Written By: Devin Golden
Stage 3 Mesothelioma
Stage 3 mesothelioma is an advanced stage of mesothelioma, which means the cancer has spread to the lymph nodes, nearby tissues and other organs. At this stage, tumors may have infiltrated the chest wall, diaphragm or other structures. Treatment options vary for each type of mesothelioma and each individual case.
Medically Reviewed By
Dr. Stephen Williams
Precision Oncology Scientist
Medically Reviewed By
Dr. Stephen Williams
Precision Oncology Scientist
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Important Facts About Stage 3 Mesothelioma
- Stage 3 malignant mesothelioma is an advanced stage of cancer that has spread beyond the mesothelial lining (lining of the lungs or abdomen) to nearby organs, lymph nodes and tissues.
- Symptoms become more severe as the disease progresses, often including chest pain and difficulty breathing. New symptoms emerge as fluid builds up in the chest or abdomen and tumors spread.
- The average life expectancy for stage 3 mesothelioma is approximately 12-16 months.
- Treatment for stage 3 mesothelioma varies with each individual patient.
Overview of Stage 3 Mesothelioma
Stage 3 mesothelioma is an advanced stage of the disease due to the spread of the cancer beyond where it formed. This progression means mesothelioma has spread outside of the pleura (lining of the lungs) or peritoneum (lining around the abdomen), and local metastasis has started.
Similar to stage 1 pleural 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 is often more challenging to treat with surgery.
Stage 3B pleural mesothelioma may involve tumors in the following areas:
- Spine
- Deep into the chest wall and between the ribs
- Through the diaphragm into the peritoneum
- Mediastinal organs (heart, esophagus and trachea)
Key Characteristics of Stage 3 Mesothelioma
- For pleural mesothelioma, tumors have spread beyond the pleural lining to lung tissue, mediastinal fat (fatty tissue between the two lungs), and lymph nodes. The disease may also affect the chest wall, diaphragm or pericardium (lining of the heart).
- For peritoneal mesothelioma, the cancer has spread throughout the abdominal cavity, potentially affecting multiple organs, the peritoneal lining and lymph nodes. Symptoms such as abdominal swelling, pain and digestive issues often worsen during this stage.
Common Symptoms of Stage 3 Mesothelioma
As the stages progress, symptoms of mesothelioma become more pronounced and significantly impact the patient’s quality of life.. Patients diagnosed with stage 3 mesothelioma have tumors that have spread extensively, leading to increased discomfort and complications. Additionally, some early stage symptoms may persist in this stage.
The stage 3 mesothelioma symptoms include:
- Difficulty breathing or swallowing – Tumor growth and fluid accumulation can restrict airflow and compress the esophagus.
- Dry cough – A persistent cough worsens as tumors press against the lungs and airways.
- Shortness of breath – Fluid buildup in the pleural or peritoneal cavities restrict breathing.
- Lumps and fluid buildup in the chest or abdomen – Tumors become visible.
- Persistent pain in the chest or ribs – Tumor invasion into the chest wall and nerves cause chronic pain.
- Fever – Recurrent fevers, including night sweats can be a sign of the body’s immune response.
- Decreased appetite and unexplained weight loss – Cancer-induced metabolic changes, digestive issues and nausea can lead to significant weight loss.
- Coughing up blood (hemoptysis) – Tumors in the airway can often cause irritation and bleeding.
If you have any new or worsening symptoms, speak with your doctor right away.
Stage 3 Mesothelioma Treatment Options
Among all the mesothelioma stages, treatment options for stage 3 are often the most debated. Some doctors advocate for chemotherapy, immunotherapy and radiation as the primary treatment methods for advanced stages of mesothelioma.
They believe the cancer has spread too far to use a surgical approach. However, some oncologists support surgery for a select group of stage 3 mesothelioma patients. Treatment options for stage 3 mesothelioma patients may be limited for patients with extensive lymph node involvement or tumors invading vital structures.
Surgery
Pleural Mesothelioma Surgery
In some cases, pleural mesothelioma surgery is an effective treatment for stage 3 mesothelioma. The primary surgeries for malignant pleural mesothelioma are extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D).
