Stages of Mesothelioma

Quick Summary

Like other types of cancer, mesothelioma is grouped according to a “stage”. Staging tells us how far the cancer has spread. People with a less advanced stage of cancer tend to live longer and have a better chance of successful treatment.

How Mesothelioma is Staged?

Your mesothelioma stage is a diagnosis of how far the disease has spread. In general, there are four stages of mesothelioma. Stage 1 is the only localized stage. That means the disease hasn’t metastasized past its point of origin. Stages 2-4 are considered advanced mesothelioma. Finding out your specific stage requires imaging and biopsy tests, which is part of the diagnostic process.

Keep in mind that the further mesothelioma is away from its origin, the higher the stage. Staging helps doctors know which treatments are better for you. Staging helps doctors understand which treatments work the best for their patients.

Did you know?

Only pleural mesothelioma has a formal staging system. Peritoneal mesothelioma is simply categorized as localized or advanced.

Pleural Mesothelioma Stages

  • Stage 1 pleural mesothelioma. This stage is subdivided into stage 1A and stage 1B. Stage 1A means that only the parietal, or outer layer, of the pleura has tumors. Stage 1B means that only the inner, or visceral layer, of the pleura has been affected. People with stage 1 disease have the greatest potential for survival. In stage 1, mesothelioma is only on one side of the body. It’s found in one or both of the linings in a specific area of the chest cavity. The lining of the diaphragm may also be involved in stage 1 mesothelioma.
  • Stage 2 pleural mesothelioma. In stage 2, cancer cells have spread to other areas of the lung and its linings. The cancer is still just on one side of the chest cavity, but it has spread within that space. Mesothelioma may have also spread to the diaphragm.
  • Stage 3 pleural mesothelioma. In this stage, still only one side of the chest is affected. Mesothelioma cells have started spreading to lymph nodes in this stage. Nearby organ spread is also possible. Tumors may spread to the muscle and cartilaginous tissue between the ribs. They also spread to the chest wall lining, heart lining, or to fatty areas between the lobes of the lungs.
  • Stage 4 pleural mesothelioma. This is the most advanced stage of mesothelioma. Severe symptoms such as coughing up blood or difficulty swallowing are not uncommon. Mesothelioma cells can be found on the opposite side of the body at this stage. Cancerous cells may have also traveled to distant organs. Even bony metastases of the spine or distant body areas are possible in this late stage of cancer. Stage 4 treatment is mainly designed around keeping you comfortable. Chemotherapy and radiation are often used to shrink as much of the cancer as possible. This helps reduce painful symptoms.

Staging of Peritoneal Mesothelioma

There is no single way of staging peritoneal mesothelioma. Most doctors simply describe this type of cancer as “localized” or “metastasized.” Localized mesothelioma is more treatable than metastasized mesothelioma. The abdomen is more complicated than the chest cavity, with many more organs. Lymph nodes, fatty tissue, the peritoneum and organ systems can be involved with this cancer.

Surgeons often decide if you’re fit enough for surgery and then see what they can do in the operating room. Surgery for peritoneal mesothelioma has been very successful this way. Many patients who have cytoreduction with heated chemotherapy live years past their diagnosis.

How Does Mesothelioma Spread?

There are three ways all types of cancers spread through the body. Mesothelioma cells use the following methods to travel through your body:

  • Body tissue. Mesothelioma cells spread to nearby muscle and fat tissue.
  • Blood vessels. Cells can get into your bloodstream, using the vessels in your body to travel to more distant organs and tissue.
  • Lymph system. This is part of your immune system. It’s a fluid that travels through vessels throughout your body. Cancer cells can get to other organs or nearby lymph nodes.

How Do Doctors Choose Your Stage?

The American Joint Committee on Cancer has agreed upon the TNM system for staging pleural mesothelioma. “TNM” is an acronym for tumor, node and metastasis.

