Written By: Devin Golden
Stage 1 Mesothelioma
Stage 1 mesothelioma is the least-advanced stage of mesothelioma and has the best prognosis of any of the four stages since the cancer is easier to treat.
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
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Important Facts About Stage 1 Mesothelioma
- Stage 1 is the most hopeful stage of mesothelioma cancer and has the best life expectancy.
- All treatment options are available to patients with stage 1 mesothelioma.
- Diagnosing stage 1 mesothelioma is difficult due to the lack of symptoms.
- The average survival time for stage 1 mesothelioma is 20 months and often much longer after surgery.
What Is Stage 1 Mesothelioma?
Stage 1 mesothelioma is the earliest of the four stages of mesothelioma. It is called early-stage mesothelioma and offers the most hope for survival. Stage 1 mesothelioma is contained to:
- 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 localized within the point of origin (pleura or peritoneum), with no spread of cancer cells to lymph nodes or organs
- Tumors are small in size
Stage 1 mesothelioma is the earliest of the four stages of mesothelioma. It is called early-stage mesothelioma and offers the most hope for survival. Stage 1 mesothelioma is contained to:
- 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
Pleural mesothelioma (lining of the lungs) is the most common type of mesothelioma. Peritoneal mesothelioma (lining of the abdominal cavity) is the next most common type. The two other types of mesothelioma -- pericardial mesothelioma and testicular mesothelioma -- are so rare that staging is difficult to determine.
Pleural mesothelioma (lining of the lungs) is the most common type of mesothelioma. Peritoneal mesothelioma (lining of the abdominal cavity) is the next most common type. The two other types of mesothelioma -- pericardial mesothelioma and testicular mesothelioma -- are so rare that staging is difficult to determine.
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. This is because most treatment options are available for patients.
For pleural mesothelioma, stage 1 is separated into 1A and 1B. Stage 1A involves tumors on the outer wall of the pleura (the parietal pleura). Stage 1B involves tumors on the outer wall and the inner wall (the visceral pleura).
Stage 1 mesothelioma patients have the best prognosis. This is because most treatment options are available for patients.
Diagnosing Stage 1 Mesothelioma
Diagnosing stage 1 mesothelioma involves imaging tests and a biopsy to test tissue.
Diagnosing stage 1 mesothelioma is rare. 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.
What Signs and Symptoms to Expect With Stage 1 Mesothelioma
Stage 1 mesothelioma typically has little to no symptoms. If patients have any signs, they are usually mild symptoms such as a persistent cough, shortness of breath, loss of appetite, chest or abdominal pain or nausea. Many people mistake stage 1 pleural mesothelioma with pneumonia because of similar symptoms.
Mesothelioma develops after asbestos fibers irritate tissue linings in one of a few cavities in your body. Asbestos exposure is the only known cause of mesothelioma, but many people were exposed years ago. They also didn’t know they were in danger at the time. Knowing which mesothelioma symptoms to expect during stage 1 can help you identify a risk.
Stage 1 Mesothelioma Treatment Options
Stage 1 mesothelioma treatment options include surgery, chemotherapy, immunotherapy and radiation therapy. The specific procedures change for each type of mesothelioma. These patients have a higher chance of survival and are better candidates for surgery. Most mesothelioma clinical trials also accept patients diagnosed with stage 1 mesothelioma.
Surgery
Pleural Mesothelioma Surgery
Pleural mesothelioma surgery is available to patients with stage 1 malignant pleural mesothelioma. The most invasive approaches are two surgeries: pleurectomy with decortication (P/D) and extrapleural pneumonectomy (EPP).
P/D involves removing the lining of the lung, which is called the pleura. This surgery spares both lungs. It has an “extended” version, which removes part or all of the diaphragm and the lining around the heart (pericardium).
EPP is the complete removal of the affected lung, pleura and part of the diaphragm. It’s the most invasive surgery.
After EPP, 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 likely hasn’t spread to the lung yet.
Peritoneal Mesothelioma Surgery
Peritoneal mesothelioma surgery is available to patients with stage 1 peritoneal mesothelioma. Patients usually undergo cytoreduction with heated intraperitoneal chemotherapy (HIPEC). Cytoreduction is the removal of all visible tumors in the abdomen. This surgery stops mesothelioma tumors from growing in the abdominal cavity and affecting organs.
Part of the cytoreduction process is HIPEC, which is heated intraperitoneal chemotherapy. It uses warm liquid chemotherapy to attack tumors. Another common part of this surgery is a peritonectomy, which is removal of the protective lining around the abdomen (the peritoneum).
Pericardial Mesothelioma Surgery
Pericardial mesothelioma surgery is rarely a treatment option, and few cases are diagnosed in stage 1.
Pericardial mesothelioma is a very rare cancer and there are only a handful of cases diagnosed in the U.S. each year. It forms in the pericardium, which is a lining around the heart. The surgery for this type is a pericardiectomy, which involves removing the pericardium.
