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Stage 3 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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In Stage 3, mesothelioma cancer has spread to nearby tissues, organs and/or lymph nodes. As a result, stage 3 symptoms are more prominent compared to symptoms in the earlier stages. Median survival ranges from 16 to 26 months for the most common forms of stage 3 mesothelioma.


01. Overview

What Is Stage 3 Mesothelioma?

Stage 3 mesothelioma is considered an advanced stage of the disease. In this stage, symptoms may become prominent and recognizable.

Characteristics of Stage 3 Mesothelioma

  • Cancer metastasizes (spreads) to tissue and organs near the cancer’s origin.
  • Cancer may also spread to nearby lymph nodes.
  • Pleural mesothelioma cancer can be further classified as stage 3a or stage 3b.

One significant difference between stage 3 and stage 4 pleural mesothelioma is that stage 4 indicates spreading to distant organs and tissues.

Compared to stage 3, stage 4 peritoneal mesothelioma typically involves spreading to additional regions or the presence of larger tumors.

Staging of Mesothelioma

Staging is an important way to determine prognosis and treatment options. Common mesothelioma staging systems examine tumor location, lymph node involvement and spreading. Mesothelioma type and cell type also help doctors understand the cancer’s progression and a patient’s life expectancy. (Read more about lymph node involvement below)

02. Stage 3 Symptoms

What Are the Symptoms of Stage 3 Mesothelioma?

By stage 3, mesothelioma symptoms are more intense and may be severe compared to earlier stages of the cancer.

Stage 3 Mesothelioma Symptoms*

  • Chest or abdominal pain
  • Chest tightness
  • Coughing
  • Difficulty breathing (dyspnea)
  • Fatigue
  • Fever
  • Fluid buildup
  • Weight loss

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

Stage 3 patients often undergo palliative treatments to relieve symptoms. Doctors may recommend palliative treatment during the treatment plan to decrease patient discomfort.

03. Stage 3 Types

Stage 3 Mesothelioma by Type

During a mesothelioma diagnosis, physicians will determine stage and mesothelioma type. The type of mesothelioma will impact staging protocol.

Stage 3 Pleural Mesothelioma

Pleural mesothelioma is the most commonly diagnosed type of the cancer. Doctors have established three staging systems for this type:

The TNM system is the most commonly used. The system looks at the size and extent of mesothelioma tumors (T), lymph node involvement (N) and metastasis (M). Under the TNM system, stage 3 malignant pleural mesothelioma is classified further into stage 3A and stage 3B.

In stage 3A, pleural mesothelioma:

  • Cancer cells are present in the pleura (lining of the lungs) and on one side of the chest.
  • Cancer may have also spread to nearby lymph nodes, the chest wall or lining of the heart.

Stage 3B pleural mesothelioma involves many of the same characteristics as 3A. However, stage 3B patients may have distant lymph node involvement and cancer spreading to the lung lining on the opposite side of the chest.

Stage 3 Peritoneal Mesothelioma

Malignant peritoneal mesothelioma comprises 15 – 20% of all diagnoses. Because of its rarity, peritoneal mesothelioma doesn’t have its own staging system.

Instead, mesothelioma doctors may use the Peritoneal Cancer Index (PCI). The PCI grades tumors in distinct areas of the abdomen and then totals the scores. A score ranging from 21 – 30 indicates stage 3 peritoneal mesothelioma.

Mesothelioma tumors are localized to the abdomen at this stage, but may have spread to nearby organs and lymph nodes. Some stage 3 peritoneal mesothelioma cases show cancer growth in the chest wall and throughout the abdominal cavity.

Stage 3 Pericardial Mesothelioma

Pericardial mesothelioma comprises 1 – 2% of diagnoses. Due to limited research, doctors have not established a pericardial mesothelioma staging system.

Pericardial mesothelioma tumors are often aggressive and fast-growing. When these tumors are detected, the cancer has often spread:

  • Throughout the chest cavity
  • To nearby organs
  • To nearby lymph nodes

Pericardial mesothelioma may also spread to the lungs in some cases.

Patients with this form of mesothelioma may be diagnosed at an advanced stage or posthumously.

Stage 3 Testicular Mesothelioma

Testicular mesothelioma does not have an established staging system. Doctors use general staging principles to diagnose the disease. A stage 3 testicular mesothelioma diagnosis could indicate the cancer has spread outside of the linings of the testicles. Patients may have more limited treatment options at this stage when compared to stage 1 or stage 2.