Here’s a simple explanation of each group:

  • Tumor. The first part of this staging process is simple. Look at the original tumors themselves and where they have spread. There are different levels of tumor spread from T0 (no sign of main tumor) to T4 (extensive spread throughout body).
  • Node. The node factor accesses the involvement of lymph nodes. Remember that mesothelioma cells can travel through the lymph system. There are nodes throughout your lymph system. They function as excellent markers to determine how far the disease has spread. Doctors categorize node involvement from N0 (no involvement of nodes) to N3 (spread to nodes on opposite side of body as tumor).
  • Metastasis. The M-group is the most straightforward. M0 means there is no spread to other organs or far away lymph nodes. M1 indicates distant metastasis.

Doctors who use the TNM system can put your diagnosis into categories that help them determine an appropriate stage. Picking the right stage is an important part of your eligibility for certain treatments.

Each stage has possible combinations of TNM groups. As an example, stage 3 patients may have the following TNM combinations:

  • T1, N1, M0
  • T1, N2, M0
  • T2, N1, M0
  • T2, N2, M0
  • T3, N0, M0
  • T3, N1, M0
  • T3, N2, M0

Patients with stage 1 have T1, N0, M0. Stage 2 patients have T2, N0, M0. As you can see, it’s critical to have no detectable disease spread for doctors to diagnosis you in earlier stages.

Treatment Based on Stage

The best treatments to improve your life expectancy are surgical procedures with some form of chemotherapy and/or radiation. The combination of surgery and medicine has proven time and time again to extend life expectancies. Pleural patients are now tripling the average prognosis. Peritoneal patients are living upwards of 7 years in some cases.

In general, patients in stages 1-3 are potentially operable. Most doctors consider stage 4 inoperable.

Many people think the stage is the most important factor in determining treatment, especially surgery. But there are three main factors doctors think about when determining treatment.

These factors are:

  1. Overall health
  2. Cell type
  3. Stage of your disease

These factors can work together, making up for failings in the others. For example, if a patient has stage 3 pleural mesothelioma, surgery may be unlikely. But if that same patient has an epithelioid cell type and decent overall health, surgery could be possible. In fact, many stage 3 patients in this same situation are eligible for surgical treatment. In another example, a patient with sarcomatoid cell type (the fastest spreading type) is rarely eligible for surgery. However, surgery is likely if the patient is in good health and an earlier stage.

And what about bad overall health? If you have epithelioid cell type and are in the early stages, you’re in the best possible scenario. But bad health could still prevent you from receiving surgical treatment. When going under the knife, it’s important to have good heart and lung function and good red blood cell count. You also must be able to go about daily life normally. These health aspects are important to ensure you can survive and recover from your operation. That being said, someone in stage 2 with the same health as someone in stage 3 has better chances of getting a life-saving surgery.

Of course, there are many other factors that doctors take into account when deciding on surgery. (Some other factors include tumor size, patient age, amount of fluid buildup and gender.) The scenarios above are just broad examples. Each individual patient is a unique case with unique treatment possibilities. It’s impossible to list each nuanced scenario, so never give up hope of getting the best treatment possible.

Prognosis Based on Stage

Most survival statistics involving pleural mesothelioma are related to the disease stage. It’s important to remember that these statistics are from several years ago.

Statistics on survival times can only be gathered after previous patients have passed away. This means that these statistics don’t account for patients who are still alive. This includes those who have lived beyond the observed 5-year mark. “The [survival] estimate may not show the results of better diagnosis or treatment available for less than 5 years,” according to the American Society of Clinical Oncology.

The average survival time for patients with pleural mesothelioma are as follows:

  • Stage 1 – 21 months
  • Stage 2 – 18 months
  • Stage 3 – 16 months
  • Stage 4 – 12 months

These survival times are based on the patient’s stage at the time of diagnosis. The above statistics also account for treatment received. Remember that these are just numbers. Numbers you can beat with the help of your specialist.

Getting the Right Treatment for Your Stage

No matter the stage of your mesothelioma there are treatments for you. Don’t focus on your stage, focus on treatment. There are mesothelioma specialists across the ready to help.

Important things to remember about mesothelioma stage:

  • There are treatments for all stages.
  • Stages 1 through 3 may be eligible for surgery.
  • You can improve your prognosis.

Veterans have more resources than the average mesothelioma patient through the VA. There are specialists on the east and west coast who treat veterans with all stages of mesothelioma. Find out more about treatment options and benefits within the VA now.