Prognosis depends on a variety of factors like type, stage and patient characteristics.
Early detection is the best way to improve mesothelioma prognosis.
Patients may be able to extend their survival with treatment.
Prognosis will ultimately vary on a case-by-case basis.
Prognosis refers to how a disease will progress, taking patient survival into account. This differs from survival rate in that it looks at disease progression, in addition to how long the patient is expected to survive. The prognosis for patients with malignant mesothelioma is considered poor compared to other diseases and conditions due to the cancer’s aggressive nature. However, mesothelioma research continues to focus on improving diagnostic tools and developing new treatments, providing patients with the opportunity to catch the disease sooner and utilize a wider range of aggressive mesothelioma treatment options.
A projection for how the disease is expected to progress and the overall likelihood of survival.
A percentage that shows how many patients live for a given amount of time after diagnosis.
How long a patient is likely to live after diagnosis. This estimate depends on treatment success and other factors.
Factors Influencing Mesothelioma Prognosis
Every mesothelioma patient will face a different prognosis based on a variety of factors. All of these factors are taken into account when a patient is given their initial prognosis, at the time of diagnosis.
Factors Affecting Mesothelioma Prognosis
- Mesothelioma type
- Cell type
- Patient age and overall health
Prognosis by Mesothelioma Type
One of the most influential factors is mesothelioma type and cell type. Mesothelioma type is determined based on initial tumor location, usually occurring in the linings of the lungs, abdomen, heart or testicles. Pleural mesothelioma (lungs) and peritoneal mesothelioma (abdomen) are the two most common types.
Prognosis by Mesothelioma Type
- Pleural Mesothelioma: Multimodal treatment is most common with an average survival of 6 – 12 months after diagnosis.
- Peritoneal Mesothelioma: Commonly treated with surgery and chemotherapy with an average survival of around one year.
- Pericardial Mesothelioma: Treatment plan is primarily palliative with an average survival of around six months.
- Testicular Mesothelioma: Typically addressed with multimodal treatment and average survival is around 20 – 23 months.
In terms of cell type, mesothelioma cancer may be composed of sarcomatoid cells or epithelioid cells. If the cancer has both cell types, it’s referred to as biphasic mesothelioma.
Sarcomatoid mesothelioma usually has the worst prognosis of the cell types, as these cancer cells are aggressive and less responsive to treatment. Epithelioid mesothelioma usually has the best prognosis with slower spreading cells that are responsive to treatments. The prognosis for biphasic patients typically falls in between the two types, differing based on which cell type is dominant. In some cases, patients may be diagnosed with rare cell types, which also result in varied survival times.
Prognosis by Mesothelioma Stage
Staging can also help physicians predict how a patient’s condition may progress. Mesothelioma is typically staged using the TNM staging system, classifying the disease based on tumor location, lymph node involvement and metastasis. Metastasis references whether or not the disease has spread.
If a patient is diagnosed at stage 1 or stage 2, they are likely able to undergo multimodal treatments with radical surgeries and chemotherapy or radiation therapy to stop or slow disease progression, therefore improving prognosis. Diagnoses at stage 3 or stage 4 typically progress much quicker with lower survival rates because the mesothelioma cancer has already spread to the lymph nodes and distant organs within the body.
Prognosis by Mesothelioma Stage
- Stage 1: The disease hasn’t spread and patients typically live 21 months or longer.
- Stage 2: The disease is slightly more advanced and patients live around 19 months, on average.
- Stage 3: The disease has begun to spread with an average mesothelioma life expectancy of 16 months.
- Stage 4: Distant spreading has occurred and treatment is limited with survival around 12 months.
Other factors potentially influencing mesothelioma prognosis include patient age and overall health. Older patients may not respond as well to treatment, or may not be able to undergo aggressive treatments to slow progression. Patients with weakened immune systems or pre-existing conditions may also experience a worse prognosis.
Determining Mesothelioma Prognosis
Patients with malignant mesothelioma will typically discuss their prognosis with a specialist at the time of diagnosis. The mesothelioma doctor will review the patient’s medical records, type of cancer, stage and other characteristics to help determine a relative prognosis.
Prognosis can vary greatly from patient to patient, even if they have the same mesothelioma type and cell type and are diagnosed at the same stage. A prognosis is also not guaranteed, and survival time can vary based on how patients respond to cancer treatment and if they face any additional challenges after their original mesothelioma diagnosis.
