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Mesothelioma Prognosis

If you or a loved one has been diagnosed with mesothelioma, you need all the information you can get. Your medical team should provide as much detailed prognosis information as possible when you are newly diagnosed with mesothelioma. The prognosis can be frightening to hear but is important for making decisions about the future.

The outlook for mesothelioma is rarely positive or hopeful. This is an aggressive type of cancer and it tends to spread quickly to other tissues in the body. Diagnosis is often delayed because symptoms are similar to those of other conditions and don’t emerge until decades after asbestos exposure. If you have been diagnosed with mesothelioma, so you can take steps right away to get a prognosis so you can choose your treatment for the best possible outcome.

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Prognosis is Different for Everyone

The prognosis for a mesothelioma diagnosis is an estimate of life expectancy based on large numbers of patients with the same disease. It tells you how long you can expect to survive, even with treatment.

Survival after diagnosis is expressed in months by doctors but it is ONLY AN ESTIMATE. Long term survival (more than 5 years) for mesothelioma is low, but there are always individual differences based on a number of factors:

  • Cancer stage
  • Type of mesothelioma
  • Cancer cell type
  • Overall health
  • Age

Most patients should not be surprised to get a prognosis that is disappointing. Mesothelioma is aggressive and challenging to treat, although there are rare exceptions and there is always hope.

Average Survival Rates

Doctors use a medical statistic called survival rate to estimate a prognosis for each individual patient. It’s just one factor that helps figure out an estimate prognosis for each individual. Five-year survival rate refers to the percentage of patients that live five years or longer after an initial diagnosis.

This is a useful and fairly accurate estimate because it is based on large numbers of patients. But every patient is different. Doctors can make the average survival more specific by considering individual factors. It is important to remember that every individual’s expected survival time will be different.

Survival rates are not very high for mesothelioma, but important strides have been made over the years. Younger patients can receive different treatment modalities and have a better outlook. One large study, for instance, found that 37 percent of patients younger than 45 survived five or more years after a mesothelioma diagnosis. For those over 45 the survival rate at five years was significantly lower, at only 20 percent.

Challenges in Diagnosing Mesothelioma

Mesothelioma is difficult to diagnose. For many patients this means a delay or misdiagnosis, which leads to delay in treatment and a worse prognosis. By the time many patients get the final diagnosis, they are already in the advanced stages of cancer. Life-saving or even curative treatment can be delayed when diagnosis and treatment are missed or administered in a timely fashion.

Challenges of diagnosing mesothelioma include the latency period. This is the time between exposure to asbestos, chronic changes and damage to the lining of the lungs (pleura), and the onset of symptoms. The latency period can be decades.

The most frequent symptoms are cough, chest pain and shortness of breath, and can be mistaken for signs of more common illnesses, like chronic bronchitis, pneumonia, or lung cancer. When symptoms do become troubling, diagnosis can be delayed further when they are not evaluated by a specialist in pulmonary diseases or thoracic (chest) surgery.

Prognosis by Type

Prognosis also depends on type of mesothelioma. Mesothelioma, although rare, is the most frequent type of tumor that arises from the pleura or lining of the lung and chest cavity. The chest cavity contains the lungs, heart, main vessels of the body and other organs.

There are three main types of mesothelioma based on cell type: epithelial, sarcomatoid and mixed. The latter is a combination of the two others.

Epithelial mesothelioma usually grows and invades surrounding organs and structures more slowly than the sarcomatoid type. The biphasic or mixed type is in between. Prognosis depends on these types of cells, but also the location in the body where the main tumor has grown.

Pleural mesothelioma grows in tissue around the lungs. Mesothelioma can also arise from the lining of the abdominal organs or cavity, in this case it is called peritoneal mesothelioma. Peritoneal mesothelioma generally has a better prognosis than the pleural type.

Pericardial mesothelioma, which grows in the tissue around the heart, has a worse prognosis because it is a difficult area to treat.

In summary, identification of mesothelioma cell type impacts treatment and prognosis:

  • Epithelial cells stick together more and don’t spread to other areas as readily as sarcomatoid cells. This type is easier to treat and has a better prognosis.
  • Sarcomatoid cells  spread more readily. This type of mesothelioma comes with a worse prognosis.
  • Biphasic tumors contain a mix of both types of cells. The prognosis depends on which cell type predominates.

Staging and Prognosis

Staging is a crucial factor in determining prognosis and a plan of treatment. Cancer is staged to describe the extension of the tumor, meaning how large it is and what structures it invades around the main tumor and if there are small tumors that broke off from the main tumor and were sent to distant areas away from the main area of disease.

Tumors can extend through the lymph nodes or lymphatic system, the blood or vascular system and through the surfaces that line the cavities of the body. It can also spread by continuity or just by growing against and into other structures from the main tumor or local extension.

The American Cancer Society determined the median five-year survival rates for mesothelioma by stage, based on patients treated between 1995 and 2009. Patients have a better or worse outlook depending on individual factors.

