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Mesothelioma, like other types of cancer, is staged at the time of diagnosis. The stages include 1, 2, 3, and 4 with 1 being the earliest and 4 being the stage of furthest progression of the disease. Staging is important because it guides treatment and helps give patients a more accurate prognosis.
Because mesothelioma is difficult to diagnose, because it is rare, because it mimics more common illnesses, and because it has a long latency period, stage 1 diagnoses are not common. This cancer, which attacks the mesothelium tissue lining organs in the body, is aggressive and moves quickly. Most patients get a diagnosis at a later stage, but those that do manage to catch it early, at stage 1, have more treatment options and a better overall prognosis, including real hope it can be cured.
There are multiple systems for staging cancer, but the TNM system is most common and most often used for mesothelioma. While diagnosing the cancer, doctors, pathologists, and specialists will try to also stage the disease. This involves looking at the cells in the tumor, the extent of the tumor, and any metastasis or spreading of the original tumor to the lymph nodes or any other part of the body. Doctors use biopsy samples and imaging scans. In some cases they may need to do exploratory surgery, although this is invasive and avoided if possible.
In the TNM system the T describes the primary tumor, how far it has penetrated and grown into other tissues, and its overall size. The N is descriptive of intrusion into lymph nodes. It is from these immune system organs that it is possible for cancer to spread to other parts of the body. Finally, the M stands for metastasis and describes whether the cancer has become metastatic or not.
Stage 1 Mesothelioma – TNM Designation
Stage 1 mesothelioma is diagnosed if the TNM assignments are T1, N0, and M0. T1 indicates the original tumor has not spread very far from its primary location. With pleural mesothelioma, the most common type of this cancer, T1 describes a tumor that exists in the pleura—the tissue that surrounds the lungs—on just one side of the chest. It may have penetrated the pleura around the diaphragm, which is the muscle underneath the lungs, or the pleura in between the two lungs. An assignment of N0 means that the cancer has not yet spread to any nearby lymph nodes and an assignment of M0 means that there has been no metastasis.
Treatment at Stage 1
Because there has been no spread of the cancer to lymph nodes or other organs, patients with stage 1 mesothelioma has the most treatment options. Mesothelioma is almost always considered incurable, but for those at stage 1 there is hope and a possibility of going into remission. As long as a patient is healthy and able to withstand it, most doctors will recommend aggressive and multimodal treatment at this stage.
One of the most important distinctions between stage 1 and later stage mesothelioma is that it is most likely resectable. In other words, surgery to attempt to remove all or most of the cancerous tissue is a possibility. When the cancer has spread to other locations, surgery becomes a less viable option. For most stage 1 patients a combination of surgery, radiation, and chemotherapy gives the best hope of survival.
For surgical treatment there are a couple of options. A pleurectomy and decortication removes all of the pleura on the side of the chest with the tumor that surrounds the lungs, the diaphragm, and the space between the lungs.
More radical and risky is an extrapleural pneumonectomy, which removes the pleura, but also the lung and the diaphragm on the side where the tumor is found. This surgery is only recommended for health patients and is only performed by specialists. Surgery to remove as much of the tumor as possible is also an option for peritoneal mesothelioma. That surgery may remove the abdominal mesothelium as well as the omentum, a layer of fat that hangs over the abdominal organs.
Chemotherapy is medication that targets fast-growing cells in the body and radiation is a beam of high-energy waves that can be aimed at a tumor to kill cancer cells. Each of these are often used before or after surgery in patients with stage 1 mesothelioma. Chemotherapy may be used before surgery to shrink the tumor and either may be used after to kill any remaining cancer cells and to prevent a recurrence.
Prognosis for Stage 1 Mesothelioma
It is rare for a patient to receive a stage 1 diagnosis for mesothelioma, but it is the stage with the best prognosis and an average survival time of nearly two years. As a comparison, patients with stage 4 mesothelioma are typically given a prognosis of less than a year. These averages, of course are only guidelines. Everyone is different, and some stage 1 patients have gone into remission for years or decades after treatment.
Aside from the stage of the cancer, other factors that improve the prognosis include being younger, having good overall health, engaging in positive lifestyle habits, such as not smoking, and opting for aggressive and early treatment. Getting treatment for mesothelioma almost always extends life expectancy, and in stage 1 it actually has a chance of curing the cancer. If you have been diagnosed at this stage, you may want to take an aggressive approach to give yourself the best prognosis possible.
Most people with mesothelioma were exposed to asbestos at work through materials they used on the job. Years of exposure has led to thousands of cases of this devastating cancer and too few receive a diagnosis early enough to have much hope of surviving it. Even if you are a stage 1 patient with hope of beating it, you still have legal rights to sue and seek compensation for your illness. Let a mesothelioma lawyer help you decide what to do next and what steps to take to get justice.
Page Medically Reviewed and Edited byLuis 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.