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Stage 1 Mesothelioma

Expert Fact Checked

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 mesothelioma is the earliest stage and may not cause symptoms. Any symptoms are often mild. Stage 1 tumors have not spread and often respond well to treatment. Combining treatments is common and often successful. Some patients have experienced long-term survival after surgery and chemotherapy.


01. Stage 1 Mesothelioma Overview

What Is Stage 1 Mesothelioma?

For patients with stage 1 mesothelioma, tumors have not spread to other areas of the body and may not cause symptoms. At this early stage, patients often have many treatment options.

Stage 1 mesothelioma patients may have a hopeful outlook, or prognosis. For example, the average life expectancy range is about 2 to 5.5 years with treatment. As with all mesothelioma stages, treatment may help improve prognosis.

Mesothelioma specialists use staging to understand how much cancer a patient has. This helps estimate prognosis and treatment options. The staging process varies depending on the staging system used. Doctors may also adjust their staging process based on patients’ mesothelioma type.

The two most common types are pleural mesothelioma and peritoneal mesothelioma. More rare forms of mesothelioma do not have established staging systems. General cancer staging guidelines are often used in these cases.

Understanding Mesothelioma Stages

The Purpose of Staging Systems

Staging mesothelioma helps doctors understand the extent of the cancer. With this information, they can better estimate prognoses. In general:

  • There are four stages of mesothelioma.
  • Stage 1 and stage 2 are considered early stages.
  • Stage 3 and stage 4 are considered later stages.

There are various staging systems doctors may use for mesothelioma. Tumor nodes and metastases (TNM) staging system is the most common for pleural and peritoneal cases.

Stage 1A and Stage 1B

Stage 1 pleural mesothelioma can be further separated into stage 1A or 1B. The primary difference is that stage 1B cancer has started affecting nearby tissues.

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

How Does Stage 1 Mesothelioma Develop?

Mesothelioma is a type of cancer that develops after asbestos exposure. Asbestos is a fibrous mineral that many industries used until the 1980s. Research shows that people can easily inhale or ingest the small asbestos fibers. The fibers can lodge in organ linings and cause irritation. Over time, tumors may form in these spots of irritation and develop into asbestos-related diseases, like mesothelioma.

The latency period, or time between exposure and a mesothelioma diagnosis, can be 10 to 50 years long. Various factors can impact each individual latency period.

02. Is Stage 1 Mesothelioma Curable?

Is Stage 1 Mesothelioma Early Enough to Cure?

There is no cure for mesothelioma. However, some stage 1 patients have achieved a “functional cure.” This means patients may have had no sign of cancer for years. Some patients have been mesothelioma survivors for more than a decade after treatment.

Patients diagnosed in earlier stages may be eligible for more aggressive treatments. This may mean a functional cure is more realistic for stage 1 patients than any other stage. Early diagnosis also allows patients to begin treatment sooner into their illness.

In general, treatment can help extend patient survival and improve prognosis. Mesothelioma researchers continue working toward better diagnostic tools and treatment methods. These medical advances may also be steps towards a future cure.

Can Stage 1 Mesothelioma Go Into Remission?

Some early-stage mesothelioma patients have gone into remission after receiving combined treatments. These combined, or multimodal, treatments involved both surgery and chemotherapy. Although remission is uncommon, it may become more common with ongoing treatment advances.

03. Stage 1 Mesothelioma Prognosis

Stage 1 Mesothelioma Life Expectancy and Survival Rates

After a stage 1 mesothelioma diagnosis, doctors will estimate a prognosis. A mesothelioma prognosis is how doctors expect a patient’s disease to progress. This includes various related topics, such as life expectancy and quality of life.

Life expectancy is an estimate of how long patients will live after their diagnosis. In general, the stage 1 mesothelioma life expectancy ranges from about 21 to 67 months, or longer. For these patients, treatment options often aim to help extend life expectancy. There are many promising treatment options that stage 1 patients may qualify for.

Survival rate is a clinical statistic. It is the percentage of people with a specific diagnosis who are still alive after a set amount of time. This can vary for patients based on various individual factors.

Many factors may affect individual patients’ survival, including treatment. Patients often undergo multimodal treatment and receive additional treatment if the cancer comes back later, or recurs. In general, they have better survival than those who are not treated again if the cancer recurs.

In one related study, pleural mesothelioma patients initially received chemotherapy and surgery. Some patients received additional treatment when their cancer returned, but others did not. The patients who also had treatment for recurrence lived about six times longer than those who did not.

Other common factors impacting survival and prognosis include mesothelioma cell type and location.

