As with all forms of cancer, the prognosis for treatment is much better when the disease is diagnosed early in development. Unfortunately that is often not the case with mesothelioma, since the few early symptoms that develop mimic the behavior caused my much more common diseases. In addition, most of the people who develop mesothelioma are over the age of sixty and many are well into their retirement years, often with one or more of the physical ailments that come with age. A physician diagnosing a persistent cough won't immediately consider a disease as rare as mesothelioma. In general the survival period beyond a mesothelioma diagnosis is not extensive. For a case of pleural mesothelioma the average mesothelioma life expectancy is sixteen months; for a patient with an advanced case the average is less than six months. These are average figures however that don't take the many variables into account. Some doctors are having far more successful results under certain treatment conditions.
Mesothelioma Diagnostic Decisions
Physicians diagnose cancer cases today based on characteristics that assign it a "stage," meaning level of development. The only type of mesothelioma for which a formal staging system has been developed is pleural mesothelioma, since the others are so rare. The second most common form of the disease, peritoneal mesothelioma, is diagnosed in the U.S just 100 to 500 times annually.
The staging for pleural mesothelioma generally utilizes the TNM system, which stands for Tumor, Nodes, Metastases – the three major gradients of for the presence of malignant mesothelioma. If the cancer is in the tumor stage, it has not migrated into the lymph system. When it does, the disease has spread into nodes. If it has metastasized, the cancer has traveled to remote locations in the body removed from the origin on the pleura. There are also levels of severity for each of these three categories T1, T2, T3, etc. Treatment decisions are based on the stage assigned to a case of pleural mesothelioma.
Here is the basic categorization for staging pleural mesothelioma:
Stage 1 – Only one layer of the pleura is affected by mesothelioma. It may have spread to the pericardium or diaphragm.
Stage 2 – both layers of the pleura are affected by mesothelioma on only one side of the body.
Stage 3 – The mesothelioma has spread to the chest wall, esophagus, or lymph nodes on one side of the body.
Stage 4 – Mesothelioma has spread to other organs, such as the brain, bones, lymph nodes, liver, or to the other side of the body.
It is also important to incorporate the cell type into the decision making process. The most common mesothelioma cell is epithelioid and is also the most treatable. Far more aggressive and resistant to treatment is the sarcomatoid cell; the third type of cellular variant for the disease is biphasic, which is a mix of the two cell types. Some thoracic surgeons believe that recognition of the cell type should be part of the staging process.
Mesothelioma Survival Rate
In most cases, mesothelioma is not diagnosed until the disease has been active for a while. Mesothelioma symptoms do not appear until the malignancy development has begun to cause inflammation in the mesothelium and often, the accumulation of fluid in the form of pleural effusion. However if the cancer is in stage one, the patient (if personal health allows) is a candidate for an extrapleural pneumonectomy, which involves removal of the pleura, diaphragm and lung on the side of the body where the mesothelioma is located.
Other surgical options include a partial resection, or "debulking" of the diseased pleura in order to remove as much malignant tissue as possible. In some cases a stage 2 patient in good health will undergo this surgery if physicians believe they can remove the impacted lymph nodes. In all cases a combination of chemotherapy and radiotherapy will be employed to treat pleural mesothelioma.
Some physicians that are employing aggressive chemotherapy techniques are reporting an improved mesothelioma survival rate for patients who are eligible for surgery. A treatment program for epithelial peritoneal mesothelioma has yielded remarkable resorts at four different medical centers. The surgical component ranges from removal of the peritoneum to removal of the peritoneum plus malignant nodes plus any impacted section of the lower intestine. Surgery is followed by the use of hyperthermic (heated) intraperitoneal chemotherapy, which is delivery of the chemotherapy medication directly to the targeted area with a shunt, followed by ongoing chemotherapy and radiotherapy treatments. Over 300 cases were reviewed using this protocol showing over a 75% survival rate at one year and over 50% at five years.
- Malignant Mesothelioma Treatment, National Cancer Institute, Malignant Mesothelioma Treatment
- How is Malignant Mesothelioma Staged? American Cancer Society, http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_malignant_mesothelioma_staged_29.asp?rnav=cri
- Mesothelioma, Department of Thoracic Surgery, Vanderbilt University Medical Center, http://www.mc.vanderbilt.edu/root/vumc.php?site=thoracic&doc=3594
- Mesothelioma Treatment, Comments, European Journal of Cardio-Thoracic Surgery, 2007, http://ejcts.ctsnetjournals.org/cgi/content/full/31/5/770
- Treatment of Peritoneal Mesothelioma, Oncology Associates, Sugarbaker, http://www.surgicaloncology.com/meso.htm