Stage 3 Mesothelioma

Stage 3 mesothelioma is a common diagnosis for this rare type of cancer. By this stage, it has spread into the lymph nodes and other organs near the original site of tumor growth. Treatment options at stage 3 are limited, the prognosis is poor, and life expectancy is short.[1]

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About Stage 3 Mesothelioma

Stage 3 mesothelioma is the third of four stages of this cancer. It is considered late stage. If you or a loved one received this diagnosis, here are some important facts:

• In stage 3 mesothelioma the cancer has spread through the pleura and into the lymph nodes. It may also be in other areas of the chest cavity.
• The cancer has not yet metastasized at stage 3.
• Symptoms of chest pain, coughing, and shortness of breath are likely to be more severe and frequent in this stage.
• Experimental treatments may help extend life, but standard therapies can do little in stage 3 to cure this cancer.
• Survival rates are low for stage 3 mesothelioma.

What Are the Symptoms of Stage 3 Mesothelioma?

Many patients receive a diagnosis at this late stage because the symptoms finally become worrisome. This is also the point at which a patient may have already received one or more misdiagnoses of more common illnesses with similar symptoms:

• Difficulty breathing
• Shortness of breath
• Wheezing
• Coughing
• Chest pain and tightness
• Lumps under the skin
• Fever
• Fatige
• Weight loss

Late-stage peritoneal mesothelioma causes pain and swelling in the abdomen, constipation and diarrhea, a feeling of fullness, pain, fatigue, fever, and weight loss.

How Do Doctors Stage Mesothelioma?

The official and most common staging system for mesothelioma is TNM. Doctors and specialists look at a patient’s imaging scans and biopsy samples to determine where the cancer originated and how far it has spread. This forms the basis for determining stage.

To assign a stage, specialists look at three distinct factors:[2]

• Primary Tumor, T. The first designation, T, describes the original tumor, its size and where it has spread from the primary location.
• Lymph Nodes, N. N describes the spread of cancer to nearby or distant lymph nodes. These are immune system organs that contribute to the distant spread of cancer cells.
• Metastasis, M. Metastasis describes the spread of tumors out of the primary region and to distant parts of the body.

Why Is the Stage Important?

Staging is important for any type of cancer. For cancer that is aggressive and moves quickly, getting the staging right is especially crucial. It helps inform your next steps.

Mesothelioma is often diagnosed at stage 3 or 4. It is often first diagnosed as a more common illness, delaying the correct diagnosis.[3] It is difficult to treat, incurable, and comes with a shortened life expectancy at these later stages.[4]

This information can be hard to take, but you need to know. It will guide your decisions about treatment but also many other practical choices.

What Are the Characteristics of Stage 3 Mesothelioma?

Experts devide stage 3 mesothelioma into two subcategories with three possible combinations of T, N, and M:[4]

• 3A with T3, N1, and M0. In stage 3A mesothelioma, the primary tumor has grown throughout the pleural tissue and into the lung, diaphragm, and mediastinum on one side of the chest. It has also spread to either the chest wall, the fatty tissue between the lungs, or the pericardium around the heart. The tumor has also spread to nearby lymphnodes but has not yet metastasizes.
• 3B with T1-T3, N2, and M0: This desitnagion for 3B mesothelioma describes cancer that may or may not have spread into nearby tissues, like the diaphragm, lung, or chest wall. It has spread to nearby lymph nodes and also to lymp nodes on the other side of the chest or those above the collarbone. There is no metastasis yet.
• 3B with T4, any N, and M0. At this stage, the primary tumor has spread so much within the local region that surgery cannot remove it all. It has spread to the chest wall, peritoneum around hte abdomen, tissue between the lungs, the spine, the pericardium, or the pleura on the other side of the chest. It may or may not have spread to lymph nodes. It has not metastasized.

There is no metastasis in stage 3 mesothelioma, which means the cancer has only spread in the chest cavity and not to more distant tissues or organs.

