Mesothelioma Prognosis

What Is a Prognosis?

A prognosis is the medical prediction of a disease’s outcome. In most cases, prognosis is measured by length of survival for the patient.

In the case of cancers like mesothelioma, this forecast often includes a life expectancy, plus chances of recovery or recurrence. Mesothelioma prognosis may also include predictions about quality of life, such as if the patient will have difficulty breathing, exercising or enjoying their pre-cancer lifestyle.

When Do Doctors Give Patients a Prognosis?

Doctors usually give patients their prognosis once they officially diagnose the condition. Patients may receive a prognosis at multiple times during their cancer journey, especially if they undergo aggressive surgery or a new cancer therapy. Doctors may also give multiple prognoses when they diagnose the patient, one for each treatment option available. For instance, chemotherapy may provide patients with a different life expectancy than surgery.

What Is the Usual Prognosis for Mesothelioma?

The average predicted survival for mesothelioma is 1-2 years. This is based on survival rates from past mesothelioma cases, taking into account new therapies. There are variances based on the health and age of the patient, the type of mesothelioma, and the treatment chosen.

Some patients receive a better prognosis due to eligibility for surgery or joining a clinical trial that pairs surgery with immunotherapy. Others outlive their life expectancy thanks to surgery or their overall health.

Prognosis for Pleural Mesothelioma

For instance, doctors usually anticipate people with pleural mesothelioma to live at least 12-18 months if they have some form of treatment, such as immunotherapy or chemotherapy. Aggressive treatment, such as surgery, can improve the prognosis to around two years.

Early Stage Pleural Mesothelioma

Early stage (stage 1 or 2) pleural mesothelioma patients have the best prognosis. According to Dr. David Sugarbaker, who was a top mesothelioma expert before he passed away, patients diagnosed with stage 1 pleural mesothelioma have an average life expectancy of 22 months.

Those diagnosed with stage 2 pleural mesothelioma have a life expectancy of 19 months. These life expectancies include all the cell types of mesothelioma (epithelioid, sarcomatoid and biphasic).

Late-Stage Pleural Mesothelioma

Late-stage pleural mesothelioma is considered stage 3 or stage 4. The average prognosis is around 15 months for stage 3 pleural mesothelioma. The prognosis for stage 4 pleural mesothelioma is usually 11-12 months.

Unfortunately, most patients are diagnosed in stage 3 or stage 4. The disease often hides in tissue linings for years before symptoms occur, and by the time patients see their doctor and get a biopsy for diagnosis, the disease is in stage 3 or stage 4.

Prognosis for Peritoneal Mesothelioma

Despite the rarity of peritoneal mesothelioma diagnoses, there is some good news for these patients:

• They have some of the longest life expectancies
• The cancerous growth doesn’t seem to spread as quickly as pleural mesothelioma
• Surgical treatment depends more on overall health and less on the stage

There is no universally accepted staging system for peritoneal mesothelioma; however specialists categorize it as localized or metastatic. Patients with localized tumors are considered an early stage diagnosis in cases of peritoneal mesothelioma.

The other staging system is the Peritoneal Cancer Index (PCI). The index scores peritoneal mesothelioma from 1-39 based on how far tumors have spread within the abdominal cavity. The prognosis is usually better for lower PCI scores.

What Factors Affect Prognosis for Mesothelioma?

Since each mesothelioma prognosis is specific to the individual case, a few patient factors affect the doctor’s prognosis. The main factors affecting prognosis of mesothelioma are:

• Age and Gender
• Location of Mesothelioma
• Cell Type of Mesothelioma
• Stage of Mesothelioma
• Treatment Options and Surgery
• Lifestyle and Diet
• Survival Rates

Age and Gender

Younger patients often have a better mesothelioma prognosis. This fact is due to their overall health status. Younger patients are more likely stronger and more likely to be surgical candidates.

Women also have a better prognosis because they recognize and react to symptoms sooner and get an earlier diagnosis. Women also are more consistent with receiving chemotherapy and immunotherapy and attending doctor visits.

Location of Mesothelioma

The location and cell type plays a major role in prognosis for mesothelioma. There are two main locations where mesothelioma starts: the lining of the lungs (pleura); and the lining of the abdomen (peritoneum).

Mesothelioma in the lining of the lungs is called pleural mesothelioma. The other, in the lining of the abdomen, is called peritoneal mesothelioma. Patients with peritoneal mesothelioma usually have a better prognosis. This is because pleural mesothelioma quickly spreads to the lungs, a vital organ, and can lead to respiratory issues.

Cell Type of Mesothelioma

There are three cell types of mesothelioma: epithelioid, sarcomatoid, and biphasic.

Patients with epithelioid cells have a better prognosis. Patients with sarcomatoid cells usually have the worst prognosis. This is because epithelioid cells are easier to locate and remove during surgery. They also grow slower than sarcomatoid cells.

Biphasic is a mixture of epithelioid and sarcomatoid. The prognosis depends on whether patients have a majority of epithelioid cells or sarcomatoid cells.

Epithelioid – Longest Life Expectancy

Epithelioid mesothelioma has an average life expectancy of two years. The prognosis is a little higher for people with peritoneal mesothelioma. Fortunately, most patients have epithelioid mesothelioma cell type.

