Stage 1 Mesothelioma

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This page was medically reviewed by James Stevenson, M.D. on February 6, 2019. For information on our content creation and review process read our editorial guidelines. If you notice an error or have comments or questions on our content please contact us.

James Stevenson, M.D. Thoracic Medical Oncologist

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Stage 1 is the earliest stage of mesothelioma cancer and offers the best treatment options for patients. The cancer has not yet spread, and symptoms are typically mild. In most cases, stage 1 mesothelioma has the best prognosis of all four stages. The life expectancy for stage 1 mesothelioma averages 21 months or longer.

01. Overview

What Is Stage 1 Mesothelioma?

During stage 1, the mesothelioma cancer is localized and not spread to distant organs or lymph nodes. Symptoms are usually manageable at this stage. Because the tumor is localized, treatments can be highly effective.

Mesothelioma specialists often use staging as a guide for predicting disease symptoms and treatment options. Symptoms, disease progression and treatment options for stage 1 mesothelioma can also vary based on type.

Staging of Mesothelioma
02. Stage 1 Symptoms

What Are the Symptoms of Stage 1 Mesothelioma?

Early-stage mesothelioma symptoms frequently go unnoticed or are misdiagnosed as more common conditions. Stage 1 mesothelioma is often discovered when patients are undergoing imaging scans for another reason. However, patients may be able to recognize early-stage symptoms, especially with a known history of asbestos exposure.

Stage 1 Mesothelioma Symptoms*

  • Abdominal pain
  • Chest pain
  • Coughing
  • Shortness of breath
  • Fatigue
  • Fever

*List is a combination of common pleural, peritoneal, pericardial and testicular symptoms

Patients should seek medical care as soon as they recognize potential mesothelioma symptoms. In most cases, early detection is the best way to improve mesothelioma life expectancy.

03. Stage 1 Types

Stage 1 Mesothelioma by Type

There are four main types of mesothelioma, including pleural, peritoneal, pericardial and testicular mesothelioma. Each type originates in a different area of the body, affecting different organs and lymph nodes. Stage 1 mesothelioma progression will differ based on the location of the original tumor.

Stage 1 Pleural Mesothelioma

Malignant pleural mesothelioma is the most common type of mesothelioma. Pleural mesothelioma can be further classified as stage 1A or stage 1B using the TNM staging system.

Stage 1A Pleural Mesothelioma
  • Cancer is present in the pleural lining, on just one side of the chest.
  • There is no metastasis to lymph nodes or distant organs.
Stage 1B Pleural Mesothelioma
  • Cancer is present in the pleural lining, on just one side of the chest.
  • There is no metastasis to lymph nodes or distant organs.
  • The cancer has begun to affect nearby tissues.

For stage 1A pleural mesothelioma and stage 1B pleural mesothelioma, the cancer is present in the pleural lining on just one side of the chest. At this point, there is no metastasis to lymph nodes or distant organs.

The differentiating factor between stage 1A and stage 1B is the impact on nearby tissues. During stage 1B, the cancer may have spread into the lung tissue, diaphragm, chest wall, pericardium (thin tissue surrounding the heart), chest cavity fat or other nearby tissue linings.

Stage 1 Pleural Mesothelioma Characteristics

  • Stage 1 pleural mesothelioma can be further divided into stage 1A and stage 1B.
  • Mesothelioma tumors develop in the pleural lining on one side of the chest.
  • There is no distant metastasis.

Stage 1 Peritoneal Mesothelioma

Peritoneal mesothelioma is the second most common type. It does not have its own staging system, but is often staged using the Peritoneal Cancer Index (PCI) or a modified version of the TNM staging system. The PCI scores regions of the abdomen and uses score totals to determine stage.

Stage 1 peritoneal mesothelioma indicates the tumor is localized within the abdominal lining. The cancer has not yet spread to other organs or lymph nodes.

Early symptoms of mesothelioma are typically mild and treatment options, such as surgery in combination with hyperthermic intraperitoneal chemotherapy (HIPEC), can be highly effective. HIPEC is a highly concentrated, heated chemotherapy that fills the abdominal cavity.

Stage 1 Peritoneal Mesothelioma Characteristics

  • Stage 1 peritoneal cancer has a PCI score of less than 11.
  • Mesothelioma tumors are localized within the lining of the abdomen.
  • There is no distant metastasis.

Stage 1 Pericardial Mesothelioma

Accounting for only 1 – 2% of all mesothelioma diagnoses, pericardial mesothelioma does not have a definitive staging system. This type progresses quickly and is not normally recognized in the early stages. A stage 1 diagnosis would imply the cancer is localized within the pericardium (heart lining) and has not yet spread to other areas of the body.

Stage 1 Testicular Mesothelioma

Testicular mesothelioma is also rare, accounting for only 1% of all mesothelioma cases. It does not have a definitive staging system. A stage 1 diagnosis would imply the cancer is localized to the tunica vaginalis (testicle linings) with no distant metastasis or lymph node involvement.

04. Stage 1 Prognosis

Stage 1 Mesothelioma Prognosis

Prognosis for stage 1 mesothelioma predicts how long the patient will live, as well as how the disease will progress. The prognosis for stage 1 is the most favorable of the mesothelioma stages.

