer Mesothelioma Database. Journal of Thoracic Oncology. November 2012;7(11):1631-1639. doi: 10.1097/JTO.0b013e31826915f1

Shavelle R, Vavra-Musser K, et al. Life expectancy in pleural and peritoneal mesothelioma. Lung Cancer International. January 2017;2017(ID2782590). doi: 10.1155/2017/2782590

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