Specialists have no official staging system for peritoneal mesothelioma. When referring to stage 3 peritoneal cancer, they describe a similar stage: extensive abdominal spread and spread to some lymph nodes.

What Are the Treatment Options for Stage 3 Mesothelioma?

By stage 3 of mesothelioma, treatment options are limited.[5] The more cancer spreads, the more difficult it becomes to treat. Many patients at this stage fail to qualify for significant surgery. They may have palliative procedures but generally don’t undergo surgery with remission as a goal.[6]

Treatments for stage 3 mesothelioma include:[7]

• Combinations of chemotherapy and radiation to shrink tumors
• Surgery, which may be used with chemotherapy or radiation to shrink tumors first or to eliminate any remaining cancer cells after a procedure
• Emerging and experimental treatments, including immunotherapy or gene therapy
• Palliative treatments to manage symptoms and side effects

Another option for some patients at this stage is participation in a clinical trial. Speak with your medical team about any trials for which you may qualify.

Clinical trials test newer procedures and medicines and are often open to patients with few other treatment options. Many studies recruit patients who have not responded to first-line treatments, like chemotherapy.

Treatment may be limited for a stage 3 diagnosis, but you do have options. Seek out mesothelioma specialists and cancer centers with mesothelioma groups for the best care and most choices.

What Is Palliative Care for Stage 3 Mesothelioma?

Although curing mesothelioma at this stage is highly unlikely and even the ability to extend lifespan is limited, treatments can help patients feel better and enjoy a higher quality of life for their remaining time.

Patients with stage 3 mesothelioma have several options for palliative care:[8]

• Debulking surgery to remove part of a tumor can help a patient breathe more easily
• Procedures to drain fluid from around the lungs reduce pain, improve breathing, and help patients be more mobile
• Medications to relieve pain, nausea, and other symptoms
• Alternative therapies can also be used at this stage to help patients cope with the consequences of having cancer and facing death.
• These therapies may also help reduce pain and stress and include acupuncture, massage, exercise and nutrition, yoga, meditation, and others that are guided by the patient’s medical team.

What Is the Prognosis for Stage 3 Mesothelioma?

As the stage of mesothelioma advances, the prognosis gets worse for patients. It is highly unlikely that stage 3 mesothelioma can be cured, but treatments can extend life expectancy and improve quality of life.

The median survival time for stage 3 is eighteen months after diagnosis.[9] This is with treatment. Patients who do not begin treatment can expect to have significantly less time.

Younger and healthier patients can undergo more aggressive treatments and are likely to survive longer than older patients with poor health.

Another way to look at prognosis is with five-year survival rate. The percentage of people still alive five years diagnosis with mesothelioma that has spread extensively within the chest is just 12%.[10]

Is Stage 3 Mesothelioma Curable?

Unfortunately, this is highly unlikely. The spread of the cancer at this point is extensive enough that surgeons cannot reach it all. Without surgery as a potentially curative procedure, remission is nearly impossible. What patients can achieve with treatment is more time and a better quality of life.

How Can I Improve My Prognosis?

A prognosis is never set in stone. You can always take steps to improve it, even if there is no hope for remission or a cure. If you received a diagnosis of stage 3 mesothelioma, do these things for the best possible outcome:

• Seek the advice of experienced mesothelioma specialists.
• Begin treatment as soon as possible.
• Choose the most aggressive treatments for which you are eligible and that you can tolerate.
• Communicate with your treatment team, follow their instructions, and tell them about your symptoms.
• Make healthy lifestyle choices so you can better tolerate and complete treatments.
• Talk to your doctors about palliative treatment options.

The prognosis is never good for mesothelioma, and too many people struggling with this disease were exposed to asbestos without being aware of the dangers. Find specialists for your treatment and expert lawyers to guide your legal decisions for seeking justice and compensation.

Page Medically Reviewed and Edited by
Luis 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.

Connect with Mesothelioma Doctor Luis Argote-Greene, M.D.