Written By: Karen Ritter, RN BSN

Mesothelioma Prognosis

Mesothelioma prognosis is a doctor’s assessment of a patient’s expected survival with the cancer mesothelioma. Mesothelioma is an aggressive cancer that forms in the lining of the lungs or abdomen usually. The mesothelioma life expectancy changes with each individual case and is affected by individual patient factors. Historical data for survival rates also affect mesothelioma prognosis.

Dr. Hassan Khalil

Medically Reviewed By

Dr. Hassan Khalil

Mesothelioma Thoracic Surgeon

Dr. Hassan Khalil

Medically Reviewed By

Dr. Hassan Khalil

Mesothelioma Thoracic Surgeon


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Important Facts About Prognosis for Mesothelioma

  • The prognosis for mesothelioma is different for each type of mesothelioma. The types vary in where mesothelioma forms in the body and the type of cancerous cells.
  • A few other factors affecting mesothelioma prognosis include: age, gender, treatment options and availability, location to a top cancer center, patient lifestyle and overall patient health.
  • The general prognosis for mesothelioma is at least 12-18 months. Patients who have surgery usually have a better prognosis (at least two years), and people who go to a cancer center to see a mesothelioma specialist also have a better prognosis.

What Is a Prognosis?

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

In the case of cancers like malignant mesothelioma, this forecast often includes a projection of survival, plus chances of recovery or recurrence. Doctors may refer to what’s called a “survival rate.” A survival rate is the percentage of patients who reach a specific survival time.

Mesothelioma prognosis may also include predictions about the quality of life, such as if the mesothelioma 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 outlook than surgery.

What Is the Average 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 mesothelioma patient, the type of mesothelioma, and the treatment chosen.

Some patients receive an improved prognosis due to eligibility for surgery or joining a clinical trial that pairs surgery with immunotherapy. Others have a longer mesothelioma survival 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 of a mesothelioma patient to around two years.

Early Stage Pleural Mesothelioma

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

Those diagnosed with stage 2 live for an average of 19 months. These figures include all the cell types of mesothelioma (epithelioid, sarcomatoid and biphasic).

Late-Stage Pleural Mesothelioma

Late-stage pleural mesothelioma is considered stage 3 or 4. The average is around 15 months for stage 3. 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 survival times
  • The cancerous growth doesn’t seem to spread as quickly as pleural mesothelioma

Surgical treatment for this type of cancer depends more on overall health and less on the stage

Cytoreductive surgery and HIPEC is the driving force behind the hopeful outcomes for malignant peritoneal mesothelioma. This mesothelioma treatment is associated with survival times for peritoneal mesothelioma patients of 3-5 years depending on patient factors such as age and health.

There is no universally accepted staging system for this cancer; however specialists categorize it as localized or metastatic. Patients with localized tumors are considered an early-stage diagnosis.

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.

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What Factors Affect Prognosis for Mesothelioma?

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

  • Age
  • Gender
  • Location, cell type and stage of mesothelioma
  • Treatment options
  • Overall health and lifestyle
  • Historical mesothelioma 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, which plays a role in prognosis.

Women with mesothelioma live longer than men diagnosed with mesothelioma. Women also are more consistent with receiving chemotherapy and immunotherapy and attending doctor visits.

Location of Mesothelioma

The location and cell type play a major role in a prognosis. 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 and patents with this cancer usually have a better prognosis. This is because malignant pleural mesothelioma quickly spreads to the lungs, a vital organ, and can lead to respiratory issues.

The other forms of mesothelioma are pericardial mesothelioma (lining of the heart) and testicular mesothelioma. Both are extremely rare, and there is not much data about prognosis.

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.

EpithelioidBest Prognosis

Epithelioid mesothelioma has a longer life expectancy than the other two cell types usually. The average for patients is two years. The prognosis is a little higher for people with peritoneal mesothelioma. Fortunately, most patients have epithelioid mesothelioma cell type.

BiphasicMixed Results

The average survival 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 improve the life expectancy of mesothelioma patients.