Stage 1 Mesothelioma Survival Rates
Type 1-Year 2-Year
Pleural 75% 41%
Peritoneal 92% 89%

*Survival rates shown are for patients who have had some form of treatment.

Factors Influencing Stage 1 Mesothelioma Prognosis

Age

Younger stage 1 mesothelioma patients generally have a better prognosis than older patients.

Cell Type

In general, stage 1 epithelial mesothelioma has a better prognosis than biphasic or sarcomatoid.

Overall Health

In general, patients in good health typically have a better prognosis than those with poor health. Pre-existing medical conditions may also affect prognosis.

Tumor Location

In general, a peritoneal or pleural mesothelioma patient will have a better prognosis than patients with less common types, like pericardial mesothelioma.

Patients and their doctors can discuss these and any other factors impacting prognosis. Doctors can explain if a multimodal plan may be a treatment option.

04. Stage 1 Mesothelioma Treatment

Treatments for Stage 1 Mesothelioma

In general, patients with stage 1 mesothelioma have many treatment options available. Treatments are often aggressive and aimed at removing or killing as much cancer as possible. Research shows that multimodal treatment is the best way to do that. Multimodal therapy involves a combination of treatments. Combinations may include chemotherapy, immunotherapy and surgery.

Surgeries for Stage 1 Mesothelioma

Surgery aims to remove as much of the cancer as possible. Stage 1 mesothelioma is localized, which means it only affects a specific part of the body. So, surgeons may be able to achieve complete surgical resection. This means that they were able to remove any visible mesothelioma tumors and affected tissues.

Surgery is not typically a standalone mesothelioma cancer treatment, but is often used in multimodal plans. Surgery is often performed before chemotherapy, which kills the remaining cancer cells. There are many types of mesothelioma surgeries. Some stage 1 patients may only qualify for certain types of surgery. This can depend on the patient’s type of mesothelioma and overall health.

Pleurectomy / Decortication (P/D)

Pleurectomy/decortication (P/D) removes the lining of the lung (pleura) and nearby diseased tissue. This surgery method helps patients keep both lungs while removing cancerous tissue. P/D has played a role in some of the most successful studies in mesothelioma research.

One example is a 2021 study on P/D for early-stage mesothelioma patients. In this study, P/D was part of a multimodal treatment plan. The plan also included hyperthermic intrathoracic chemotherapy (HITHOC). Results showed that patients had a 100% 1-year survival rate.

Extrapleural Pneumonectomy (EPP)

An extrapleural pneumonectomy (EPP) removes a patient’s lung and pleura. It also removes part of the diaphragm and the lining of the heart. Some research showed encouraging results for EPP.

For example, a 2016 study investigated multimodal treatment that involved EPP. All patients completed surgery, and some completed the full multimodal plan. All participants had mesothelioma, with 25% having stage 1 mesothelioma. The median survival for patients with epithelioid mesothelioma was 42.8 months.

Heather Von St. James is a 16-year mesothelioma survivor who received EPP. She says it was “a means to extend or possibly save my life and get rid of the cancer.”

EPP is more extensive and presents more challenges than P/D. In many cases, doctors now prefer P/D to EPP. But for some patients, EPP may still be a valuable option.

Which Surgery Is Better for Stage 1 Pleural Mesothelioma – P/D or EPP?

EPP was once considered the best surgery for eligible pleural mesothelioma patients. This may have been because the removal of cancerous tissue was so close to complete.

Now, many recent studies point to P/D as a better surgical method than EPP. With P/D, patients are able to keep both lungs. Researchers also say this method offers benefits like improved survival and better health. This allows more patients to receive treatment if the cancer returns after surgery.

Cytoreductive Surgery (CRS)

Cytoreductive surgery (CRS) attempts to remove as much visible tumor tissue as possible. Typically, CRS is followed by chemotherapy. This helps kill remaining cancer cells and prevent recurrence. For example, CRS is often combined with hyperthermic intraperitoneal chemotherapy (HIPEC). This combination is generally associated with the best outcomes for peritoneal mesothelioma.

One study conducted in 2017 showed how effective this approach can be in peritoneal mesothelioma. Study patients underwent CRS followed by HIPEC. Some also received additional chemotherapy. The 5-year survival rate was 75%.

Multimodal Treatment for Stage 1 Mesothelioma

Multimodal therapy is the combination of two or more treatment methods. For eligible patients, these combined methods often work better together. Treatment plans often combine surgery with chemotherapy. This multimodal approach may sometimes include radiation for patients with pleural mesothelioma.

Various studies show the power of multimodal treatments for pleural and peritoneal mesothelioma.

