Stage 1 Mesothelioma

Stage 1 mesothelioma is the least-advanced stage and has the best prognosis. It’s also the easiest stage to treat because the disease has not spread throughout the body.

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Written by Jenna Campagna, RN

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What Is Stage 1 Mesothelioma?

Stage 1 mesothelioma is the initial stage of mesothelioma and offers the most hope for long-term survival. Stage 1 mesothelioma is contained to the point of origin:

  • The pleura (the thin lining between the lung cavity and chest wall) for pleural mesothelioma
  • The peritoneum (a thin membrane around the abdominal cavity) and a relatively small portion of the abdomen for peritoneal mesothelioma

Some characteristics of stage 1 mesothelioma are:

  • Tumors are localized within the point of origin (pleura or peritoneum), with no spread to lymph nodes or organs
  • Tumors are small in collective size
pleural symptoms
pleural symptoms

Some characteristics of stage 1 mesothelioma are:

  • Tumors are localized within the point of origin (pleura or peritoneum), with no spread to lymph nodes or organs
  • Tumors are small in collective size

Stage 1 mesothelioma is the initial stage of mesothelioma and offers the most hope for long-term survival. Stage 1 mesothelioma is contained to the point of origin:

  • The pleura (the thin lining between the lung cavity and chest wall) for pleural mesothelioma
  • The peritoneum (a thin membrane around the abdominal cavity) and a relatively small portion of the abdomen for peritoneal mesothelioma

For pleural mesothelioma, stage 1 is separated into 1A and 1B. Stage 1A involves tumors only on the outer wall of the pleura (the parietal pleura). Stage 1B involves more spreading of tumors within this cavity, including to the inner wall (the visceral pleura).

Stage 1 mesothelioma patients have the best prognosis because most treatment options are available for patients.

For pleural mesothelioma, stage 1 is separated into 1A and 1B. Stage 1A involves tumors only on the outer wall of the pleura (the parietal pleura). Stage 1B involves more spreading of tumors within this cavity, including to the inner wall (the visceral pleura).

Stage 1 mesothelioma patients have the best prognosis because most treatment options are available for patients.

What Symptoms to Expect With Stage 1 Mesothelioma

If you have stage 1 mesothelioma, then you may experience some initial, moderate symptoms of the disease. Some patients do not experience any noticeable symptoms during this stage.

Asbestos exposure is the only known cause of mesothelioma, but many people were exposed years ago and didn’t know at the time. Knowing which mesothelioma symptoms to expect during stage 1 can help you identify a potential risk and seek answers with your primary physician.

Many people mistake stage 1 pleural mesothelioma with pneumonia because of similar symptoms, including:

  • Persistent cough
  • Shortness of breath
  • Loss of appetite
  • Chest or abdominal pain
  • Fever
  • Nausea

Stage 1 Mesothelioma Treatment Options

There are many treatment options for stage 1 mesothelioma. These patients have a higher chance of survival and are better candidates for surgical interventions. Chemotherapy and radiation can be used before, during or after surgeries to prevent a mesothelioma recurrence.

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Surgery

Pleural Mesothelioma Surgery

If the patient is in otherwise good health, they can expect their doctor to take aggressive action in treating their stage 1 mesothelioma. The most invasive, aggressive approaches are the two primary surgeries: pleurectomy with decortication (P/D) and extrapleural pneumonectomy (EPP).

A P/D involves removing the lining of the lung, which is called the pleura. This surgery spares both lungs but has an “extended” version, which may require removing part of the diaphragm and the lining around the heart (pericardium).

Used on stage 1 pleural mesothelioma patients, EPP is the complete removal of the affected lung, pleura and part of the diaphragm.

EPP requires removal of the affected lung, and the respiratory system does not have the same working function as before. P/D is more common than EPP in stage 1 patients because the disease most likely hasn’t spread to the lung yet. Therefore, EPP is not necessary.

Peritoneal Mesothelioma Surgery

Stage 1 peritoneal mesothelioma patients usually undergo a cytoreduction with heated intraperitoneal chemotherapy (HIPEC). A cytoreduction is the removal of all visible tumors in the abdomen. Stage 1 patients undergo this surgery to stop mesothelioma tumors from growing in the abdominal cavity and affecting organs.

Part of the cytoreduction process is HIPEC, which involves warm liquid chemotherapy applied directly into the abdomen to attack tumors. Another common part of peritoneal mesothelioma surgery is a peritonectomy, which involves removing the protective lining around the abdomen (the peritoneum).

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Chemotherapy and Radiation

Chemotherapy or radiation — or both — may be involved as a treatment before, during or after surgery for stage 1 mesothelioma. They can reduce the size of tumors — making them easier to remove during surgery — or kill remnant cancerous cells left over from surgery.

Stage 1 mesothelioma patients can also expect surgical treatment aimed to increase their comfort, including pleurodesis (for pleural mesothelioma) and paracentesis (for peritoneal mesothelioma). These surgeries relieve pain by reducing fluid buildup.

