Mesothelioma Prognosis Analysis
Mesothelioma is a form of cancer that affects mesothelium (Source)- a thin lining of internal organs. It is rare cancer, caused by long-term exposure to asbestos. The benign form is even rarer and we know almost nothing about it- its causes are unknown. Just like in case of other malignancies- the timely established diagnosis (Source) improves patient’s life expectancy and chances for recovery (Source).
Mesothelioma, in general, has a poor prognosis (Source). The reason for such a poor prognosis lies in a fact that mesothelioma remains „silent“ for a long time (long latency period) and often, at the time the first symptoms emerge, the disease has already advanced to its terminal stage.
Prognosis of mesothelioma relies majorly on the time of diagnosis and the force with which the cancer is attacked. It is sad, however, that most times mesothelioma is often discovered at a very advanced stage and the patients always end up giving up in the same year the disease is discovered.
Mesothelioma Trеаtmеnt Options
The level of cancer spread is what dictates what treatment plans will be available. There are three-stage systems used now which are not widely different from each other. The majorly used system is thе Butсhаrt Sуѕtеm. This system depends on how far the primary tumor mass has spread. It is further divided into four mesothelioma stages.
Stage I: Mеѕоthеlіоmа is located in the right or left pleura and affects that diaphragm in that area.
Stаgе II: the tumor covers either the wall of the chest, esophagus, heart or both the left and right pleura. It could also affect the lуmрh nodes іn thе breast.
Stаgе III: Mesothelioma has gone deep into the peritoneum or the lining of the аbdоmіnаl саvіtу оr the peritoneum. It could also affect the Lуmрh nodes located outside thе brеаѕt.
Stаgе IV: metastasis is visible or it can be passed to the other organs through the blood.
The recently developed TNM system makes use of the tumоr mass, lymph node involvement, spread аnd mеtаѕtаѕіѕ.
TNM system: variables of T (tumоr), N (lymph nоdеѕ) аnd M (mеtаѕtаѕіѕ)
Stage I: Mеѕоthеlіоmа is found in either the right оr left pleura аnd could affect the lung, diaphragm or pericardium on that affected side. It doesn’t affect the lymph nodes.
Stаgе II: mеѕоthеlіоmа affects the pleura and then moves on to the lymph nodes around the lings on the affected side. The diaphragm, pericardium, and lungs on the affected side are also involved.
Stаgе III: Mesothelioma penetrates the chest wall, heart, esophagus, nerves, muscles and the organs on the affected side. It is under probability for the lymph nodes to be affected.
Stаgе IV: Mеѕоthеlіоmа penetrates the lymph nоdеѕ opposite the affected side оf thе chest, moves on to the pleura or lung opposite the affected side and then spreads to the organs located on either the аbdоmіnаl cavity or neck. Each distant mеtаѕtаѕіѕ takes place іn thіѕ ѕtер.
Thе most recent system is the Brigham ѕуѕtеm, and the stages are dependent on the success of removing the tumor through surgery and also in the lymph nodes participation.
Brіghаm Sуѕtеm: Variables; Tumor rеѕіѕtаnсе and nоdе ѕtаtе
- Stage I: Surgically removable mеѕоthеlіоmа аnd non-involvement оf lуmрh nоdе
- Stаgе II: Surgically removable mеѕоthеlіоmа, involvement of lymph nоdе
- Stаgе III: unresectable mеѕоthеlіоmа that have spread to the chest wall, diaphragm, heart, or peritoneum. The extrathoracic ganglion may or may not be involved.
- Stаgе IV: mеtаѕtаѕіѕ
Before you choose a treatment plan, ensure that you speak to a specialist first to help guide you on what plan is best for you. Don’t rely only on things you hear from the public; your best bet is always what your doctor tells you.
Most times, the prognosis for patients is not encouraging despite having treatment options to choose from, and patients end up not living for very long. This is why early diagnosis and aggressive treatment is often recommended.
Factors That Affect Life Expectancy
Staging And Life Expectancy
Prognosis depends almost entirely on the stage of the disease at the time of diagnosis. Essentially, staging is based on the categorization of mesothelioma according to how much it spread. Staging is a common step in diagnosing all malignancies and staging systems differ depending on the type and location of cancer.
For malignant mesothelioma, the system of four stages (stage 1-4) is used to describe the extent of cancer within the body. Stage 1 has the best prognosis, while stage 4 is used for terminal disease (palliative care).
Once determined, the stage of cancer does not change as the disease progresses or recedes. The classification is performed only once, at the time of diagnosis. Stages help doctors choose the treatment program to begin with, but later on, progression or regression of a disease determines the actual treatment.
