Stage 1 Mesothelioma
Stage 1 mesothelioma is considered early stage and symptoms are generally mild. Diagnosis during stage 1 means a better prognosis than during advanced stages since more treatment options are available.
Determining life expectancy for stage 1 mesothelioma patients is challenging as the disease is often not diagnosed until advanced stages. However, life expectancy averages around 21 months, with much longer survivorship possible with some treatment options.
The five-year relative survival rate for localized (stage 1) pleural mesothelioma, according to the American Cancer Society, is 20 percent. For peritoneal mesothelioma, isolated to the abdominal cavity, the survival rate is much higher.
Stage 1 mesothelioma characteristics
Stage 1 mesothelioma hasn’t spread beyond the lining of the lungs, abdomen, or heart. Doctors may remove the tumor tissue with surgery and extend your life expectancy.
If you’re diagnosed with stage 1 mesothelioma, you have the most treatment options—and the best prognosis—because the disease is confined to the lining of one lung or abdomen and easier to remove via traditional treatment methods, like surgery and chemotherapy.Stage 1 mesothelioma quick facts
- The tumor is limited to the lining of the one lung or abdomen.
- Curative treatments are most effective at this stage.
- The life expectancy of a stage 1 mesothelioma patient ranges from 30 to 40 months.
- Symptoms are typically mild.
- Most of the time, it is detected accidentally.
Stage 1 mesothelioma by type
There are four main types of mesothelioma, named for where cancer originates in the body:
- Pleural, found in the lining of the lungs (pleura)
- Peritoneal, originates in the tissue lining the abdominal wall (peritoneum)
- Pericardial, starts in the membrane surrounding the heart
- Testicular, found in the testes
The progression of mesothelioma from stage to stage will likely be different based on the type.
Malignant pleural mesothelioma is the most common type of mesothelioma, accounting for an estimated 80 percent of new cases. This mesothelioma can be staged 1A or 1B based on the TNM staging system–the main system used to stage mesothelioma.
Stage 1A pleural mesothelioma
During this early stage, tumors develop in the layers of the pleural lining on one side of the chest. Tumors can be in one or both layers of the pleura but have not spread to other parts of the body.
Stage 1B pleural mesothelioma
The main difference between this stage and 1A is that cancer in stage 1A does not impact nearby tissue, whereas stage 1B does. In stage 1B, tumors are found outside the pleura and impact nearby tissues like the lungs, diaphragm, chest wall, pericardium, and more.
Peritoneal mesothelioma is the second most common type of mesothelioma. It accounts for 300-500 new cases per year. This kind of mesothelioma is staged either with the peritoneal cancer index (PCI) or an adapted version of the TNM staging system.
During stage 1 of peritoneal mesothelioma, cancer remains isolated to the abdominal lining and has not yet spread. As a result, symptoms are generally mild during this early stage.
Because tumors are isolated to the abdomen in stage 1, surgery may be an available option. Patients might also be eligible for hyperthermic intraperitoneal chemotherapy (HIPEC), a two-step surgery and chemotherapy procedure that can be an effective treatment for peritoneal mesothelioma.
Pericardial mesothelioma is a rare type of mesothelioma, accounting for just 1-2 percent of new cases. Because this cancer is so rare, there is no official staging system for pericardial mesothelioma. Further, because early symptoms can be nonspecific, it is often not recognized in the early stages.
Like pericardial mesothelioma, testicular mesothelioma is extremely rare and makes up just 1 percent of cases. Given the rarity of this cancer, there is no official staging system for testicular mesothelioma. It is often not recognized in the early stages as symptoms might be mistaken for more common conditions.
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How doctors make a Stage 1 mesothelioma diagnosis
Doctors use three staging systems to describe how far stage 1 mesothelioma has spread. Using these systems helps them determine which treatment options will work best for your diagnosis.
TNM is the most common staging system doctors use to describe the spread of mesothelioma. It emphasizes three growth factors:
- T (tumor) refers to the spread of the primary tumor.
- N (node) refers to the extent the tumor has spread to nearby lymph nodes.
- M (metastasis) refers to the tumor’s spread to other organs.
