After being diagnosed with mesothelioma, patients obviously want to know how much time they have left. We know that, in most cases, a patient’s mesothelioma prognosis isn’t going to be what they had in mind. The disease is pernicious and spreads in the body rapidly, making most prognoses negative to say the least. In general, the standard range for mesothelioma life expectancy is 1 to 2 years.
Still, new and more aggressive treatment options have helped life expectancy increase substantially for some patients. Many factors go into determining the prognosis for mesothelioma patients.
How Do Doctors Determine Your Prognosis?
When you begin to experience the symptoms of mesothelioma, you will likely go to your doctor to get checked out.
To diagnose you accurately, doctors will run a battery of tests including:
- Imaging scans (MRI, X-ray, PET scan, and CT-Scan)
- Blood tests (looking for blood count and biomarkers)
- Biopsies (needle, camera-assisted, and surgical)
Imaging scans and blood tests can only determine if you are likely to have the disease. They are good first steps in the diagnostic process.
Biopsies, however, are the only surefire way to provide an accurate diagnosis. A biopsy involves a surgery that essentially takes a portion of the affected tissue so that a pathologist can test it and identify whether mesothelioma is present or if it is some other disease.
Once you have been officially diagnosed, your doctor will take a look at a variety of factors to determine your overall prognosis. These factors include:
- The location of the disease
- Cell type
- The disease stage (including whether it has spread to other areas or not)
- Overall health
Depending on these variables, your doctor will then attempt to identify your prognosis. Below, we’ll discuss each of these variables further.
The two most common types of mesothelioma are pleural (occurring in the lining of the lungs or pleura) and peritoneal (occurring in the lining of the abdominal cavity).
Pleural mesothelioma accounts for between 70 and 90% of all cases while the peritoneal variety accounts for 10 to 30%.
Pericardial mesothelioma, which affects the lining of the heart, accounts for about 1%. A fourth type of mesothelioma, testicular, is so rare that it has been reported fewer than 100 times.
With aggressive treatment, pleural and peritoneal forms of the disease have average prognoses of around 1 to 2 years. With limited or no treatment, prognoses can range from 4 to 12 months. In many cases, pericardial mesothelioma goes undetected until the victim has passed (usually due to a heart attack). If it is caught prior to death, the prognosis is usually only around 6 months or less.
Again, the location of the disease is only one factor that affects prognosis. Other factors combined with the location can also determine life expectancy.
Different types of cancer cells can develop depending on your genetics. For mesothelioma, there are three main cell types, each with different prognoses:
- Epithelioid (accounts for 50 to 70% of all cases)
- Sarcomatoid (accounts for 10 to 20% of all cases)
- Biphasic (accounts for 20 to 40% of all cases)
Epithelioid mesothelioma is the most prevalent, which also means it’s the best understood of the three. It’s also the least aggressive cell type. Because researchers have studied it further, the prognoses and treatment options are generally better. Patients with pleural epithelioid mesothelioma have life expectancies of around 19 months while those with peritoneal epithelioid mesothelioma have life expectancies of 54 months.
Sarcomatoid cells, on the other hand, are much more aggressive and treatment options don’t work as well against them. They mostly occur in the peritoneal form of the disease where patients have a life expectancy of only around 5 months. Patients with pleural sarcomatoid mesothelioma survive an average of 8 months after diagnosis.
Biphasic cells are essentially a combination of epithelioid and sarcomatoid cells. They can be found in both pleural and peritoneal forms of the disease, but are most common with peritoneal mesothelioma. The prognosis for those with peritoneal mesothelioma is less than 5 months while pleural mesothelioma sufferers with biphasic cells usually survive just longer than a year.
With biphasic cells, the prognosis often depends on how much of one type of cell there is compared to another. For instance, biphasic mesothelioma with a majority of sarcomatoid cells will be much deadlier than biphasic mesothelioma with a majority of epithelioid cells.
Stage of the Disease
The disease stage is usually one of the more important factors when determining prognoses. Obviously, when mesothelioma has progressed to a later stage, the prognosis will be poorer than one for mesothelioma at an earlier stage.
There are four generally accepted stages of mesothelioma:
earliest stage with localized tumor. Patients can survive two years or more after diagnosis
tumor has made a limited spread to nearby organs. Patients usually survive 19 months after diagnosis
cancer has spread to one region or side of the body. Patients can survive up to 16 months after diagnosis.
cancer has spread to multiple regions of the body. Patients can survive up to a year, but often less.
These prognoses are usually based on patients who receive both curative and palliative treatments like surgery, chemotherapy, and radiation therapy. By contrast, someone with stage 4 mesothelioma may only have 4 months to live if aggressive treatment isn’t an option.
The problem with mesothelioma is that it is hard to identify and diagnose. Most symptoms do not start appearing until stage 3 or 4 of the disease, which is why the overall mesothelioma prognosis is so bad.
If mesothelioma is detected early and patients can undergo aggressive treatments, the prognosis improves drastically. Patients diagnosed with stage 1 mesothelioma have been known to survive between 5 and 10 years after diagnosis.