Staging is done after numerous diagnostic tests have been performed (imaging techniques, laboratory findings, and physical examination).
Having in mind how rare the mesothelioma is, only pleural mesothelioma has detailed guidelines for staging, while other types (peritoneal and pericardial) are classified based on the American Joint Committee on Cancer (AJCC) general guidelines.
The cancer is in one location, there is no detectable spreading to lymph nodes, other organs or tissues. Surgery is the treatment method of choice in such cases.
Cancer has spread on the surrounding organs and tissues, lymph nodes may be involved as well. In such cases, surgical resection is the treatment method of choice, but the success depends on the extent of the growth.
Cancer has invaded surrounding tissues and entire anatomical region, infiltrates structures like chest wall, regional lymph nodes, esophagus, etc. In cases like this surgery is not an option (in terms of curative treatment, palliative interventions may be an option, depending on the symptoms). Other treatment modalities may be tried.
Cancer has spread to distant organs and regions across the body. The treatment goal in this stage is to reduce discomfort and pain. Rarely, palliative surgical intervention may be carried out.
Pleural Mesothelioma Staging
Since the Pleural mesothelioma is the most common type, different systems for its staging have been developed over the years. The most important are:
– Butchart Staging System
– TNM Classification
– Brigham Staging System
Each of these has its advantages and disadvantages. Each patient diagnosed with Pleural mesothelioma goes through all of these classifications.
Staging systems provide guidance about prognosis. Each patient reacts differently to the treatment, so sometimes those classified as stage 2 outlive patients with stage 1 mesothelioma.
The lower the stage, the longer the life expectancy is. Here are the numbers:
– Stage 1 malignant mesothelioma life expectancy is (on average) 21+ months.
– Stage 2 malignant mesothelioma life expectancy is (on average) 19 months.
– Stage 3 malignant mesothelioma life expectancy is (on average) 16 months.
– Stage 4 malignant mesothelioma life expectancy is (on average) 12 months.
Mesothelioma Prognosis: Relation Between Age And Life Expectancy
In general, older patients have a shorter life expectancy. The explanation lies in the fact that an older population often has comorbidities that interfere with the treatment.
– If the age at the diagnosis is <65 yo, the life expectancy is (on average) 12 months
– If the age at the diagnosis is 65+ yo, the life expectancy is (on average) 8 months
– If the age at the diagnosis is 75+ yo, the life expectancy is (on average) 4 months
Cell Type And Life Expectancy
The mesothelioma can be divided into three categories based on the cell type: epithelioid, sarcomatoid, and biphasic (a mixture of epithelioid and sarcomatoid cancer).
In general, epitheloid carcinoma has the longest life expectancy (19 months for pleural and 54 months for peritoneal mesothelioma), biphasic has the poorer prognosis (13 months for pleural and 4.6 months for peritoneal mesothelioma), while the sarcomatoid type has the shortest life expectancy (8 months for pleural mesothelioma, there is not enough statistical data for the estimation of the life expectancy in case of peritoneal mesothelioma).
Life Expectancy For Men And Women
Women diagnosed with malignant mesothelioma live, on average, 5.5 months longer than men. The incidence of malignant mesothelioma is lower in women, due to occupational differences.
Other Factors And Life Expectancy
Factors that correlate with a better prognosis are non-smokers (and no history of smoking), normal white blood cell count at the time of diagnosis, low platelet count, low hemoglobin level, asymptomatic.
On the other hand, the prognosis is poorer in those who are smokers (or have been smokers at some point in their lives), have elevated white blood cell count, have high platelet and/or hemoglobin count and report symptoms.
While the life expectancy is the period of time a person is expected to live, the survival rate is a median percentage of patients who live a certain amount of time. Typically, the 5-year survival rate is a standard statistic category in cancer treatment and prognosis research, but having in mind how aggressive and deadly malignant mesothelioma is, shorter periods of time are used as statistical categories as well.
Just like in the case of life expectancy, different factors affect survival rates.
Mesothelioma Prognosis: Survival Rates Depending On The Mesothelioma Type
Peritoneal mesothelioma has the highest survival rates. The first year survive 92% of the patients, and at 10 years mark 39% of patients are still alive.
Pleural mesothelioma 1-year survival rate is 73% and after 10 years less than 5% of patients are still alive.
Pericardial mesothelioma 1-year survival rate is 51%, while there is no available data for a 10-year survival period (it is close to 0%).
Mesothelioma Prognosis: Survival Rates Depending On The Age And Gender At the Time Of Diagnosis
Depending on the age and gender, 5-years survival rate varies from 54% for women and 35% for men younger than 45 years at the time of diagnosis to %5 for women and 3% for men older than 75 years at the time of diagnosis.