04. Stage 3 Prognosis

Stage 3 Mesothelioma Prognosis

Stage 3 mesothelioma prognosis is less favorable than earlier stages. In stage 3, the disease has become more invasive. As such, aggressive surgical treatments may no longer be an option.

In addition to the extent of spreading, other factors may impact an individual’s prognosis.

Factors Influencing Stage 3 Mesothelioma Prognosis

  • Tumor location: The location of a tumor determines if it can be removed. If a patient’s tumor(s) can be removed, the patient may have a better prognosis.
  • Cell type: Patients diagnosed with epithelioid mesothelioma typically have more favorable life expectancies than those diagnosed with sarcomatoid mesothelioma. Life expectancy for patients with biphasic mesothelioma will depend upon the percentage of epithelioid versus sarcomatoid cells.
  • Patient age: Younger stage 3 mesothelioma patients typically live longer than older patients diagnosed at this stage.
  • Overall health: Patients with pre-existing conditions like diabetes or chronic obstructive pulmonary disease (COPD) may have a less favorable prognosis.

Stage 3 Mesothelioma Life Expectancy

Prognosis and life expectancy for stage 3 mesothelioma will vary from patient to patient. Mesothelioma life expectancy is an estimate of how long a patient will survive. Stage 3 mesothelioma life expectancy varies based on a number of factors, such as a patient’s health history, cell type and cancer type.

How Long Can You Live With Stage 3 Mesothelioma?

The median survival for stage 3 pleural mesothelioma is 16 months. Studies show stage 3 peritoneal mesothelioma patients have a median survival of 56 months.

Understanding Lymph Node Involvement and Life Expectancy

By stage 3 mesothelioma, cancer cells may have spread to nearby lymph nodes. This indicates a more advanced stage of the disease.

Lymph nodes and lymph vessels are part of the body’s immune system. The lymph nodes collect waste material, viruses and bacteria from nearby body tissue. As such, they serve as a highway connecting many tissues.

If cancer cells spread to lymph nodes, their interconnections to the rest of the body can lead to metastasis. This means the cancer may spread to multiple locations via lymph vessels or the bloodstream.

Once the cancer has spread to lymph nodes, a mesothelioma patient may have a shorter life expectancy. Lymph node involvement may limit treatment options, but researchers continue to test therapies for advanced-stage mesothelioma.

Stage 3 Mesothelioma Survival Rate

Mesothelioma survival rates continue to increase as researchers and mesothelioma doctors discover new treatment techniques. Survival rates for stage 3 mesothelioma cancer are typically recorded at 2- and 5-year intervals.

Stage 3 Pleural Mesothelioma Survival Statistics

  • The 2-year survival rate for stage 3 pleural mesothelioma is 29%.
  • The 5-year survival rate for stage 3 pleural mesothelioma is 6%.
  • The median survival for stage 3 pleural mesothelioma is 16 months (compared to 12 months for stage 4).

Stage 3 Peritoneal Mesothelioma Survival Statistics

  • The 2-year survival rate for stage 3 peritoneal mesothelioma is 71%.
  • The 5-year survival rate for stage 3 peritoneal mesothelioma is 48%.
  • The median survival for stage 3 peritoneal mesothelioma is 56 months (compared to 26 months for stage 4).

Stage 3 Testicular and Pericardial Mesothelioma Survival

Given the rarity of testicular and pericardial mesothelioma, data on the associated stage 3 survival rates is unavailable. A mesothelioma specialist can advise pericardial and testicular mesothelioma patients on their individual prognosis.

05. Can It Be Cured?

Can Stage 3 Mesothelioma Be Cured?

There is currently no cure for mesothelioma cancer. Mesothelioma patients diagnosed at stage 3 typically have a less favorable prognosis than those diagnosed at earlier stages. However, doctors are evaluating new and existing treatments to extend patient life expectancy.

Stage 3 Mesothelioma Survivors

Thanks to ongoing advancements in treatment, some stage 3 mesothelioma patients outlive their initial prognosis. Although stage 3 is considered a late stage of mesothelioma, some patients are still able to undergo aggressive treatment.

One recent study examined the potential of bidirectional chemotherapy for late-stage peritoneal mesothelioma. After undergoing bidirectional chemotherapy, half of the participants were able to receive more aggressive treatment, including surgery. This group of patients achieved a 2-year overall survival rate of about 83%.

06. Stage 3 Treatment

Stage 3 Mesothelioma Treatment

Staging is an important factor in determining a patient’s treatment plan. Accurate staging gives physicians insight into the most appropriate treatment options for their patients.

