Factors Affecting Life Expectancy
An important topic to discuss with your care team is life expectancy. This is a general estimate of how long you may live with your cancer, provided by medical specialists that take into account the specifics of your mesothelioma and other medical conditions. It is difficult for physicians to provide an exact time frame. However, several factors are helpful to help provide you with a general estimate:
- The kind of mesothelioma diagnosed (pleural, peritoneal, or pericardial) and the stage of the cancer at diagnosis
- Type of cells that became cancerous
- Whether the cancer has spread to other areas of the body
- Overall health. This includes age, fitness, smoking status, and the presence of other illnesses or diseases
Location of the Primary Tumor
An important variable in estimating life expectancy is the location of the original tumor. There are four types of mesothelioma based on location:
- Pleural mesothelioma is the most common form and affects the pleural tissue lining the lungs.
- Peritoneal mesothelioma is the next most common, originating in the lining in the abdominal cavity.
- Pericardial mesothelioma, which affects the lining of the heart is rare.
- Testicular mesothelioma, affecting the lining of the testes. This form is extremely rare.
Of these four, pleural mesothelioma is generally considered to be a positive prognostic indicator, meaning patients generally live longer when it originated in the pleural lining compared to other locations. Peritoneal mesothelioma tends to have a shorter life span compared to pleural. However, this location allows for some newer more aggressive treatments, such as heated chemotherapy instilled directly into the peritoneal cavity, or HIPEC. This may improve survival rates in the future.
Pericardial mesothelioma is incredibly rare, and prognosis is poor. Because there are so few patients diagnosed, it can be difficult to provide specific information on estimated survival. A recent review of 103 published cases of pericardial mesothelioma found overall median survival to be 6 months. However, those that received chemotherapy had a median survival of 13 months.
Testicular mesothelioma is the rarest subtype. The first documented case was in 1957, and only about 250 cases have been reported since then. Overall prognosis tends to be very poor, especially if the pathology type is more aggressive or the cancer has spread to lymph nodes or other organs. Since these numbers are so low, individualized life expectancy estimate will be patient specific.
Median Life Expectancy by Stage
Even more important than primary tumor location in determining a life expectancy is the stage of the cancer. When a patient is diagnosed with mesothelioma, it comes with a stage designation. This stage designation describes the extent of the cancer to the patient and other doctors. This takes into account the size of the primary tumor, invasion into other structures, lymph nodes involved, and spread to distant organs. The earlier the stage, the longer the life expectancy, although other factors must also be taken into account.
Mesothelioma is typically staged from one to four.
- Stage I
Stage I is an early diagnosis and rare for mesothelioma. It means the original tumor is still in one place, although it may have penetrated the tissue surrounding the pleura. Based on averages from previous cases, the life expectancy in stage I is 21 months.
- Stage II
By stage II, the tumor has invaded tissues like the lung and diaphragm. The average life expectancy is 19 months.
- Stage III
In stage III, mesothelioma has spread farther, possibly into the lymph nodes. Patients with stage III mesothelioma have an average life expectancy of 16 months.
- Stage IV
By stage IV, the cancer has spread into lymph nodes and possibly into more distant sites in the body. Life expectancy at this stage is just 12 months.
Cell Type and Life Expectancy
Another important factor in determining mesothelioma life expectancy is the cell type, or pathology. For mesothelioma, there are three main categories of cell type:
- Biphasic, or a mixture of epitheloid and sarcomatoid
In sarcomatoid mesothelioma, the cancer is mostly comprised of sarcomatoid cells. Sarcomatoid cells are more loosely attached to each other, making it easier for them to spread to other areas of the body. This kind of mesothelioma metastasizes more rapidly and has a lower life expectancy.
Biphasic mesothelioma contains a mixture of epithelioid and sarcomatoid cells. The ratio of these cells will determine how the cancer tends to act. For example, if you have more sarcomatoid cells, then the cancer will likely act more aggressive.
The stage, cell type, and location are all very useful pieces of information to determine estimated life expectancy. There are also many individual factors that impact survival time. Some are things the patient can control, like smoking. Others are beyond the patient’s control, including their age. Younger patients and non-smokers have a better life expectancy than those who are older or who smoke.
Doctors often use something called a performance status to help gauge what kind of shape someone is in. This is different than evaluating someone’s medical status or age. Instead, it looks at how functional and active a person is. For example, a person who is able to perform all of their daily functions independently is considered to have a higher performance status. This includes things such as taking a shower, dressing themselves, and walking around independently. Those that spend most of their time in bed and need people to help them with routine functions are conserved to have a poor performance status. This factors into what treatment options may be most appropriate for a patient.