Prognosis

The mesothelioma prognosis for stage 1 patients is generally positive. The earlier the disease is diagnosed, the more treatment options are available. The outlook for remission is also better than it is for the other stages.

According to a study that involved mesothelioma expert Dr. David Sugarbaker, stage 1 pleural mesothelioma patients have an average prognosis of around 22 months. In a different study published on UpToDate, the stage 1 pleural mesothelioma life expectancy was a median of 20 months.

Survival time can depend on which surgery a patient has for their treatment. Stage 1 pleural mesothelioma patients often benefit more from P/D than they do from EPP. The reason is P/D spares the lung, which keeps patients’ respiratory systems healthier.

A study published in the Annals of Translational Medicine compared the survival rates for P/D and EPP:

  • Around 59% of patients undergoing P/D survived for two years.
  • Around 39% of EPP patients survived for two years.
  • The median survival time for P/D patients was 23.7 months, versus just 18 months for EPP patients.

P/D also leads to less likelihood of postoperative complications. In one study, P/D patients had a lower 30-day mortality rate and fewer issues with heartbeat rate (arrhythmias).

Diagnosing stage 1 mesothelioma is rare. The latency period associated with mesothelioma can be up to 50 years from the time of asbestos exposure. While symptoms may begin at stage 1, many patients relate them to old age or familiar illnesses, such as the common cold or indigestion.

According to a study published by Lung Cancer International, only 16% of pleural mesothelioma patients were diagnosed at stage 1. Only 5% of peritoneal mesothelioma patients were diagnosed in stage 1.

The same study found that:

  • 71% of stage 1 peritoneal mesothelioma patients survived for at least one year
  • 53% survived for at least two years

Stage 1 mesothelioma patients have some of the best opportunities to improve their prognosis. If you have mesothelioma, learn how you can live longer in our free Mesothelioma Guide.

Stage 1 by Different Staging Systems

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TNM System

The TNM Staging System is the newest and most popular current system for pleural mesothelioma. It combines measuring the collective size of the tumors, lymph node involvement and metastasis.

In the TNM System, stage 1 pleural mesothelioma shows the presence of cancer in the lining of the lungs, stomach or heart. The cancer is localized to only one side of the body and has not metastasized to lymph nodes or other organs.

The TNM Staging System separates this stage of pleural mesothelioma into 1A and 1B. The difference between the two is how much tumors have spread within the pleura, which is the small cavity separating the lungs and chest wall. It’s where this cancer forms.

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Butchart System

The Butchart Staging System is the original one for pleural mesothelioma. In this system, stage 1 pleural mesothelioma is localized in one small area of the pleura and confined to its point of origin.

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Brigham System

The Brigham Staging System was developed at Brigham and Women’s Hospital in Boston. It focuses on whether surgery is an option for pleural mesothelioma patients. Doctors explicitly look for lymph node involvement. In a stage 1 pleural mesothelioma diagnosis, the cancer can be removed by surgery due to no lymph node involvement.

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Peritoneal Cancer Index

The peritoneal cancer index (PCI) is the system used to determine the severity of peritoneal mesothelioma. The system splits the abdominal cavity into 13 sections, each with a score ranging from 0 to 3. They are then totaled to a score between 0 and 39.

PCI scores from 0-10 for a peritoneal mesothelioma diagnosis are correlated to a stage 1 disease. If a patient has a PCI score no greater than 10, then their disease has not spread much within the abdominal cavity. Surgery is the primary treatment option.

Common Questions About Stage 1 Mesothelioma

What is stage 1 mesothelioma?

Stage 1 of mesothelioma is the earliest stage of this cancer. The disease has not spread beyond the point of origin. For pleural mesothelioma, stage 1 means it was only found in the pleura. For peritoneal mesothelioma, it was only found in the peritoneum.

What are the symptoms of stage 1 mesothelioma?

The symptoms of stage 1 mesothelioma are usually less severe than later stages. Coughing, nausea, low-grade fever, fluid buildup in the chest or stomach, weight loss and decreased appetite may arise as the disease progresses.

Is stage 1 mesothelioma curable?

There is no cure for mesothelioma, even in the earliest stage. However, stage 1 mesothelioma has the best prognosis and is the most treatable. The average prognosis for stage 1 mesothelioma is 20 months, although patients who receive surgical treatment have survival rates of around 30 months.

How likely is it to have stage 1 mesothelioma?

A stage 1 mesothelioma diagnosis is rare, mostly due to the difficulty detecting the cancer at this stage. Symptoms are mistaken for other health conditions, and the long latency period keeps mesothelioma out of initial consideration. In one study, only 12% of patients were diagnosed in stage 1.

How can you treat stage 1 mesothelioma?

Most doctors will suggest surgery to remove the pleura or peritoneum, which is where stage 1 mesothelioma originates. This option will quickly address most, if not all, of the diseased tissue. Other treatment options include chemotherapy, radiation and immunotherapy.

Last Edited: October 26, 2020.

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