In stage 3, patients may be eligible for curative treatments, such as surgery, chemotherapy and radiation. Mesothelioma doctors may recommend a multimodal approach, which involves a combination of two or more treatment types. These treatments may improve life expectancy.

These standard treatments may also be applied palliatively to relieve symptoms. Palliative care is often a large component of stage 3 treatment to provide the patient with the highest quality of life possible.

Stage 3 Mesothelioma Treatment Options

  • Surgery
  • Chemotherapy
  • Radiation therapy
  • Multimodal therapy
  • Clinical trials
  • Immunotherapy
  • Palliative care
  • Alternative therapies

Surgery

Some patients with stage 3 mesothelioma may still be eligible for invasive surgery to remove tumors. In rare cases, pleural mesothelioma patients in stage 3 may qualify for an extrapleural pneumonectomy. This procedure removes the entire affected lung and its lining (pleura), the lining around the heart and diaphragm.

For stage 3 patients not eligible for aggressive surgery, palliative surgical procedures may be an option. Surgeries to lessen symptoms and improve quality of life are more common among stage 3 patients. Palliative surgeries include:

  • Pleurodesis: A procedure administered to pleural mesothelioma patients with fluid buildup around the lungs. The surgery closes space within the pleural cavity and drains excess fluid.
  • Pleurocentesis (thoracentesis): A procedure to remove pleural fluid buildup. Draining fluid can relieve symptoms like shortness of breath.
  • Paracentesis: A procedure administered to peritoneal mesothelioma patients. The surgery drains excess fluid from the abdominal area.

Chemotherapy

For stage 3 patients with advanced spreading, chemotherapy may be the primary treatment option. Patients who are able to undergo surgery may also receive chemotherapy to kill remaining cancer cells.

Many mesothelioma patients receive chemotherapy through an IV. Intravenous chemotherapy drugs are being used to extend life expectancy and improve quality of life. Doctors may recommend pemetrexed, cisplatin and/or bevacizumab for mesothelioma.

Radiation Therapy

Radiation therapy may be used palliatively. It can be used to shrink tumors and reduce symptoms, such as chest pain and difficulty breathing. In some cases, radiation may be administered after surgery to prevent localized tumors from growing.

Multimodal Therapy

Studies have shown the use of two or more mesothelioma treatments may extend patient life expectancy. A multimodal treatment plan can be aggressive and may not be suitable for every patient. A mesothelioma doctor can determine whether a stage 3 patient is eligible.

Clinical Trials

Researchers and doctors are continuously working on a cure for malignant mesothelioma. Clinical trials allow doctors to test emerging treatments on mesothelioma patients. Late-stage cancer patients may be eligible for a clinical trial if they are unresponsive to standard treatment options.

Immunotherapy

Immunotherapy is a viable, emerging option for late-stage mesothelioma patients. Clinical trials are testing immunotherapy drugs for stage 3 patients.

In a clinical trial at the Baylor College of Medicine Lung Institute, researchers are testing the effectiveness of immunotherapy drug nivolumab when combined with a new agent, MTG201. Phase 2 of the trial will be open to patients who previously received chemotherapy and still saw disease progression.

The trial is moving into phase 2 after researchers obtained positive results in the phase 1 trial. The next phase of the study will include patients at all stages of the mesothelioma, including stage 3.

Palliative Care

Treatment options for advanced-stage mesothelioma can be limited. As a result, palliative care is common among stage 3 and 4 patients. Palliative treatments can lessen symptoms and make patients more comfortable.

Patients with stage 3 mesothelioma have more prominent symptoms and can benefit from palliative therapies.

In some cases, advanced stage patients may receive standard forms of treatment and palliative therapies. Studies have shown patients who receive standard and palliative care may have better quality of life and survival rates versus those receiving palliative care alone.

Alternative Therapies

In addition to standard treatment options, patients may consider alternative therapies. These complementary therapies can help reduce symptoms and treatment side effects. Alternative therapies may be used at any time during a patient’s treatment journey.

Complementary alternative treatments include:

  • Herbal and nutritional supplements
  • Hypnotherapy
  • Light therapy for cancer
  • Meditation
  • Reflexology for cancer
  • Yoga and personal fitness

Although stage 3 mesothelioma signifies the cancer is advanced, patients can seek treatment that improves outcomes. Recent studies found improved survival for stage 3 patients who undergo standard or new treatments. Patients should discuss their options with a mesothelioma doctor.

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