Doctors assign to each letter a number that provides more detail about the spread of the cancer. After they do so, they stage the cancer with a number ranging from 1 to 4. According to the TNM system, a stage 1 patient will show small tumors spread through the lining of one lung, the stomach or the heart. The tumor will not have spread to any other organs or areas of the body.
The Brigham staging system focuses on how easily a doctor can remove the mesothelioma tumor. If you’re diagnosed with stage 1 mesothelioma under the Brigham system, you’re likely a good candidate for curative surgery.
Doctors use the Butchart system to describe the location of the main tumor, rather than its growth. Stage 1 mesothelioma under the Butchart system hasn’t spread beyond where it first appeared in the lining of the lungs, abdomen, or heart.
Symptoms of stage 1 mesothelioma
Symptoms caused by stage 1 pleural mesothelioma are similar to those caused by other lung diseases, like pneumonia and asthma. The main symptom you may feel is a slight to moderate pressure in your chest, which is caused by the buildup of fluid in the lung’s lining.
If you’re diagnosed with stage 1 peritoneal mesothelioma, you may experience a similar pressure as your main symptom. It will, however, occur in your abdominal area, and be caused by excess fluid in the lining of your abdomen.
Outside of chest or abdominal pressure, symptoms caused by stage 1 mesothelioma are general, a characteristic which makes it difficult for doctors to attribute them to mesothelioma.
Below is a list of symptoms you may feel if you have stage 1 mesothelioma.
- Chest pain
- Shortness of breath
- Chest pressure
- Persistent cough
- Abdominal pain
If you’ve been exposed to asbestos in the past, and are experiencing any of the above symptoms, see a doctor as soon as possible. While these symptoms aren’t specific to mesothelioma, finding out at an early stage if the disease is causing them may drastically improve your life expectancy.
How early-stage mesothelioma is detected
Most patients do not have symptoms of mesothelioma in stage 1. As a result, mesothelioma is rarely diagnosed in this early stage. Stage 1 is often discovered accidentally through non-related scans. However, patients with histories of asbestos exposure and who are proactive can also catch mesothelioma in stage 1.
In stage 1, symptoms are mild and may resemble seasonal flu or pneumonia. As the disease progresses, patients may experience pain as tumors invade more tissues and wrap around the lungs in stages 2 and 3. Pain might also be caused by fluid buildup between the pleural lining.
Mesothelioma may be found in later stages as symptoms progress and patients seek care. Physicians may use x-rays, biopsies, and other methods to diagnose mesothelioma in the pleura.
Learn more about the stages of mesothelioma
Find out more about the other stages of mesothelioma, including the symptoms, treatment options, prognosis and how you or a loved one can get help.
Mesothelioma treatment options for patients in stage 1
If you’ve been diagnosed with stage 1 mesothelioma, you’re eligible for curative treatments designed to remove mesothelioma from your body and extend your life expectancy.
While these treatments are available for patients with other stages of mesothelioma, they’re most effective on stage 1 mesothelioma; the disease is easier to remove because it’s confined to the lining of one lung and hasn’t spread to any other organs.
Pleurectomy with decortication (P/D)
The P/D is a lung–sparing surgery, and ideal for patients with stage 1 pleural mesothelioma. The first part of the P/D is a pleurectomy, a procedure doctors use to remove the lining of the lung. The second part is a decortication, the careful removal of any visible tumors in the vicinity of the lung. Depending on how far the mesothelioma has spread, doctors will only remove the parts of the lung’s lining that are affected by tumor growth; they’ll leave the lung and the rest of its lining intact.
Extrapleural pneumonectomy (EPP)
The EPP is a more extensive surgery for patients with pleural mesothelioma. Doctors use it to remove the entire lung—and its lining—affected by tumor growth so that the mesothelioma doesn’t grow back. If the tumor has spread far enough, the doctor may also remove part of your diaphragm and of your heart’s lining. Removing so much may seem drastic, but it decreases the chance that the mesothelioma will recur and increases your chance for an improved prognosis.
If you’ve been diagnosed with stage 1 peritoneal mesothelioma, you also have a curative treatment option: cytoreduction. This surgery is actually a number of smaller, specific procedures doctors use to remove the lining of the abdomen, and any visible tumors in the abdominal area. It’s often combined with heated chemotherapy (HIPEC) for amazing results. Many studies have shown that cytoreduction with HIPEC increases the overall survival rate of patients with peritoneal mesothelioma—some have even lived over 5 years after the combined procedure.