Multimodal Study for Pleural Mesothelioma

In this study, patients received a combination of chemotherapy and surgery (P/D or EPP). Many patients received multiple rounds of chemotherapy. The effects on survival were encouraging:

  • Overall survival: 50% of patients lived at least 4.8 years.
  • 3-year survival rate: 65% of patients lived three years or longer.

Multimodal Study for Peritoneal Mesothelioma

In this study, patients received a combination of surgery (CRS) and chemotherapy (HIPEC). The effects on stage 1 patients were promising:

  • 1-year survival rate: 92% of patients lived one year or longer.
  • 5-year survival rate: 85% of patients lived five years or longer.

Immunotherapy

Immunotherapy is a new and promising mesothelioma treatment that helps the body’s immune system identify and fight cancer cells. It has become a standard option for many patients. Various immunotherapy drugs have been useful for treating mesothelioma.

In recent years, one immunotherapy drug pair has become a pillar of mesothelioma treatment. These drugs, Opdivo® (nivolumab) and Yervoy® (ipilimumab), have substantially improved prognosis for some patients. In a study, Opdivo+Yervoy extended survival by 50% and improved patients’ quality of life more than chemotherapy. This immunotherapy duo is approved to treat some cases of pleural mesothelioma.

For some patients, immunotherapy may be part of a first-line multimodal treatment plan. It may also be used to fight tumors if the cancer comes back.

Immunotherapy can also be an option for patients with difficult-to-treat cases. For example, some stage 1 pleural mesothelioma cases may not qualify for surgery. In the past, patients with similar cases may have had limited treatment options. Now, immunotherapy advances may help these patients receive therapeutic care.

Chemotherapy

Chemotherapy treats mesothelioma by killing cancer cells, stopping cell division and preventing growth. For stage 1 mesothelioma patients, these drugs are often used after surgery. This helps kill any remaining cancer cells and prevent recurrence. Chemotherapy has played a role in some of the most successful treatment plans.

For example, a study treated pleural mesothelioma with surgery and two types of chemotherapy. This approach extended survival better than past approaches. In fact, every single study patient survived at least one year after surgery. And more than half survived at least three years after surgery.

Clinical Trials

Stage 1 patients may qualify to join mesothelioma clinical trials. Clinical trials offer different treatments that have shown promise for mesothelioma patients. These treatments may include standard, emerging and experimental methods.

For patients who have tried other therapies first, clinical trials may be a second option. Patients may be able to access trials by consulting their oncologist or cancer center.

How Can I Improve My Stage 1 Mesothelioma Prognosis?

Treatment offers the best chance of improving prognosis. Some mesothelioma patients may consider adding alternative therapies to their standard treatment plans. Some alternative therapies may help improve prognosis and reduce side effects.

Patients can also turn to palliative care at any point during their cancer journey. This type of care can help manage lifestyle aspects of mesothelioma including symptoms and treatment side effects. The goal of palliative care is to improve quality of life and increase patient comfort.

Common alternative therapies include acupuncture, massage and yoga. Some patients may also consider supplementing their diet with herbs and vitamins. Patients should discuss nutritional supplements with their oncologists. Some options may offer benefits, but others might negatively impact treatment. A mesothelioma doctor can explain the potential risks and benefits of supplements and other alternative therapies for individual patients.

05. Stage 1 Mesothelioma Symptoms

Early Signs and Symptoms of Stage 1 Mesothelioma

Early-stage mesothelioma symptoms often go unnoticed or are mistaken for more common conditions. Some stage 1 patients do not have any symptoms. Other stage 1 patients may have mild symptoms that seem unrelated to cancer. In some cases, doctors may find mesothelioma during a routine exam or when examining a patient for other reasons.

For many patients, the earliest sign of mesothelioma may be chest pain. Doctors may order imaging scans for these patients. However, at stage 1, an imaging scan may not suggest that the patient has cancer. Doctors can help monitor any symptom development. Signs of mesothelioma may later show in imaging scans if the disease progresses.

Common Stage 1 Mesothelioma Symptoms*

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

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

Experts encourage patients to seek medical care for any unusual symptoms that mesothelioma could potentially cause. Early detection often provides treatment opportunities for the best prognosis.

How Do You Identify Early Signs of Stage 1 Mesothelioma?

Early mesothelioma symptoms may be mild and easy to miss. Many common conditions can cause similar symptoms, too. By performing diagnostic tests, like biopsies, doctors can confirm if mesothelioma is the cause. Then, using the TNM staging system, doctors can determine which stage a patient has.

Patients can also tell their doctor about any known or suspected asbestos exposure. Knowing about past asbestos exposure helps doctors watch for early signs of mesothelioma. Then, doctors can order the right tests to diagnose mesothelioma as early as possible.