Stage 1 Pleural Mesothelioma

Quick Summary

Stage 1 pleural mesothelioma is the most localized form of pleural mesothelioma. In this stage, the cancer has not spread past the lining of the lungs. Stage 1 patients have all potential treatments at their disposal, including radiation, chemotherapy, and surgery. This gives them the most favorable prognosis of all types and a median life expectancy of 21.2 months.

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What Is Stage 1 Pleural Mesothelioma?

Doctors use mesothelioma stages to describe how advanced a patient’s cancer is. Stage 1 mesothelioma is the first of four malignant pleural mesothelioma stages. It is the least advanced stage.

This stage describes patients whose tumors haven’t started growing and spreading beyond their origin. Tumors are still in the linings of the lung (pleura) but haven’t yet spread to the lungs.

Stage 1: Medical Overview

Stage 1 pleural mesothelioma describes cancer that is contained to the lining of the lung (pleura) on one side of the body.

In this stage, tumors have not yet spread to:

  • Lung tissue beneath the pleura
  • Lymph nodes
  • Distant parts of the body

Stage 1 is one of four stages outlined in the TNM staging system (Tumor Node Metastasis system), a globally recognized method for determining how far certain cancers have spread.

In rare cases, or when citing past research, U.S. doctors may also use the older Butchart System or Brigham System of mesothelioma staging.

In 2017, doctors changed the way that they categorize pleural mesothelioma tumors under the TNM system. There is no longer a distinction between Stage 1A (cancer that has only invaded the outer pleura) and Stage 1B (cancer that has reached the outer and inner pleura).

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Stage 1 Mesothelioma Symptoms

Symptoms of stage 1 mesothelioma are easy to miss. Most common symptoms of pleural mesothelioma haven’t yet developed at stage 1 because the tumors are small and confined to a small part of the pleura.

Symptoms you may experience in stage 1 include:

  • Shortness of breath
  • Persistent cough
  • Potential bouts of bronchitis or pneumonia

These vague symptoms are common to many minor illnesses, causing many patients to dismiss them. However, this is dangerous because patients may not see a doctor until their mesothelioma symptoms worsen after their cancer has spread.

Veterans who smoke may attribute their shortness of breath to cigarettes, and most patients — especially those who are older — don’t think twice about symptoms like coughing. In a healthy person, a cough can persist for weeks after being sick.

Additionally, bronchitis, which often accompanies this cancer, may be hard to tie to mesothelioma.

Veterans exposed to asbestos 20-50 years ago who are suffering from these symptoms may not suspect they have mesothelioma or another serious asbestos-related condition.

Stage 1 Mesothelioma Diagnosis

Because those with stage 1 mesothelioma may have few to no symptoms, few patients get diagnosed at this stage.

Did you know

Only 10.2% of patients are diagnosed when their cancer is localized, according to the National Cancer Institute (NCI).

If a patient is experiencing potential mesothelioma symptoms like chest pain or a cough — especially if they have a history of asbestos exposure — their doctor will typically start with imaging scans.

Imaging scans, like X-rays, CT scans, or an MRI, allow doctors to look for fluid or masses in the lungs. If a doctor finds something that looks like cancer on a scan, they will perform a biopsy.

During a biopsy, a fluid or tissue sample is collected and sent to a lab where pathologists will test the cells for traits unique to mesothelioma cancer. It is the only way to confirm a mesothelioma diagnosis.

If you know you have a history of asbestos exposure and are experiencing abnormal respiratory- or abdominal-related symptoms, consider speaking to your doctor. Early detection and diagnosis of mesothelioma typically lead to more treatment options.

Stage 1 Mesothelioma Treatment

Mesothelioma requires aggressive treatments like surgery. Patients with stage 1 mesothelioma can get the greatest benefits from these curative (life-extending) treatment options.

Surgery options for stage 1 pleural mesothelioma include:

These surgeries offer the best chances for long-term survival. Those with good overall health are generally able to undergo mesothelioma surgery.

Did you know

Patients with stage 1 pleural mesothelioma who underwent EPP or P/D surgery had a median life expectancy of 38 months — this is over a year longer than the average survival time for stage 1.

Surgery is usually combined with chemotherapy or radiation. Doctors may use cancer-destroying chemotherapy drugs on stage 1 patients after surgery (adjuvant therapy) to kill any remaining mesothelioma cells and slow the return of the cancer.

Alternatively, doctors may perform radiation therapy on stage 1 mesothelioma patients directly before surgery to shrink tumors so they are easier to remove. Radiation may also be used after surgery to kill remaining cancer cells.

