Stage 3 Mesothelioma

Stage 3 is an advanced stage of mesothelioma. The cancer has spread to lymph nodes, nearby tissue and organs. Treatment varies for each case.

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Written by Jenna Campagna, RN

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Important Facts About Stage 3 Mesothelioma

  • Stage 3 mesothelioma is considered an advanced cancer. It has spread beyond the mesothelial linings and reached organs.
  • Symptoms worsen and new ones appear as fluid builds up in the chest or stomach and tumors spread.
  • The average survival for stage 3 mesothelioma is a little more than one year.
  • Treatment varies in this stage, and some patients may not be candidates for surgery.

What Is Stage 3 Mesothelioma?

Stage 3 mesothelioma is considered advanced since the cancer is not confined to the point of origin. This means the cancer has spread outside of the pleura (lining near the lungs) or peritoneum (lining around the abdomen). Local metastasis has started.

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Some characteristics of stage 3 mesothelioma include:

  • For pleural mesothelioma, tumors have reached the nearby lung and even the fat between the two lungs
  • For peritoneal mesothelioma, the cancer has spread across the abdominal cavity
  • Lymph nodes (for pleural mesothelioma) are affected

Stage 3 mesothelioma is considered advanced since the cancer is not confined to the point of origin. Local metastasis has started, but the cancer has not yet spread to the other side of the body.

Similar to stage 1 mesothelioma, stage 3 is split into 3A and 3B. The TNM system differentiates the two by how far the cancer has spread. While still considered localized metastasis, stage 3B often is more challenging to treat with surgery.

Stage 3B pleural mesothelioma involves tumors reaching one of the following:

  • The spine
  • Deep into the chest wall
  • The peritoneum
  • The mediastinum (area containing the heart, esophagus and trachea)

What Symptoms to Expect With Stage 3 Mesothelioma

As the stages progress, the mesothelioma symptoms become more noticeable. If you have stage 3 mesothelioma, you should prepare for discomfort. Additionally, some early-stage symptoms may persist in this stage.

If you haven’t received a mesothelioma diagnosis and experience many of the above symptoms, speak to your doctor immediately. You can undergo pain-relieving treatment and may still be eligible for curative surgery.

The stage 3 mesothelioma symptoms include:

  • Difficulty breathing or swallowing
  • Dry cough
  • Shortness of breath
  • Lumps and fluid buildup in the chest or abdomen
  • Persistent pain in the chest or ribs
  • Fever
  • Low appetite and weight loss
  • Coughing up blood (hemoptysis)

If you haven’t received a mesothelioma diagnosis and experience many of the above symptoms, speak to your doctor immediately. You can undergo pain-relief treatment and may be eligible for surgery.

Stage 3 Mesothelioma Treatment Options

Of all the mesothelioma stages, stage 3 probably involves the most debate regarding treatment options. Some doctors believe chemotherapy and radiation should be the primary methods. They think the disease has spread too much to use surgery. Other doctors support surgery for stage 3 mesothelioma.

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Surgery

Pleural Mesothelioma Surgery

The primary surgeries for pleural mesothelioma are extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D). EPP is an aggressive surgery that removes the:

  • Pleura
  • Pericardium (lining around your heart)
  • Diaphragm
  • Affected lymph nodes
  • Affected lung

P/D is far less aggressive. It removes the pleura, which is where the cancer originates. This surgery does not remove the lung.

Some doctors use a more aggressive version of P/D (called “extended P/D”). This surgery removes part or all of the diaphragm and pericardium. Many elderly patients cannot endure removal of a lung, which eliminates EPP as an option. If combined with radiation and chemotherapy, extended P/D can help survival.

Dr. Raja Flores is the director of thoracic surgical oncology at Mount Sinai Medical Center in New York. He explained why more surgeons prefer P/D rather than EPP for stage 3 mesothelioma.

“The ‘pleurectomy’ part takes out the parietal pleura wall, which is the side against your chest,” Dr. Flores said. “‘Decortication’ is removing the visceral pleura wall, which is next to your lungs. Taking out that visceral pleura should remove many of the tumors off of the lung.“

If there are any remaining tumors on the lung or elsewhere in the thorax, Dr. Flores said patients usually undergo radiation.

Peritoneal Mesothelioma Surgery

Stage 3 peritoneal mesothelioma patients can undergo cytoreduction with heated intraperitoneal chemotherapy (HIPEC). This operation involves “debulking,” which is the medical term for removing as many tumors as possible.

HIPEC is a warm liquid chemotherapy treatment delivered directly into the abdomen, which is used to kill any remaining microscopic cancer cells.

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Chemotherapy, Radiation and Palliative Surgery

Chemotherapy and radiation are used either along with surgery or to relieve pain. Both therapies can reduce the size of tumors before surgery, which makes an operation more effective. Chemotherapy and radiation also can eliminate recurrence after surgery.

If surgery isn’t an option, then doctors often recommend chemotherapy and radiation. They slow the growth of tumors and decrease pain caused by tumors pressing against the chest.