Early detection allows patients to begin treatment early. Treatments are usually more aggressive and targeted at stage 1 and stage 2, because the cancer is localized to one area.

To support early detection, patients should be aware of all potential mesothelioma symptoms. Patients with a known history of asbestos exposure should disclose their exposure to their physician and maintain regular checkups.

There are several factors that can impact patient prognosis, including tumor location, cell type, patient age and overall health.

Factors Influencing Stage 1 Mesothelioma Prognosis

  • Tumor location: Stage 1 peritoneal and stage 1 pleural mesothelioma typically have the best prognosis.
  • Cell type: Stage 1 epithelial mesothelioma typically has a better prognosis than stage 1 sarcomatoid mesothelioma.
  • Patient age: Younger stage 1 mesothelioma patients typically have a better prognosis than older patients.
  • Overall health: Patients in better overall health typically have a better prognosis than those in poor health or with other existing medical conditions.

Stage 1 Mesothelioma Life Expectancy and Survival Rate

Life expectancy is an estimate of how long the patient is expected to live. Mesothelioma studies rarely capture stage 1 life expectancy, as patients often survive past the end of the studies.

As a result, survival statistics are typically represented as median survival and survival rates. The median survival for stage 1 mesothelioma is 21 months (compared to 19 months for stage 2 pleural mesothelioma).

Survival rates show what percentage of individuals with a particular diagnosis have survived for a certain number of years. Mesothelioma survival rates are typically displayed in 2- and 5-year increments. On average, stage 1 mesothelioma patients have higher survival rates than those with advanced-stage mesothelioma.

  • The 2-year survival rate for stage 1 pleural mesothelioma is 41%.
  • The 5-year survival rate for stage 1 pleural is 33%.

There are several factors that can impact survival. Patients and their loved ones should consult with a mesothelioma specialist for an accurate understanding of life expectancy for their particular case. Patients may be able to increase their life expectancy with timely, aggressive mesothelioma treatment.

05. Can It Be Cured?

Can Stage 1 Mesothelioma Be Cured?

Currently, there is no cure for mesothelioma cancer. However, mesothelioma researchers continue to develop improved diagnostic tools and treatment options. In many cases, treatment can extend patient life expectancies. Multimodal therapy has shown particular success.

Some stage 1 or stage 2 mesothelioma survivors are now cancer-free. Their stories offer hope and inspiration to those newly diagnosed with the disease.

06. Stage 1 Treatment

Stage 1 Mesothelioma Treatment

Patients with stage 1 mesothelioma usually have more treatment options available to them than those diagnosed at later stages. Treatments can also be more aggressive. At this stage, the cancer is localized and can be better targeted with treatment. Stage 1 patients are generally in good health, allowing them to better withstand treatment side effects.

Stage 1 mesothelioma treatment plans typically involve multimodal therapy. Multimodal therapy involves a combination of treatments. Multimodal treatment plans often include surgery, chemotherapy or radiation therapy, but may also involve experimental options. Not all patients can pursue these options. Mesothelioma doctors can provide the best insight into a patient’s individual case.

Stage 1 Mesothelioma Treatment Options

  • Surgery
  • Chemotherapy
  • Radiation therapy
  • Immunotherapy
  • Clinical trials


Surgery aims to remove as much of the cancer as possible. Stage 1 mesothelioma is localized, so patients may be able to undergo complete surgical resection. Complete resection aims to remove any visible mesothelioma tumors and affected tissues. Chemotherapy is often performed after surgery to kill the remaining cancer cells.

Common stage 1 mesothelioma surgeries include pleurectomy, pleurectomy/decortication and extrapleural pneumonectomy (EPP).

  • A pleurectomy removes the lining in the lung (pleural lining).
  • A pleurectomy/decortication removes the pleural lining and nearby diseased tissue.
  • An extrapleural pneumonectomy removes a patient’s lung, a portion of the diaphragm, the lining of the lungs and the lining of the heart.


Chemotherapy treats mesothelioma by killing cancer cells, shrinking tumors and preventing growth. Chemotherapy for stage 1 mesothelioma patients is often used after surgery to kill any remaining cancer cells and help prevent recurrence.

Radiation Therapy

Radiation treats mesothelioma by damaging cancer cells, which causes cell death or slows growth. The human body then naturally processes and removes dead cancer cells. Radiation is a targeted treatment that can cause harm to vital organs, such as the lungs. As a result, radiation is most effective when used to treat a stage 1 tumor that is localized.


Immunotherapy is a newer treatment for mesothelioma, compared to traditional treatments, such as surgery, chemotherapy and radiation therapy. Immunotherapy stimulates the patient’s immune system to fight cancer cells. Some immunotherapy drugs, such as Keytruda®, have been successful in extending patient life expectancies.

Clinical Trials

Stage 1 mesothelioma patients may be able to participate in clinical trials. Clinical trials utilize experimental treatments not yet available to all patients. This option is particularly helpful for patients who do not respond to standard treatment options.

Patients should discuss treatment options with their medical care team. In addition to standard treatment options, there are also alternative treatments that can prove especially helpful for reducing treatment side effects and disease symptoms.

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