EPP is an aggressive surgery that removes the:
- The entire affected lung to eliminate as much cancer as possible
- Pleura (the lining of the lungs where the cancer originates)
- Pericardium (lining around your heart)
- Diaphragm (muscle that aids in breathing)
- Affected lymph nodes (to reduce the risk of metastasis)
P/D is far less aggressive. It spares the lung and removes the:
- Pleura
- Any other diseased tissue (but not 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 the 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, director of thoracic surgical oncology at Mount Sinai Medical Center in New York, has explained why more surgeons prefer pleurectomy with decortication (P/D) over extrapleural pneumonectomy (EPP) for treating stage III pleural 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.”
Unlike EPP, which involves removing an entire lung, P/D preserves the lung, making it a less aggressive but still an effective option. The goal of P/D is to remove as much tumor tissue as possible while maintaining better lung function and improving quality of life.
Dr. Flores also noted that if any remaining tumors persist on the lung or elsewhere in the thoracic cavity, patients typically undergo radiation therapy to target residual cancer cells. This multimodal approach—combining surgery with additional treatments like radiation, chemotherapy, or immunotherapy—can help slow disease progression and improve patient outcomes.
Peritoneal Mesothelioma Surgery
For patients diagnosed with stage 3 peritoneal mesothelioma, one of the most effective treatment options is cytoreduction with heated intraperitoneal chemotherapy (HIPEC). This operation involves “debulking,” which is the medical term for removing as many tumors as possible. Since peritoneal mesothelioma often spreads across the abdominal lining, the procedure may involve removing portions of affected organs, such as the omentum, spleen, intestines or peritoneum.
HIPEC is a heated liquid chemotherapy treatment delivered directly into the abdomen, which is used to kill any remaining microscopic cancer cells.
Chemotherapy, Immunotherapy, Radiation and Palliative Surgery
Chemotherapy, immunotherapy and radiation are effective treatment options available for patients with stage 3 mesothelioma. These therapies are typically used along with surgery or to manage symptoms and slow disease progression. These therapies can reduce the size of tumors before surgery, which can make an operation more effective. Chemotherapy and radiation can also help to eliminate recurrence after surgery.
If surgery is not a viable option, then doctors often recommend chemotherapy, immunotherapy or radiation. They can slow the growth of tumors and decrease pain caused by the tumors.
Another option is immunotherapy, specifically Opdivo and Yervoy (FDA-approved in 2020). These two drugs often 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
Stage 3 Mesothelioma Life Expectancy
A stage 3 mesothelioma life expectancy depends on various factors, notably whether you’re a candidate for surgery. The average survival time for stage 3 pleural mesothelioma patients is 14-16 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 mesothelioma 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 uses a different staging system than 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 of mesothelioma. According to a study published by the American Cancer Society:
- Around 53% of patients survived for 5 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 mesothelioma patients. In one study, around 37% of patients who received extended P/D surgery survived for at least 3 years. By comparison, around 23% of EPP patients survived that long.
Clinical trials offer increased hope for stage 3 mesothelioma patients. These trials provide patients access to treatment options not yet available to the public. These include:
- New chemotherapy drugs
- Immunotherapy
- Combinations of therpaies
- Gene therapy
- Oncolytic virus therapy
Mesothelioma Guide can provide information about ongoing clinical trials. We can also help you find a mesothelioma specialist with experience treating stage 3 mesothelioma. Use this free Find a Doctor resource to get started.
How to Improve Your Stage 3 Mesothelioma Prognosis
Improving your prognosis with stage 3 mesothelioma involves a combination of medical treatments, lifestyle factors, and emotional support. While some factors are out of a patient’s control, there are several actions that can potentially extend life expectancy and improve quality of life throughout the treatment journey.
Seek a Second Opinion With a Specialist
Consulting with a mesothelioma specialist can provide invaluable insight into your diagnosis and treatment options. Specialists are familiar with the latest research, clinical trials, and advanced treatments that might not be widely available elsewhere.
A mesothelioma second opinion can help you make informed decisions about your treatment plan, potentially leading to more effective therapies and better outcomes.