There are several lifestyle factors that affect a person’s performance status. Staying active both mentally and physically is beneficial to overall health and may allow a person to receive more aggressive treatment, should they wish.
Maximizing Mesothelioma Life Expectancy
One important thing a person with mesothelioma can do to maximize life expectancy is seek medical treatment from a qualified mesothelioma specialist. These highly-trained physicians have extensive exposure to this rare disease. They also have access to the latest and most successful treatment options.
There are also lifestyle changes that can positively impact life expectancy. For example, if you are a smoker, it is very important for you to quit as soon as possible.
Doctors use a statistic called survival rate as another way to estimate life expectancy. Medical researchers and physicians measure a five-year survival rate, which is the percentage of patients that live five years or more after receiving a cancer diagnosis.
A more accurate prognosis can be made by looking at five-year survival rates. These rates take into account large populations of cancer patients. For mesothelioma survival rates, only mesothelioma patients are measured. Although these numbers are useful, a prognosis is still only an estimate.
Survival rates for mesothelioma are generally low compared to many other types of cancers. Generally, patients diagnosed with mesothelioma at age 45 or older have a five-year survival rate of only 20 percent. For younger patients, the survival rate goes up to 37 percent. Survival rates and life expectancy for mesothelioma are also measured by stage.
For stage I mesothelioma, the median survival rate is 21 months. If diagnosed during stage II, the life expectancy drops to 19 months. For patients diagnosed at stage III, a median life expectancy is only 16 months. Finally, stage IV patients have a life expectancy of only one year. These are only median numbers. Individual factors influence how long a patient will survive after a diagnosis.
Treatment and Survival Rate
When looking at average statistics and survival rates, there are clear patterns in how treatment impacts patient survival. Multimodality treatment, meaning a combination of aggressive surgery, radiation, and chemotherapy tend to have overall improved survival rates.
Among patients with pleural mesothelioma, those that received only chemotherapy, survival rates were around 20 percent after two years and four percent after five years. Survival rates increased significantly when aggressive surgical treatments were added to chemotherapy. For example, patients who received a pleurectomy, survival rates for two and five years went up to 40 and ten percent. For those who received the more aggressive extrapleural pneumonectomy, survival rates for two and five years were 37 and 12 percent.
Living with a Difficult Prognosis
Being diagnosed with mesothelioma is difficult and filled with a mix of emotions. Receiving that prognosis can be shocking. The best thing to do when getting this news is gather the support of loved ones. Being supported by people who care is the most effective way to cope with a difficult prognosis.
If you or a loved one with mesothelioma has been given a poor prognosis, you have important choices to make. Even if you choose aggressive treatment, your prognosis could remain disappointing. However, the choices you make now can make a difference in how long you live. Involving palliative care services can help identify clear goals of care and make sure your treatment aligns with your top life priorities.
It also helps to spend time with people who know what you are experiencing. Your friends and family care, but they don’t necessarily understand what it is like to receive a terminal diagnosis. Consider joining a cancer support group, if you can find one. There are support groups that meet in person and online. People in these groups understand and can provide solace you won’t find anywhere else.
As a final step in coming to grips with your prognosis, you may consider starting a lawsuit to seek justice for the illness you are facing. If you were exposed to asbestos, chances are there is someone responsible for your cancer. A lawsuit can give you a sense of justice and closure but can also provide financial assistance for medical care. These funds can also help loved ones after you are gone. Regardless of a lawsuit, there are certain legal matters that you and your family will want to discuss. This includes identifying a legal representative to speak on your behalf for medical and financial decisions if you are not capable of doing so.
Page Medically Reviewed and Edited byLuis Argote-Greene, M.D.
Luis Argote-Greene is an internationally recognized thoracic surgeon. He has trained and worked with some of the most prominently known thoracic surgeons in the United States and Mexico, including pioneering mesothelioma surgeon Dr. David Sugarbaker. He is professionally affiliated with University Hospitals (UH). His areas of interest and expertise are mesothelioma, mediastinal tumors, thoracic malignancies, lung cancer, lung transplantation, esophageal cancer, experimental surgery, and lung volume reduction. Dr. Argote-Greene has also done pioneering work with video-assisted thoracoscopic surgery (VATS), as well as robotic assisted minimally invasive surgery. He has taught the procedures to other surgeons both nationally and internationally.