Emerging Methods to Determine Prognosis
In an effort to provide patients with clear insight as to how their disease is likely to progress, doctors continue to develop new methods for determining prognosis. Two common studies being utilized recently include gene expression and biomarkers in the blood.
- Research has found that genes often express themselves differently with those that have a malignancy, across different diseases of varying severity.
- One study used frozen tissue samples from malignant pleural mesothelioma patients to analyze RNA expression compared to survival rates. The study confirmed that gene expression can be used to predict how long a patient will survive and provide insight into whether or not surgical resection is viable, helping guide treatment.
- Gene expression was not completely accurate with predictions and was most beneficial when analyzed alongside other prognostic factors
- Blood tests are an innovative diagnostic tool that can be used to pick up certain biomarkers in the blood, or products that the body produces under certain circumstances.
- Current mesothelioma blood tests can aid in early detection, may reveal a history of asbestos exposure or may show common mesothelioma symptoms.
- Blood tests are also being used to aid with prognosis.
- Many studies have focused on fibulin-3, determining that elevated levels of the glycoprotein are seen in certain types of cancers and can provide information on how mesothelioma and other diseases will progress.
Improving Mesothelioma Prognosis
The best way to improve prognosis is through early detection. The earlier that mesothelioma cancer is detected, the more treatment options likely available to the patient. Early diagnoses can also help treat the cancer before it has spread to distant areas of the body. Due to the long latency period of mesothelioma, it can be difficult to recognize and address symptoms before stage 3. However, research continues to uncover innovative diagnostic tools, like new biomarkers in the blood or the mesothelioma breath test.
Patients can aid with early detection if they are aware of a history of asbestos exposure. If occupational exposure, secondhand exposure or other contact with asbestos is known, patients should let their doctor know and have routine checkups done to monitor for potential symptoms. Some blood tests can even reveal a history of asbestos exposure if the patient is unaware.
The Effect of Treatment on Prognosis
Once mesothelioma is diagnosed, patient survival and disease progression may differ from the original prognosis, depending on the treatment plan and response to treatment. Mesothelioma is usually treated with a multimodal approach, using a combination of surgery, chemotherapy and radiation therapy. Patients with a late-stage diagnosis may opt solely for a palliative treatment plan to improve quality of life with minimal treatment side effects.
Pleural mesothelioma patients with localized disease that undergo surgery (extrapleural pneumonectomy or extended pleurectomy), alongside chemotherapy or radiation therapy have seen a 5-year survival rate of 20%.
Research continues to look at different combinations of traditional practices, such as surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC, a heated chemotherapy wash, is used to treat malignant peritoneal mesothelioma and has shown success in extending mesothelioma survival rates. Experimental treatments have also shown success in slowing disease progression and extending survival in clinical trials.
Patients and their loved ones should discuss their individual case and personal treatment options with their mesothelioma doctor to fully understand what’s available to them. Not all patients are eligible for clinical trials, though some experimental treatments, such as immunotherapy, are now becoming more widely accessible due to their success.
Mesothelioma Remission and Recurrence
Despite the statistics surrounding survival for mesothelioma patients, it is possible to achieve disease remission. Remission doesn’t indicate that the cancer has been cured, but rather that the condition has significantly improved. There are two types of remission: partial remission and complete remission.
- Patients have a significant percentage reduction in tumor size
- Treatment is typically reduced, but not stopped
- Tumor progression is monitored extremely closely
- There are no visible signs of mesothelioma cancer
- Treatments are typically stopped
- Patients undergo frequent follow-ups to monitor for recurrence
Remission is often the result of patients undergoing aggressive multimodal treatments, as is seen with many mesothelioma survivors. Early detection can also contribute towards the possibility of remission as patients can begin treatment sooner, before the disease has spread. Whether in partial or complete remission, it’s crucial for patients to undergo frequent follow-up appointments to address potential recurrence.
Recurrence is common for mesothelioma patients in remission. Recurrence indicates that the cancer has returned after a period of remission. Mesothelioma recurrence is usually described as local, regional or distant, depending on where the cancer has been found.
- Tumor growth near or at the original location of cancer development
- Tumor growth at tissues and/or organs close to the original location
- Metastatic growth to distant organs or tissues from where the cancer originally developed
Mesothelioma patients that are experiencing a return of their cancer may not be able to undergo aggressive surgeries again. However, chemotherapy, radiation therapy and clinical trials may be viable options.
Patients in remission should discuss recurrence rates, cancer prevention techniques and continued treatment options with their specialist to fully understand their individual case.