Biphasic – Medium Life Expectancy

The average life expectancy for biphasic mesothelioma is 13 months. Around 25% of mesothelioma cases are classified as the biphasic cell type. Some patients can have surgery, which improves the prognosis. For those who cannot, immunotherapy has helped patients live beyond the average life expectancy.

Sarcomatoid – Shortest Life Expectancy

Sarcomatoid mesothelioma has an average life expectancy of 8-12 months, depending on the location of the disease, but the average prognosis is improving. A study found that the average survival for patients with this cell type was 17 months after immunotherapy. This fast-emerging treatment option is changing the outlook for patients who for long have had the worst prognosis.

Stage of Mesothelioma

The patient’s stage of mesothelioma is another contributing factor for their prognosis. People in stage 1 have a better life expectancy than people in stage 4.

The stages differ based on how far the cancer has spread. The further mesothelioma has spread in the body, the worse the prognosis usually is for the patient.

Treatment Options and Surgery

Treatment options also affect prognosis for mesothelioma. People who can have surgery receive a better life expectancy.

Pleurectomy/Decortication Surgery

Patients who have pleurectomy/decortication surgery for mesothelioma receive a better prognosis from their doctors because this surgery removes most, if not all, visible tumors. Since the median survival is 23-32 months, the prognosis for new cases is around two years.

Extrapleural Pneumonectomy Surgery

Another surgery for pleural mesothelioma, extrapleural pneumonectomy, removes one of the lungs. The prognosis depends on the age and health of the patient, particularly if they can handle living with one lung. The median survival after this surgery is close to 20 months, so the prognosis is a little better than the average.

Cytoreductive/HIPEC Surgery

Cytoreduction/HIPEC surgery has the largest impact on survival rates. The average life expectancy for patients with peritoneal mesothelioma who had cytoreduction/HIPEC surgery is 50-60 months. This extraordinary number equates to approximately half of patients with peritoneal mesothelioma living up to five years.

Immunotherapy and Chemotherapy

Mesothelioma chemotherapy has long been the treatment of choice for patients who can’t have surgery. The life expectancy is close to the average prognosis for mesothelioma, around 12-14 months.

Immunotherapy for mesothelioma is helping improve life expectancies. The FDA approved the use of nivolumab (Opdivo) and ipilimumab (Yervoy) for pleural mesothelioma. These two immunotherapies are used together, and the median survival is 18 months. While durvalumab (Imfinzi) is not approved yet, the median survival in the latest study was 20 months for durvalumab with chemotherapy.

Lifestyle and Diet

Lifestyle and daily habits are important factors. People who can tolerate light exercise and follow a healthy diet will have a slightly better prognosis due to their body’s strength.

Survival Rates

A patient’s prognosis is based in part on survival rates. A survival rate is a percentage indicating how many patients survive over a certain amount of time. For instance, the 5-year survival rate for mesothelioma is approximately 12%.

Doctors look to the survival rates of mesothelioma to help give a prognosis.

4 Ways to Improve Prognosis for Mesothelioma

Some of the factors that affect prognosis are within the patient’s control. Therefore, there are ways patients can improve or even beat their original prognosis.

Consider Your Treatment Options

Mesothelioma research has come a long way in the past decade, creating more treatment options than ever before. Surgery is the best treatment option available to prolong a patient’s life. For patients who cannot have surgery, another option is immunotherapy, which in many studies has done better for survival than chemotherapy. Another option to consider is enrolling in clinical trials.

Find a Great Mesothelioma Specialist

Finding a mesothelioma specialist is one of the most important steps to take, because it guarantees you will have access to treatment options that will improve your prognosis. Finding a mesothelioma doctor ensures you will have access to all surgical options, if you are eligible, or receive the newest approved therapies such as immunotherapy.

You also open up possibilities for enrolling in clinical trials. Mesothelioma specialists have years of experience treating mesothelioma and conducting research for new therapies. There are top specialists in every area of the country.

Improve Your Personal Health

A healthy immune system does better with treatments like chemotherapy and fights off diseases impacting recovery. The healthier a patient is when cancer strikes, the better the body defends itself. However, it’s never too late to begin healthy habits. Patients can actively improve and maintain their personal health through diet and exercise.

Get a Second Opinion

Second opinions are extremely important after receiving a diagnosis. Alexis Kidd learned her mesothelioma wasn’t as advanced as she thought after getting a second opinion. Since the diagnosed stage is important for prognosis, a second opinion can change the stage and treatment options. It also can lead to the patient speaking with a doctor willing to perform an aggressive surgery. Getting a second opinion can often mean gaining access to treatments not previously available.

How to Respond to Your Mesothelioma Prognosis

Receiving a diagnosis of mesothelioma is a difficult experience. Nobody is ready to hear they have cancer, or how long they have left to live. However, this is just the first step and can change with available treatment options. Remember that your doctor’s estimation for your life expectancy is a guess, not a fact.

Every case is different, and your case may have a better outlook than most. Before expecting or accepting a poor mesothelioma prognosis, ask for a second opinion and talk to a mesothelioma specialist. They may provide more hope due to a different stage of cancer, a surgery that they can perform, or a clinical trial testing a new therapy.