Age, Gender, and Overall Health
The age, gender, health, and lifestyle of the patient can also determine their prognosis. As you might expect, older patients tend to have shorter life expectancies than younger ones. If a patient is 75 or older, the prognosis is grim at usually 4 months or less.
The survival rate (or the rate of people who survive for a certain period of time after diagnosis) is much better for patients under 45 years of age. In fact, the five-year survival rate for that age range is around 40%.
Gender also plays a role. Women are diagnosed with mesothelioma at far smaller rates largely because men are more commonly exposed to asbestos (the substance that causes mesothelioma) in the workplace. When women are diagnosed, however, they tend to survive 5 to 6 months longer than men on average.
Obviously, a patient’s health can also be a factor in determining prognosis. For instance, a patient with existing medical conditions like lung disease, heart disease, diabetes, or virtually anything else will have a much lower life expectancy than someone who was otherwise healthy before their diagnosis.
Making the right lifestyle choices can also improve your prognosis. Eating well, engaging in moderate exercise, and seeking out mental and emotional treatments after diagnosis can help extend a patient’s life. Negative lifestyle choices, like smoking, can hinder progress, however.
Can a Prognosis Be Improved?
When you look at the statistics involved with mesothelioma, you may feel discouraged. Indeed, it is exceedingly rare for individuals to live 5 years after diagnosis with a survival rate of only 9%. That means, of the 3,000 new patients diagnosed with mesothelioma each year in the United States, fewer than 300 of them will survive 5 years or longer.
Part of this issue is related to the inaccessibility of high-quality medical care. If every mesothelioma patient had access to all treatment options, then survival rates would likely skyrocket. The other issue is that mesothelioma is difficult to detect, and most people are diagnosed when it is in the third or fourth stage.
Even so, there are always options to improve your prognosis. The best way to do that is with an aggressive treatment regimen. If you have the resources or insurance that will cover most of your costs, then there may be hope.
The most common method for combating mesothelioma includes three treatment methods:
- Radiation therapy
Surgery is the most aggressive and invasive treatment and often involves the removal tumors, organs, and/or tissues. It is currently the best curative treatment available for mesothelioma patients because it seeks to physically remove the cancer from the body.
Still, it works best in conjunction with both chemotherapy and radiation therapy. Of course, the mesothelioma survival rate for those who engage in these forms of treatment is generally higher than those who receive only one treatment. For example, if a patient undergoes only surgery with no chemotherapy or radiation treatment, then the odds that the disease will resurface are much higher.
One treatment has greatly increased the survival rate for patients with peritoneal mesothelioma. Hyperthermic (or heated) intraperitoneal chemotherapy (HIPEC) in conjunction with cytoreductive surgery has produced a 5-year survival rate of 50%. This particular therapy essentially heats up chemotherapy drugs and injects them onto the tumor site during surgery.
New and emerging treatments are also always being researched, meaning that, over time, doctors will have better treatment methods at their disposal.
Some of these new treatments include:
- Gene therapy
- Photodynamic therapy
Patients who are interested in potentially new treatments (or even testing new chemotherapy drugs) can join clinical trials. These research studies are great options if the cost of medical care becomes too burdensome.
Many clinical studies have strict eligibility requirements, but you can always ask your doctor or local cancer center for more information on them.
Are There Survivors?
The answer to this question really depends on your definition of “survivor.” Because the mesothelioma prognosis sits at an average of 1 to 2 years, most people think of the disease as almost universally fatal. But, for many mesothelioma patients, surviving even two years after diagnosis is a great triumph.
Beyond that, many people do end up surviving much longer than expected. There have been cases where a patient was given a prognosis of only 15 months but, after receiving an aggressive treatment regimen, were able to survive over 10 years after that initial diagnosis.
Mesothelioma isn’t the immediate death sentence it once was, and patients are surviving and thriving much longer now than ever before. No cure exists for mesothelioma at the moment, and even patients who have outlasted their original prognosis still have to deal with the disease in some form. But, remission is possible.
Long-term survival is exceedingly rare, which is an unfortunate aspect of a disease that spreads rapidly. Again, part of the reason that many individuals do not survive for extended periods of time is the disease’s “latency period.” This is the term for the period of time from an individual’s first exposure to asbestos to their diagnosis of mesothelioma.
We know prolonged exposure to asbestos causes mesothelioma, but it can take between 30 and 40 years (sometimes shorter and sometimes longer) for symptoms to show up. Even as tumors develop, patients may be asymptomatic. Symptoms typically only start to present in stage 3 or 4 of the disease. Thus, prognoses are rarely good.
In addition to new treatment options, scientists are also looking at new “biomarker” blood tests that can detect mesothelioma in its early stages, even if symptoms aren’t really present. This could provide good news for any future mesothelioma sufferers as stage 1 or 2 mesothelioma responds much better to curative treatments.
At present, if you are diagnosed with mesothelioma, it may be hard to see any silver lining. The prognosis for the disease is not great and it hasn’t been great for a while. But, with new treatment options, early detection methods, continued research, and further understanding of the disease, prognoses are only going to get better.
If you or a loved one has been diagnosed with mesothelioma, it can be a distressing time. But, you should never lose hope. Many people have survived much longer than their original prognosis and it’s always possible for you to do just the same.