Chemotherapy, Immunotherapy and Radiation
Chemotherapy, immunotherapy and radiation are mesothelioma treatment options for patients with stage 1 cancer. These therapies can be used on their own or in combination with other treatments, including surgery. They can reduce the size of tumors — making them easier to remove during surgery — or kill any remaining cancer cells left over from surgery.
Stage 1 mesothelioma patients may receive 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 and Survival Rate for Stage 1
The stage 1 mesothelioma prognosis is approximately two years with treatment. 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 with mesothelioma specialist Dr. David Sugarbaker, stage 1 pleural mesothelioma has an average prognosis of around 22 months. In a different study published on UpToDate, the stage 1 pleural mesothelioma life expectancy was 20 months.
The 1-year survival rate for stage 1 peritoneal mesothelioma is 71%. The 2-year survival rate for stage 1 peritoneal mesothelioma is 53%.
A study published in the Annals of Translational Medicine compared the survival rates for P/D and EPP:
- Around 59% of P/D patients 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 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).
Stage 1 by Mesothelioma Staging Systems
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 one side of the body and has not metastasized to lymph nodes or other organs.
The TNM Staging System separates this stage into 1A and 1B. The difference between the two is how much tumors have spread within the pleura, the small cavity near the lungs.
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.
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 stage 1 pleural mesothelioma, the cancer can be removed surgically due to no lymph node involvement.
Peritoneal Cancer Index
The peritoneal cancer index (PCI) is the staging system for 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 stage 1. If a patient has a PCI score no greater than 10, then their disease has not spread much. Surgery is the best treatment option.
Frequently Asked 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 include coughing, nausea, low-grade fever, fluid buildup in the chest or stomach, weight loss and decreased appetite. They are usually mild.
Is stage 1 mesothelioma curable?
There is no cure for mesothelioma, even in the earliest stage. However, stage 1 mesothelioma has the best overall prognosis and is the most treatable. The average prognosis for stage 1 mesothelioma is two years, although patients who receive successful surgery with other treatment options have improved survival 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. In one study, only 12% of mesothelioma cases were diagnosed in stage 1.
How can you treat stage 1 mesothelioma?
Treatment for stage 1 mesothelioma includes surgery, chemotherapy, immunotherapy and radiation therapy. Most mesothelioma 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.
Sources & Author
- Life Expectancy in Pleural and Peritoneal Mesothelioma. Lung Cancer International. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292397/. Accessed: 04/09/2020.
- Presentation, initial evaluation, and prognosis of malignant pleural mesothelioma. UpToDate. Retrieved from: https://www.uptodate.com/contents/presentation-initial-evaluation-and-prognosis-of-malignant-pleural-mesothelioma?topicRef=4625&source=see_link. Accessed: 04/13/2020.
- Extrapleural pneumonectomy (EPP) vs. pleurectomy decortication (P/D). Annals of Translational Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497106/table/t5/. Accessed: 04/14/2020.
- Short‐term outcomes of pleurectomy decortication and extrapleural pneumonectomy in mesothelioma. Journal of Surgical Oncology. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1002/jso.25260. Accessed: 04/14/2020.
- Current Therapy for Mesothelioma. Brigham and Women’s Hospital. Retrieved from: https://journals.sagepub.com/doi/pdf/10.1177/107327489700400404. Accessed: 04/09/2020.
- Cancer Staging. American Cancer Society. Retrieved from: https://www.cancer.org/treatment/understanding-your-diagnosis/staging.html. Accessed: 04/06/2020.
- In Memoriam: David J. Sugarbaker, MD (1953–2018). Texas Heart Institute Journal. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379011/. Accessed: 04/06/2020.
- Peritoneal Cancer Index. ResearchGate. Retrieved from: https://www.researchgate.net/figure/Peritoneal-Cancer-Index-PCI-scoring-system-PCI-is-a-diagnostic-and-prognostic-tool_fig1_315691686. Accessed: 04/12/2020.
- Malignant Mesothelioma Treatment (Adult). Vanderbilt-Ingram Cancer Center. Retrieved from: https://www.vicc.org/cancer-info/adult-malignant-mesothelioma. Accessed: 11/15/22.
- Mesothelioma. National Organization for Rare Disorders. Retrieved from: https://rarediseases.org/rare-diseases/mesothelioma/. Accessed: 04/09/2020.
- Signs and Symptoms of Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/signs-symptoms.html. Accessed: 04/06/2020.
- Mesothelioma: Symptoms and Signs. American Society of Clinical Oncology. Retrieved from: https://www.cancer.org/cancer/types/malignant-mesothelioma/detection-diagnosis-staging/signs-symptoms.html. Accessed: 04/10/2020.
- Pneumonia Symptoms and Diagnosis. American Lung Association. Retrieved from: https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/symptoms-and-diagnosis. Accessed: 04/09/2020.