The median survival times for patients given a diagnosis at each stage of mesothelioma are:

  • Stage I – 21 months
  • Stage II – 19 months
  • Stage III – 16 months
  • Stage IV – 12 months

Other Factors That Affect Prognosis

Cell type, stage, and cancer type impact prognosis the most and are out of a patient’s control. There are also individual factors to be taken into account. Age, health, and the extent of asbestos exposure play important roles in determining outlook for a mesothelioma diagnosis. Lifestyle choices that impact health can be particularly important, especially smoking. One of the best things a mesothelioma patient can do for a better outcome is to quit.

Treatment choices also affect prognosis. Patients who are eligible for and choose surgery are more likely to survive longer and have a better prognosis than those who cannot or choose not to have surgery. More aggressive treatments, such as surgery to remove an entire lung, come with unique and serious risks but can also extend a patient’s life to a greater extent than more conservative treatments.

Take Action to Improve Prognosis

By far the best way to get a better prognosis for mesothelioma is to get an early diagnosis and to begin treatment right away. Unfortunately many victims do not realize they were exposed to asbestos until it is nearly too late. If you even suspect you worked around asbestos, take steps now to learn more. Get screened and monitor your symptoms.

If you have symptoms that could be related to mesothelioma, see your doctor immediately. Explain that you were or may have been exposed to asbestos and insist on cancer screenings. If your doctor doesn’t take you seriously, or you think you may have been misdiagnosed, seek a second opinion.

How to Improve a Prognosis after Diagnosis

After a diagnosis of mesothelioma, there are some steps you can take to try to extend your survival time. One of the most important steps that you can take is to get treatment from a top-rated mesothelioma specialist as part of a multidisciplinary team.

  • Start Treatment Immediately. Putting together a treatment plan as soon as possible and starting it right away is crucial in improving a prognosis. The more aggressive the treatment the better the prognosis.
  • Combine Therapies. Some patients cannot have surgery, but they can be given chemotherapy and radiation therapy to shrink tumors or slow the rate at which they spread. For those who can have surgery, the procedure to remove as much of the tumors as possible is often followed by chemotherapy and radiation to eliminate more of the cancerous tissue.
  • Join a Clinical Trial. Another approach to extending the life expectancy of a patient after a mesothelioma diagnosis is to try experimental therapies through clinical trials. Trials determine the safety and the efficacy of new treatments and patients with terminal conditions are usually chosen to be a part of the trials. There are risks associated with clinical trials, but they can also lead to positive results.
  • Try Alternative and Complimentary Medicine. While treatment by specialists is most important, other factors can potentially improve your prognosis and certainly help you feel more comfortable. Make healthy lifestyle choices such as quitting smoking, exercising, and maintaining a healthy weight. Try alternative therapies to complement traditional treatment, such as acupuncture or aromatherapy.

Living with a Negative Prognosis

A poor prognosis is tough to deal with while you are also feeling unwell and trying to make treatment choices. With good support, coming to terms with this is easier.

Rely on Friends and Family
The first and most important thing you need is strong social support. Keep your family and friends close and let them help you. Let them lend a shoulder to cry on, someone to shout at, or just someone to be there when you feel you can’t be alone. If you have the people you love around you, the prognosis will be much easier to live with.

Connect with Other Asbestos Victims
As much as family support systems may be there for you and willing to help, they can’t fully understand your experience. In addition to having these loved ones in your life, it also helps to have connections with other people struggling with cancer and mesothelioma.

Look for a support group that you can meet with, online or in person, to talk about your shared feelings and experiences. This can help you to feel better about accepting your mesothelioma diagnosis.

Finally, consider seeking justice for the harm caused by asbestos exposure. This can bring some peace of mind during this difficult time. Getting justice and an admission of liability from a former employer or asbestos manufacturer may help you feel better. Filing a lawsuit or taking part in an asbestos trust fund can also provide you and your family with much-needed compensation. An experienced mesothelioma lawyer can help you take the next step to get justice and compensation.

Page Edited by Dave Foster

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Dave has been a mesothelioma Patient Advocate for over 10 years. He consistently attends all major national and international mesothelioma meetings. In doing so, he is able to stay on top of the latest treatments, clinical trials, and research results. He also personally meets with mesothelioma patients and their families and connects them with the best medical specialists and legal representatives available. Connect with Patient Advocate Dave Foster

Page Medically Reviewed and Edited by
Luis Argote-Greene, MD

Luis Marcelo Argote-Greene, MD
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.
Sources
  1. American Cancer Society. (2018, November 16). Key Statistics About Malignant Mesothelioma.
    Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/about/key-statistics.html
  2. American Cancer Society. (2018, November 16). Survival Statistics for Mesothelioma.
    Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/survival-statistics.html
  3. Leuzzi, G., Rea, F., Spaggiari, L., Marulli, G., Sperduti, I., Alessandrini, G., Casiraghi, M., Bovolato, P., Pariscenti, G., Alloisio, M., Infante, M., Pagan, V., Fontana, P., Oliaro, A., Ruffini, E., Ratto, G.B., Leoncini, G., Sacco, R., Mucilli, F., & Facciolo, F. (2015). Prognostic Score of Long-Term Survival After Surgery for Malignant Pleural Mesothelioma: A Multicenter Analysis. Ann. Thorac. Surg., 100(3), 890-7.
    Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/26163973

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