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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 to make the best decisions. Your medical team should provide detailed prognosis information 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. 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 Each Patient

Prognosis is an estimate of how long you can expect to survive after a diagnosis. Estimates are based on large numbers of patients who lived with and died from the same disease.

Survival after diagnosis is expressed in months 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 several 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 difficult to treat. There are rare exceptions and there is always hope.

Average Survival Rates

Oncologists use a 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 living five years or longer after an initial diagnosis.

Five-year survival rates are estimates. They are fairly accurate because they are calculated from large patient pools. Still, every case of mesothelioma is unique. The most accurate prognosis comes from this general statistic and a consideration of individual, personal factors.

Survival rates are not very high for mesothelioma compared to other cancer types, but it is always improving with better treatments and diagnostics.

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. The survival rate for patients 45 or older at five years was significantly lower, just 20 percent.

Challenges in Diagnosing Mesothelioma

Mesothelioma is difficult to diagnose. For many patients this means a delay in getting an accurate diagnosis 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.

One challenge of diagnosing mesothelioma is the long latency period, 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 common symptoms of pleural mesothelioma are cough, chest pain and shortness of breath, and can be mistaken for signs of more common illnesses. Chronic bronchitis, pneumonia, and lung cancer all have symptoms similar to these. 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 the type of mesothelioma. Mesothelioma may be pleural, peritoneal, or pericardial depending on whether it begins in the tissue around the lungs, the abdomen, or the heart.

Peritoneal mesothelioma generally has a better prognosis than the pleural type. Pericardial mesothelioma has the worst prognosis because it is difficult to treat cancer so close to the heart.

There are also three main types of mesothelioma based on cell type: epithelial, sarcomatoid and mixed.

Epithelial mesothelioma grows more slowly than cancer in sarcomatoid cells. Mesothelioma that is made up of a mix of both types of cells is called biphasic. These cell types inform prognosis, as does the original location in the body of the tumor:

  • 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 the most crucial factor in determining prognosis. Cancer is staged to describe the extent 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 may spread through the lymph nodes to the lymphatic system, the blood or vascular system and through the surfaces that line the cavities of the body. It can also spread by continuity, by growing against and into other structures from the main tumor.

The American Cancer Society determined the median five-year survival rates for mesothelioma by stage. This was 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 have the biggest effect on prognosis. There are also individual factors to be taken into account. Age, health, and the extent of asbestos exposure play important roles in determining outlook. 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 than those who cannot have or choose not to have surgery. More aggressive treatments, such as surgery to remove an entire lung, present 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 improve prognosis for mesothelioma is to get an early diagnosis and to begin treatment right away. Unfortunately many victims do not realize they are sick until it is nearly too late. If you even suspect you worked around asbestos, take steps now to investigate. Get screened and monitor your symptoms.

If you develop symptoms that seem like mesothelioma, see your doctor immediately. Tell your doctor that you may have been exposed to asbestos. Insist on cancer screenings, and get a second opinion if necessary.

How to Improve a Prognosis

After a diagnosis of mesothelioma, there are some steps you can take to try to improve your outcome. One of the most important steps that you can take is to get treatment from a mesothelioma specialist team.

  • Start Treatment Immediately. Work with your specialists to put together a treatment plan as soon as possible and start it right away. 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 growth rate. 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. Trials determine the safety and the efficacy of new treatments. 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 more, and eating well. Try alternative therapies to complement traditional treatment, such as acupuncture or aromatherapy.

Living with a Negative Prognosis

A poor prognosis is difficult, especially while you are also feeling unwell and trying to make big treatment choices. With support from loved ones, coming to terms with this is easier.

Rely on Friends and Family
Most importantly, you need 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 situation. It 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 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. 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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