Stage 3 Mesothelioma

A diagnosis of stage 3 mesothelioma is difficult to accept. Stage 3 means the cancer has spread significantly and will be very difficult to treat. The prognosis will vary by individual but is generally not positive and life expectancies are short. Unfortunately most people who have this type of cancer are diagnosed at later stages, like stage 3 or stage 4 due to the long latency period, rarity, and difficulties in diagnosing mesothelioma.

At stage 3, mesothelioma has spread throughout one side of the chest cavity and may have also spread to lymph nodes. Once cancer is in the lymph nodes, the final stage, metastasis, is not far away. At stage 3 symptoms will also be more severe, treatment options become more limited and survival time and prognosis is less positive.

Why Staging Mesothelioma is Important

Staging is important for any type of cancer, but for a cancer that is aggressive and moves quickly, getting the staging right is especially crucial. When a diagnosis of mesothelioma is made for a patient, the next step is to determine its stage. This means looking at imaging scans to see the original tumor and to detect any additional tumors or any areas of the body to which it has spread. It also means looking at biopsied samples and may include some exploratory surgery.

Most Diagnoses for Mesothelioma are Late Stage

Mesothelioma is often diagnosed at stage 3 or 4. At these later stages it is difficult to treat, incurable, and comes with a shortened life expectancy. This cancer is often diagnosed in the later stages because it develops over the course of decades after being exposed to asbestos. Once the symptoms are noticeable, though, the cancer then grows and spreads rapidly.

Another issue is that mesothelioma is rare and its symptoms are similar to those of more common conditions. It is not unusual for mesothelioma to be first diagnosed as something else, like pneumonia, chronic obstructive pulmonary disorder, lung cancer, and other illnesses. Distinguishing between mesothelioma of the pleura, the tissue lining in the chest cavity, and cancer of the lungs, is particularly difficult.

Characteristics of Stage 3 Mesothelioma

The staging system most often used for pleural mesothelioma is the TNM system. T describes the extent of the original tumor, N describes the spread of the cancer to lymph nodes, and M describes any metastasis of the cancer. Each letter is given a number designation, such as T0, N2, or M1, to communicate and describe each of these characteristics of the cancer in an individual. Together these designations lead to a stage assignment of 1, 2, 3, or 4.

For stage 3 mesothelioma, there are several possible designations:

• T1-3 with N1 or N2. These combinations describe pleural mesothelioma as having grown beyond the pleural tissue and into the lungs or diaphragm. The cancer may also have spread into the lymph nodes on the same side of the chest cavity as the primary tumor.
• M0 or T3 with N0 to N2, and M0. These designations for stage 3 indicate that the primary tumor has spread into the chest wall, fatty tissues between the lungs, or even to the lining of the heart, and possibly into the lymph nodes.

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.

Stage 3 Treatment

By stage 3 of mesothelioma, treatment options are limited. The more a cancer spreads, the more difficult it becomes to treat. The only surgery that has a chance of curing the cancer is the most aggressive, extrapleural pneumonectomy. This is an extensive surgery that is risky and must be performed by a specialist. It involves removing all of the pleura, lung, and diaphragm from one side of the chest. Not all stage 3 patients are eligible for this surgery, though, due to health and other reasons.

More common treatments for stage 3 mesothelioma include combinations of chemotherapy and radiation. Either one may be used without surgery, but are also used before or after surgical procedures to reduce the size of the tumor to be removed and to kill any remaining cells after the surgery. The hope of curing or achieving remission with any of these treatment methods is unfortunately low at stage 3, but they may extend the patient’s life.

Palliative Care

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. This is called palliative care and there are several options that can be used. Debulking surgery to remove part of a tumor can help a patient breathe more easily, as can procedures to drain fluid from around the lungs. These measures may also reduce pain and help patients be more mobile.

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.

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 the life expectancy. The median survival time for this stage is 16 months after diagnosis. This is representative of thousands of patients, though, and each individual is different. Those that are younger and healthier and able to undergo more aggressive treatments are likely to survive longer than older patients with poor health.

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. Many of these people have sought compensation through lawsuits and asbestos trust funds. It cannot make the patient better, but this compensation does help cover bills and treatments and can provide a sense of justice. Make sure you find an experienced asbestos lawyer with whom you feel comfortable to guide your decisions.

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.

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