In Stage 3 mesothelioma, the cancer has spread to nearby tissues, organs and possibly to distant lymph nodes. Stage 3 is the most frequently diagnosed stage of mesothelioma with a median life expectancy of about 16 months.
Symptoms increase in severity for stage 3 malignant mesothelioma patients as the cancer progresses. Although there is no spreading to distant organs and tissues, nearby spreading and lymph node involvement typically limits curative treatments available, and patients often turn to palliative care to relieve symptoms and provide a better quality of life.
Stage 3 Mesothelioma by Type
During the diagnostic process, physicians will look at a patient’s medical history and symptoms, conduct imaging tests and blood tests, as well as a biopsy, to determine cancer type and staging. Mesothelioma cancer uses a four-tier staging system to classify the disease, and staging varies based on the type of mesothelioma that a patient has.
Stage 3 Pleural Mesothelioma
Pleural mesothelioma is the most commonly diagnosed type of the cancer, making up 80 – 90% of all diagnoses. Specialists have established three staging systems for this type, including the Brigham system, Butchart system and TNM system, which is the most common.
The TNM system looks at the size and extent of mesothelioma tumors (T), lymph node involvement (N) and metastasis (M), or growth. Stage 3 malignant pleural mesothelioma is classified further into stage 3A and stage 3B.
Stage 3A Mesothelioma
- Cancerous cells are present in the pleura on one side of the chest
- Nearby lymph node involvement
- Potential spreading into chest wall, pericardium, fascia lining or mediastinal fat
- No distant metastasis
Stage 3B Mesothelioma
- All components of stage 3A mesothelioma with distant lymph node involvement possible
- Spreading into chest wall, peritoneum, pleura on opposite side of the chest, mediastinal organs, pericardium or other areas of the spine
- Nearby or distant lymph node involvement
- No distant metastasis
The defining characteristic between stage 3 and stage 4 mesothelioma is that stage 3 diagnoses have spreading into nearby organs and tissues, while stage 4 diagnoses indicate metastasis to distant organs and tissues. According to the American Cancer Society, the 2-year survival rate for stage 3A is around 30% and the 5-year survival rate is around 5%.
Stage 3 Peritoneal Mesothelioma
Malignant peritoneal mesothelioma makes up just 15 – 20% of all diagnoses. Less common than pleural mesothelioma, this type doesn’t have its own staging system. Instead, mesothelioma specialists use general mesothelioma characteristics or the Peritoneal Cancer Index (PCI), which grades tumors throughout distinct areas of the abdomen and totals the scores together. A score ranging from 21 – 30 indicates stage 3 peritoneal mesothelioma.
Mesothelioma tumors are localized to one side of the body at this stage, but may have spread to nearby organs and lymph nodes. Many stage 3 peritoneal mesothelioma cases show cancer growth in the chest wall and throughout the abdominal cavity.
Resources for Stage 3 Mesothelioma Patients
- Request a Free Stage 3 Mesothelioma Treatment Guide
- Connect with Top Mesothelioma Doctors
- Locate the Nearest Comprehensive Cancer Center
Stage 3 Pericardial Mesothelioma
Pericardial mesothelioma makes up only 1 – 2% of diagnoses. With limited case studies, specialists have not established a pericardial mesothelioma staging system. Pericardial mesothelioma tumors are often aggressive and fast-growing, and most patients are diagnosed at stage 3 or stage 4, or posthumously during an autopsy. At this stage, the cancer has likely spread throughout the chest cavity and to nearby organs and lymph nodes and possibly the lungs.
Stage 3 Testicular Mesothelioma
Even rarer than pericardial mesothelioma, testicular mesothelioma also does not have a definitive staging system, and specialists rely on general staging tools to diagnose the disease. Stage 3 testicular mesothelioma indicates that the cancer has spread outside of the linings of the testicles, limiting treatment options and worsening prognosis.
Stage 3 Mesothelioma Symptoms
In earlier stages, mesothelioma symptoms are often minor and may not even be noticeable. But by stage 3, symptoms are more intense and may be severe. Stage 3 patients often undergo various palliative treatments to relieve symptoms, which could involve surgeries like pleurocentesis or pleurodesis to remove fluid buildup, alleviating pain and improving breathing.
- Chest pain
- Chest tightness
- Shortness of breath (dyspnea)
- Fluid buildup
- Difficulty breathing
- Weight loss
Even if cancer has progressed to stage 3, it’s still crucial for patients to get medical care as soon as possible to begin treatment before the disease progresses further.
Prognosis of Stage 3 Mesothelioma
Stage 3 malignant mesothelioma patients face an average life expectancy of 16 months. Prognosis is less favorable than early stages because the disease has spread, and aggressive treatments like an extrapleural pneumonectomy are typically no longer an option.
Prognosis will vary from patient to patient as each diagnosis is different. Patient gender, age, genetics, overall health and history of smoking can impact prognosis, as well as cell type and cancer type. Survival rates continue to increase as researchers and mesothelioma doctors improve diagnostic tools and discover new treatment techniques.
Stage 3 Mesothelioma Treatment
Staging is an influential factor in determining a patient’s treatment plan. Stage 3 patients usually have limited options and aren’t able to undergo aggressive surgeries or multimodal treatment because of declining health and metastasis of the cancer. For stage 3A malignant pleural mesothelioma patients, curative surgery may still be an option, but is likely not viable for those at stage 3B.
Surgery, chemotherapy and radiation may be used on their own to remove as much cancer as possible or delay cancer progression. These therapies may also be applied palliatively to relieve symptoms. Palliative care is often a large component of a stage 3 treatment plan to provide the patient with the highest quality of life possible.
- Surgery: Surgery can be used to remove primary tumors, however, it is unlikely that it will remove cancer cells that have spread to the lymphatic system and other organs. Pleurodesis, paracentesis or thoracentesis are palliative surgeries that may be used to remove fluid buildup.
- Chemotherapy: Hyperthermic intraperitoneal chemotherapy (HIPEC) has shown success in extending life expectancies by at least 50% in some peritoneal mesothelioma cases, but may be too aggressive for patients with advanced spreading. Traditional chemotherapy options may be used palliatively or curatively, such as pemetrexed and cisplatin.
- Radiation: Radiation therapy is less common for advanced stages of cancer, but may be used palliatively to shrink tumors and reduce symptoms like chest pain and difficulty breathing.
Staging is an important factor in determining what treatments a patient can pursue. Accurate staging not only helps physicians understand disease progression, but can also provide patients with insight to their treatment options. For instance, stage 3A pleural mesothelioma patients may undergo surgical resection, whereas stage 3B patients are typically not candidates.
Patients may be eligible for experimental cancer treatments and clinical trials that have shown success in improving life expectancy in some cases. Patients should discuss options with their physician to see if they meet the criteria required to participate in such treatments.
Author: Linda Molinari
Editor in Chief, Mesothelioma Cancer AllianceRead about Linda
Reviewer: Annette Charlevois
Patient Support CoordinatorRead about Annette
American Cancer Society. Malignant Mesothelioma Stages. Updated December 2017.
American Cancer Society. Survival Statistics for Mesothelioma. Updated December 2017.
Billie A, Krug LM, Woo KM, et al. Contemporary Analysis of Prognostic Factors in Patients with Unresectable Malignant Pleural Mesothelioma. Journal of Thoracic Oncology. February 2016; 11(2):249-255. doi: 10.1016/j.jtho.2015.10.003