The prognosis for virtually all mesothelioma cases is not good. A case of sarcomatoid mesothelioma usually has a worse prognosis than the more common epithelioid mesothelioma because it is more difficult to treat. The difference in cell types has proven to be a challenge to oncologists working in the field of mesothelioma; a good chemotherapy regimen for sarcomatoid mesothelioma has been elusive. It is also generally true that the sarcomatoid cancer cells are more aggressive than others, multiplying rapidly and spreading the malignancy quickly.
Early Diagnosis
One of the most important issues for successful treatment of mesothelioma is the stage at which it is diagnosed. Too often the diagnosis follows attempts to identify other more common diseases with which sarcomatoid mesothelioma shares symptoms. It is also true that because of the long latency period for mesothelioma, the median age of patients diagnosed with it is close to seventy years. That often means they have other health issues that can mask the disease, preventing early diagnosis. If the tumor can be removed surgically the patient has a better chance of additional survival time; if the case is beyond surgical intervention the prognosis will be uniformly poor.
Sarcomatoid Mesothelioma Staging
Every case of cancer including sarcomatoid mesothelioma, is evaluated through a process called staging. This complex analytical tool establishes just how advanced a case is and accordingly, what sort of treatment is appropriate. The rankings are categorized by steps one through four, with four being the most advanced and serious cases. The stages for pleural mesothelioma are as follows:
Stage IA: The cancer has impacted the lining of the chest cavity and/or the lining of the diaphragm, but not the lining of the lung.
Stage IB: Mesothelioma has spread to the lining of the chest cavity and the lining of the lung
Stage II: Cancer is found in the chest cavity lining, the diaphragm lining, the lung lining, and has spread to either the diaphragm muscle or the lung.
Stage III: All of the factors in Stage II are present; in addition either the disease has spread to lymph nodes in the esophagus or trachea, or it has spread into the tissue between the ribs and the chest wall lining, soft tissues of the chest wall, or the sac covering the heart (the pericardium).
Stage IV: In this most advanced stage, the sarcomatoid mesothelioma cannot be removed by surgery. It has impacted one or both sides of the body and may have spread to lymph nodes anywhere in the chest or above the collarbone. In addition the cancer has migrated in one of the following ways: into the peritoneum affecting the abdominal cavity; to the chest wall and ribs; into the spine; or into distant organs such as the thyroid, prostate, or brain.
Staging and Prognosis
If the staging indicates that surgery is no longer possible, treatment modes will be palliative in nature in order to support the end of life process. The more aggressive treatments possible with Stages I and II will still lead to a prognosis that is measured in months rather than years. The number off sarcomatoid mesothelioma patients that survive beyond ten months after diagnosis is very low. On the other hand, patients with sarcomatoid mesothelioma that is resectable have a better chance of survival than those with epithelioid cancer because complete removal of the malignant tissue is not as difficult.
1. Stages of Malignant Mesothelioma, National Cancer Institute
2. Pleural Mesothelioma, Wanebo et al, Cancer, September 2009
3. Sarcomatoid mesothelioma: a clinical-pathologic correlation of 326 cases. Klebe et al, Modern Pathology, March 2009