Stage 1 Mesothelioma Prognosis

Mesothelioma prognosis is the expected progression of a patient’s cancer and consists of life expectancy and survival rate.

Because patients diagnosed early are usually able to undergo curative surgery, stage 1 mesothelioma has the best prognosis of all four stages.

Did you know

Patients with stage 1 mesothelioma have a median survival time of 21.2 months. Approximately 20% of pleural mesothelioma patients diagnosed at stage 1 survive for 5 years or longer.

Determining prognosis helps doctors create personalized treatment plans for patients with stage 1 mesothelioma.

Who Is Eligible for Mesothelioma Surgery?

Certain factors influence a stage 1 patient’s ability to undergo life-extending surgery and, therefore, their prognosis and life expectancy.

A patient’s eligibility for surgery may be affected by:

  • Health: Patients must be in good health to undergo surgery in most cases.
  • Cell type: Patients with epithelioid mesothelioma have a better prognosis than those with the other cell types (biphasic and sarcomatoid) since epithelial cells respond better to treatment.
  • Age: Younger patients tend to be in better health, often making them better candidates for aggressive surgery.

That said, doctors are starting to find that older patients can receive the same benefits from surgery as younger patients.

“Whereas age may be associated with more comorbid conditions in patients with malignant pleural mesothelioma undergoing extended pleurectomy and decortication, this does not necessarily translate into shorter long-term survival.”

– The Society of Thoracic Surgeons, 2015 Study

If you have stage 1 mesothelioma and are wondering whether your age will affect your eligibility for surgery, consult a mesothelioma specialist. Multiple surgeries for this cancer have proven to improve prognosis for both younger and older patients.

Mesothelioma Veterans Guide
A Free Veterans Packet can help with

  • Treatment Options
  • Financial Assistance
  • VA Benefits

Get Your Free Veterans Packet

Mesothelioma Veterans GuideGet a FREE Veterans Packet

Get information on:

  • Treatment Options
  • Mesothelioma Specialists
  • Veterans Benefits

Get a Free Veterans Packet

Stage 1 Patients Reaching for Remission

Mesothelioma is not curable, but veterans diagnosed with stage 1 mesothelioma have more treatment options than the later stages.

There is a good chance that surgery can remove all or most of your tumor. Combined with chemotherapy, or emerging therapies through clinical trials, you could outlive your prognosis by years.

Things to remember about stage 1 mesothelioma:

  • Tumors are still confined to a localized area
  • Aggressive treatments like EPP and P/D are the most effective
  • Stage 1 patients have the best chances of remission

Veterans diagnosed with stage 1 mesothelioma have cause for hope to live longer than the average prognosis. Seeing a mesothelioma specialist offers the best chance at extending your life, and the VA Health Care System employs some of the top specialists in the country.

Contact the Mesothelioma Veterans Center today at (877) 450-8973 for help connecting with a VA mesothelioma doctor.

Veterans Support Team
Todd Gersten, MD PhotoReviewed by:Todd Gersten, MD

Double Board-Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Todd Gersten, MD is a double board-certified medical oncologist and hematologist specializing in general adult oncology and hematologic disease. He is a physician partner with the Florida Cancer Specialists and practices in Wellington, Florida.

Dr. Todd Gersten is an independently paid medical reviewer.

Christopher Dryfoos PhotoWritten by:

Contributing Author

Christopher Dryfoos is a journalist and member of the American Medical Writers Association (AMWA). As the grandson of the U.S. Navy’s first forensic pathologist, he aims to help veterans with mesothelioma access needed care.

View 7 Sources
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  2. American Cancer Society. (2020, Jan. 8.) Survival Rates for Mesothelioma. Retrieved July 7, 2020 from
  3. Texas Oncology. (2020) Stage I-III Malignant Pleural Mesothelioma. Retrieved July 7, 2020 from
  4. American Cancer Society. (2018, November 16). Malignant Mesothelioma Stages. Retrieved from:
  5. American Cancer Society. “Early Detection, Diagnosis, and Staging.” Retrieved from: Accessed on August 23rd, 2017.
  6. Flores, Raja. “Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant Pleural Mesothelioma: Results in 663 patients.” Retrieved from: Accessed on August 23rd, 2017.
  7. Williams MD, Trevor. The Annals of Thoracic Surgery. “Extended Pleurectomy and Decortication for Malignant Pleural Mesothelioma Is an Effective and Safe Cytoreductive Surgery in the Elderly.” 2014. Retrieved from: Accessed on August 23rd, 2017.
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