Focus on Personal Health and Wellness
Maintain a healthy lifestyle to improve overall health, including eating nutritious foods, staying hydrated, and avoiding harmful substances (e.g., smoking or alcohol). These healthy habits can strengthen the immune system and improve your ability to tolerate treatment.
Regular physical activity, as advised by your doctor, can help boost energy levels, reduce fatigue, and maintain muscle mass. Gentle activities like walking or light stretching can also support mental well-being.
Sleep hygiene is important. Aim for adequate, restful sleep to support physical and emotional recovery.
Address Quality of Life
Quality of life is a comprehensive measure of your mental, physical, emotional, and spiritual well-being. Managing stress, coping with emotions, and staying positive can have a significant impact on how well the body responds to treatment.
Emotional support is essential. Engaging in therapy, support groups, or spiritual practices can provide a sense of peace and hope.
Pain management and palliative care are crucial components in improving comfort and overall well-being during treatment. These services help control symptoms like pain, nausea, or difficulty breathing, allowing patients to focus on their mental and emotional health.
Consider Clinical Trials
Clinical trials offer access to innovative treatments that may not yet be available through standard therapies. Talk to your doctor about potential clinical trials, as they may provide new options that could extend survival.
Stage 3 by Different Staging Systems
TNM System
The TNM (Tumor, Nodes, Metastasis) System is the most commonly used staging system for pleural mesothelioma. This system classifies the extent of the tumor, the involvement of lymph nodes, and whether the cancer has metastasized to other areas of the body.
In stage 3 mesothelioma, the disease has now started to spread to nearby organs. For stage 3 pleural mesothelioma, tumors remain on the one side of the chest cavity. However, cancer cells may also be found in the lymph nodes.
Butchart System
The Butchart System is the oldest of the three staging systems for pleural mesothelioma developed in 1976. This system divides mesothelioma into four stages (1-4), based on how far the cancer has spread within the pleura and to other organs. This system describes stage 3 pleural mesothelioma as tumors reaching beyond the chest cavity into the abdomen and to distant lymph nodes.
Brigham System
The Brigham System was developed by Dr. David Sugarbaker at Brigham and Women’s Hospital for staging pleural mesothelioma. It focuses on whether patients can undergo surgery to remove most or all of the disease.
Doctors who followed the Brigham System often used radiation and chemotherapy before surgery to slow the cancer growth and shrink tumors. By reducing the tumor burden and slowing the progression of the disease can improve the possibility of surgery being a treatment option.
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 divide the abdominal cavity in 13 sections and then assign a score between 0 and 3 to indicate the extent of disease in each of the sections. They add up the section scores for a total PCI number. Patients with a PCI between 21 and 30 correlate to stage 3 peritoneal mesothelioma. Cytoreduction with HIPEC is still an option for these cases.
Frequently Asked Questions About Stage 3 Mesothelioma
What are the characteristics of stage 3 mesothelioma?
Stage 3 mesothelioma is 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 is spread throughout the abdominal cavity.
What are the symptoms of stage 3 mesothelioma?
Symptoms in stage 3 mesothelioma become more severe than earlier stages. Fever gets worse, as does pain in either the chest or abdomen. Night sweats, digestive issues, anemia, coughing up blood, and face or arm swelling are all symptoms of this stage.
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.
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.
How is stage 3 mesothelioma treated?
Surgery is still possible for patients with stage 3 mesothelioma who are able to endure aggressive surgery. Other treatment options include chemotherapy, immunotherapy, radiation and tumor treating fields.
Sources & Author
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- Signs and Symptoms of Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/signs-symptoms.html. Accessed: 04/10/2020.
- 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.
- Types of surgery for pleural mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/treating/surgery.html. Accessed: 04/23/2020.
- 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: 04/14/2020.
- Malignant pleural mesothelioma: key determinants in tailoring the right treatment for the right patient. Journal of Thoracic Disease. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394047/. Accessed: 04/24/2020.
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- A novel tumor‐node‐metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi‐institutional database. American Cancer Society Journals. Retrieved from: https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.25640. Accessed: 04/14/2020.
- 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.