Sarcomatoid — Poorest Prognosis

Sarcomatoid mesothelioma has an average survival 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. Only a small number of mesothelioma patients have sarcomatoid cell diagnosis.

Stage of Mesothelioma

The patient’s stage of mesothelioma is another contributing factor for their prognosis. People in stage 1 and 2 have a better outlook than people in later stages.

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. Stage 4 mesothelioma has the worst survival statistics. Unfortunately, mesothelioma is often diagnosed in later stages.

Treatment Options and Surgery

Treatment options also affect the prognosis.

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 average 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. In one study, the average survival for patients with peritoneal mesothelioma who had cytoreduction/HIPEC surgery is 50-60 months. This extraordinary number equates to approximately half of patients living up to five years.

Immunotherapy and Chemotherapy

Mesothelioma chemotherapy has long been the treatment of choice for patients who can’t have surgery. Mesothelioma patients treated with chemotherapy have an average survival of 12-14 months.

Immunotherapy for mesothelioma is an emerging cancer treatment. The FDA approved the use of nivolumab (Opdivo) and ipilimumab (Yervoy) for pleural mesothelioma. These two immunotherapies are used together, and patients live for an average of 18 months. While durvalumab (Imfinzi) is not approved yet, the median survival in the latest study was 20 months for durvalumab with chemotherapy. Mesothelioma patients hoping to take immunotherapy should find a specialist.

Lifestyle and Diet

Lifestyle and daily habits are important factors for long-term survival. People who can tolerate light exercise and follow a healthy diet will have a slightly better prognosis due to their body’s strength. This can also improve quality of life for the mesothelioma patient.

Prognosis and Survival Rates

The prediction 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 less than 10%.

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 to become a mesothelioma survivor.

Consider Your Treatment Options

Mesothelioma research has come a long way in the past decade, creating more treatment options than ever before. Mesothelioma patients treated with surgery can beat their prognosis. 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.

Work With a 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

Mesothelioma patients may benefit from a second opinion, which is 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 Improve the Prognosis for Mesothelioma

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 survival 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.

Frequently Asked Questions About Mesothelioma Prognosis

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How long do people usually live with mesothelioma?

People with mesothelioma usually live a few months to multiple years. While the average for all types of mesothelioma is 1-2 years, the type of mesothelioma and treatment a person has are significant factors.

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What is the usual prognosis for pleural mesothelioma?

The standard prognosis for pleural mesothelioma is 8-19 months. This cancer forms near the lungs and can easily spread to this organ, along with lymph nodes.

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What is the common prognosis for peritoneal mesothelioma?

Patients with peritoneal mesothelioma are expected to live on average around two years. Treatment for peritoneal mesothelioma often improves the survival to 3-5 years. This cancer usually spreads within the abdomen and doesn’t reach lymph nodes. Surgery is often a treatment option.

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What are the main factors affecting your prognosis?

The type of mesothelioma and stage of the disease will significantly impact prognosis. The earlier the stage, the better the expected survival time. Therefore, early detection is vital. Peritoneal mesothelioma has a better outlook than pleural mesothelioma. Other factors are age, gender, lifestyle and overall health (diet, exercise, comorbidities), treatment options, and cell type.

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How can you improve your mesothelioma prognosis?

Early detection and high-quality medical care are the best ways. The earlier you learn you have mesothelioma, the better your prognosis is due to the limited spread of tumors. Receiving care from a mesothelioma specialist can also boost your survival chances due to their experience and access to treatment innovations.

Sources & Author

  1. Prognostic role of radiological peritoneal cancer index in malignant peritoneal mesothelioma: national cohort study. Nature. Retrieved from: https://www.nature.com/articles/s41598-020-70044-8. Accessed: 08/04/2021.
  2. Survival Rates for Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/survival-statistics.html. Accessed: 11/03/2022.
  3. Improvements in Systemic Therapies for Advanced Malignant Mesothelioma. International Journal of Molecular Sciences. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/37445594/. Accessed: 07/18/2023.
Devin Golden

About the Writer, Devin Golden

Devin Golden is a content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.