Another option is immunotherapy, explicitly Opdivo and Yervoy (FDA approved in 2020). These two drugs outperform chemotherapy for non-surgery mesothelioma cases.

Stage 3 patients may also undergo palliative surgery, which relieves pain by decreasing fluid buildup. Pain-relief surgeries for stage 3 mesothelioma include:

  • Pleurodesis (pleural mesothelioma) – Closes the pleural cavity and stops the buildup of fluid
  • Thoracentesis (pleural mesothelioma) – Uses a needle to drain fluid from the pleural cavity
  • Paracentesis (peritoneal mesothelioma) – Uses a needle to drain fluid from the peritoneal cavity
  • Pericardiocentesis (pericardial mesothelioma) – Uses a needle to drain fluid from the pericardium, which is the protective sac around your heart

Prognosis

Your stage 3 mesothelioma prognosis depends on various factors, notably whether you’re a candidate for surgery. The average survival time for pleural mesothelioma patients in this stage is between 14 and 16 months, according to multiple studies.

Stage 3 is the most common mesothelioma diagnosis, especially for pleural mesothelioma. According to a study published in the Journal of Thoracic Oncology, nearly 50% of diagnoses were stage 3.

Stage 3 pleural mesothelioma patients see significant survival benefits from surgery. According to the same study:

  • Around 40% of stage 3 patients undergoing P/D survived for at least two years
  • Patients also had a median survival time of 19 months

Peritoneal mesothelioma doesn’t follow the same staging system as pleural mesothelioma, but some doctors and researchers can correlate a patient’s diagnosis to one of the four stages.

Surgery has increased the survival time for many patients. According to a study published by the American Cancer Society:

  • Around 53% survived for five years after cytoreduction with HIPEC
  • Patients also had a median survival time of 67 months

Numerous studies compare EPP and P/D for stage 3. In one study, around 37% of patients who had an extended P/D survived for at least three years. By comparison, around 23% of EPP patients survived that long.

Clinical trials offer increased hope for stage 3 patients. These studies provide you access to treatment options not yet available at most hospitals. These include:

  • New chemotherapy drugs
  • Immunotherapy
  • Gene therapy
  • Virotherapy

We can help you learn if you’re eligible for any clinical trials. We also can help you find a doctor who specializes in surgery for stage 3 mesothelioma. Use our free Doctor Match resource to get started.

Stage 3 by Different Staging Systems

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TNM System

The TNM System is the most popular staging system for pleural mesothelioma. It classifies the status of the tumor, nodes, and metastasis of the cancer.

In stage 3, the mesothelioma has now spread to organs. Tumors are all on the same side of the body. However, cancer cells may also be found in the lymph nodes.

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Butchart System

The Butchart System is the oldest of the three staging systems for pleural mesothelioma. It focuses on the size of the tumors and where the disease has spread. This system classifies stage 3 as tumors reaching the abdominal cavity and distant lymph nodes.

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Brigham System

The Brigham System was created by Dr. David Sugarbaker for staging pleural mesothelioma. It focuses on whether patients can undergo surgery to resect most or all of the disease.

Doctors who followed the Brigham System often used radiation and chemotherapy before surgery to slow the growth or kill tumors. Doing so can make surgery an option.

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Peritoneal Cancer Index

The peritoneal cancer index (PCI) measures how far peritoneal mesothelioma has spread in the abdominal cavity. This index is the primary staging system for peritoneal mesothelioma.

Doctors assign a score between 0 and 3 to each of the 13 sections of the abdominal cavity. They add up the scores for a total PCI number. Patients with a PCI between 21 and 30 correlate to stage 3. Cytoreduction with HIPEC is still an option for these cases.

Common Questions About Stage 3 Mesothelioma

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What are the characteristics of stage 3 mesothelioma?

Stage 3 mesothelioma is considered an advanced disease. For pleural mesothelioma, stage 3 means it has spread to lymph nodes, the diaphragm and the tissue between the lungs. For peritoneal mesothelioma, it has a PCI score of 21-30, meaning it’s in most of the abdominal cavity sections.

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What are the symptoms of stage 3 mesothelioma?

The symptoms in stage 3 mesothelioma become more severe than earlier stages. Fever gets worse, as does pain in either the chest or stomach. Night sweats, bowel issues, anemia, coughing up blood and face or arm swelling are all potential symptoms of this stage.

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What is the survival rate of stage 3 mesothelioma?

Stage 3 mesothelioma has a survival rate of around 16 months. Most patients live for at least one year. There are survival stories of people with stage 3 mesothelioma living well past their prognosis with multimodal treatment.

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How often do people have stage 3 mesothelioma?

Stage 3 mesothelioma is diagnosed in 35% of all cases, making it a common stage for this cancer. Early detection is difficult, which is why mesothelioma is diagnosed in later stages.

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How is stage 3 mesothelioma treated?

Surgery is still possible for people with stage 3 mesothelioma who are able to endure aggressive surgery. Other treatment options include chemotherapy, radiation, tumor treating fields, and immunotherapy.

Last Edited: April 5, 2021.

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