Other treatment types
Chemotherapy is a treatment that uses medications to kill cancer cells and shrink tumors, and it’s effective for early-stage mesothelioma. Chemotherapy is generally used following surgery to kill any remaining cancer cells. Intraperitoneal chemotherapy can be put directly into the abdomen, rather than the vein, to treat some mesotheliomas like peritoneal mesothelioma.
Radiation therapy uses high doses of radiation to treat cancer by killing cancer cells. This radiation damages targeted cells, which hinders growth and helps to shrink tumors. Radiation therapy is most effective against localized tumors and, as a result, is most impactful during early-stage mesothelioma.
Immunotherapy is used to stimulate the immune system to fight cancer on its own. In particular, the combination of two immunotherapy drugs, Opdivo® (nivolumab) and Yervoy® (ipilimumab), has been shown to improve survival by 50 percent and is an FDA-approved treatment for malignant pleural mesothelioma.
Clinical trials & emerging treatments
Clinical trials are research studies to evaluate new interventions and emerging treatments. National Cancer Institute-designated cancer centers often lead the way in research studies for different cancers. Recent areas of study for mesothelioma include:
- Gene therapy, which alters the DNA of affected cells so the immune system can better target them
- Immunotoxins, which are proteins that bind to cancer cells, enter the cell, and kill them
- Oncolytic virus therapy, which uses viruses like herpes simplex virus to kill cancer cells
Clinical trials and emerging treatments are not available to all patients and are often given to patients who are not responding to standard treatment methods. Your oncologist will have specific recommendations for clinical trials that show promise for treating your cancer.
Life expectancy & survival rates with stage 1 mesothelioma
Life expectancy refers to how long a patient can expect to live with their cancer. For stage 1 mesothelioma, the typical median life expectancy is 21 months, and is the best prognosis of all stages. By comparison, stage 4 mesothelioma patients have a life expectancy of 12 months.
Relative survival rate refers to the percentage of people who survive mesothelioma compared to the overall population for a certain increment, often two or five years. For stage 1 pleural mesothelioma, the two-year survival rate approaches 50 percent. The five-year survival rate drops to 10 percent according to the American Cancer Society.
Many factors can impact survival, including age, gender, and general health. Additionally, aggressive treatment can help to extend life expectancy. Speak with your oncologist or other specialists about your prognosis to learn more.
Can patients with stage 1 mesothelioma be cured?
There is no cure for any stage of mesothelioma, though some patients have been able to go into short-term remission. Mesothelioma caught in an early stage has a better prognosis with more treatment options available compared to later stages. Early and aggressive treatment can improve outcomes for patients with stage 1 mesothelioma. Additionally, maintaining good overall health can improve your prognosis.
How to improve your mesothelioma prognosis
You have the most favorable prognosis if you’ve been diagnosed with stage 1 mesothelioma. The disease is confined to the lining of one lung and is easier to remove with curative surgery. As a result, you’re more likely than patients diagnosed with later stages to extend your life expectancy beyond the average.
Other factors that may affect your prognosis include age, overall health, type of cancer, cell type and treatment plan.
Just a few decades ago, mesothelioma patients were expected to live a maximum of one year. Now, patients diagnosed with stage 1 mesothelioma survive an average of three years after they’re diagnosed—some are still surviving.
Get support dealing with your mesothelioma diagnosis
If you or a loved one need help dealing with a mesothelioma diagnosis, our Mesothelioma Advocates can review your diagnosis, connect you with mesothelioma specialists and even help secure financial aid to pay for your treatment.
Attanoos, R. L., & Allen, T. C. (2014). Staging. Advances in surgical pathology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Stages of Malignant Mesothelioma. Retrieved on June 20, 2014 from http://www.cancer.gov/cancertopics/pdq/treatment/malignantmesothelioma/patient/page2
Malignant Pleural Mesothelioma Staging. Retrieved on June 20, 2014 fromhttp://emedicine.medscape.com/article/1999306-overview