Mesothelioma Prognosis

What Is a Prognosis?

A prognosis, or life expectancy, is the medical prediction of a disease’s outcome and a patient’s chances of recovery. In most cases of cancer, prognosis is measured by length of survival for the patient.

In the case of cancers like malignant mesothelioma, doctors may refer to what’s called a “survival rate.” A survival rate is the percentage of patients who reach a specific survival time.

Prognosis may also include predictions about quality of life, such as if the cancer 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 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 prognosis for mesothelioma is 1-2 years. This is the same as the average mesothelioma life expectancy.

The average mesothelioma prognosis is based on survival rates from past cases. 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

The prognosis for pleural mesothelioma is for survival of at least 12-18 months if patients have some form of treatment, such as immunotherapy or chemotherapy. Aggressive treatment, such as surgery, can improve the life expectancy of pleural mesothelioma to around two years.

Early Stage Pleural Mesothelioma

According to Dr. David Sugarbaker, who was a top mesothelioma expert before he passed away, the prognosis for stage 1 pleural mesothelioma is an average survival of 22 months. The prognosis for stage 2 pleural mesothelioma is an average survival of 19 months. These figures include all the cell types of mesothelioma (epithelioid, sarcomatoid and biphasic).

Late-Stage Pleural Mesothelioma

The prognosis for stage 3 pleural mesothelioma is approximately 15 months of survival. The prognosis for stage 4 pleural mesothelioma is usually 11-12 months.

Unfortunately, most patients are diagnosed in stage 3 or stage 4.

Prognosis for Peritoneal Mesothelioma

The prognosis for peritoneal mesothelioma is survival of 2-3 years with treatment. Cytoreductive surgery and HIPEC gives patients an average life expectancy of 3-5 years.

Despite the rarity of peritoneal mesothelioma:

• Patients 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

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.

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?

The important factors affecting a mesothelioma prognosis are:

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 patients 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.

Epithelioid – Best 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.

Biphasic – Mixed 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 mesothelioma 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

Here are four ways to improve your mesothelioma prognosis and potentially become a mesothelioma cancer 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 trained and experienced 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.

Help Improving Your Prognosis for Mesothelioma

Mesothelioma Guide can help you improve your prognosis for mesothelioma. Our team of experts can help you navigate treatment options and more. Email registered nurse and patient advocate Karen Ritter at karen@mesotheliomaguide.com for help.

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.