Stages of Pleural Mesothelioma | Stage 1 – 4 and Life Expectancy 2023/2024

Pleural Mesothelioma has various stages and for each stage, there gets to a point where life expectancy is analysed. This is why patients are conscious of the Stages of Pleural Mesothelioma.

Pleural mesothelioma is a rare but aggressive form of cancer that develops in the lining of the lungs. It is typically caused by exposure to asbestos and can take decades to develop. Unfortunately, by the time it is diagnosed, the cancer has often progressed to a late stage, making it difficult to treat. Understanding the stages of pleural mesothelioma is important for patients and their loved ones, as it can help guide treatment decisions and provide a better understanding of the prognosis.

What Are the 4 Stages of Mesothelioma?

Pleural Mesothelioma stages are used to categorize the spread and location of this cancer throughout the body. A doctor will determine the stage of a patient’s mesothelioma when they are first diagnosed. The doctor can then identify cancer treatments that are best suited to the cancer’s stage and can potentially improve the patient’s prognosis

Pleural mesothelioma is the only type of the cancer with an official staging system.

Pleural mesothelioma stages range from 1 to 4.

Stage 1 is the earliest malignant mesothelioma stage with the least cancer spread. By stage 4, the cancer has spread through the entire body. How quickly mesothelioma spreads depends on each patient.

Although peritoneal mesothelioma doesn’t have an official staging system, doctors can let patients know how advanced the cancer is to help them better understand their prognosis.

What Are the Stages of Pleural Mesothelioma

Pleural mesothelioma makes up roughly 80% of all mesothelioma cases, according to the American Cancer Society (ACS). This type of mesothelioma starts in the protective lining of the lungs (pleura).

Pleural mesothelioma can spread through:

  • Blood: Cancer can spread through the cardiovascular system and travel throughout the body.
  • Lymph vessels: Cancer cells can spread through the lymph vessels to the lymph nodes in the armpits, neck, or groin.
  • Tissue: Cancer tumors may spread from the pleura to the tissue of nearby areas such as the chest wall or lungs.

Pleural mesothelioma is the only type of this cancer that has been researched enough to be officially staged using the tumor-node-metastasis (TNM) staging system. This staging system helps mesothelioma patients understand the projected outlook of their disease.

*Located in lining of the lungs

Stage 1 Mesothelioma

  • This is the earliest stage of mesothelioma, during which the cancer has not spread beyond the layers of the pleura.
  • The average life expectancy for stage 1 malignant pleural mesothelioma is about 21 months.

Patients have treatment options that may improve life expectancy by several months or years.

*Located in lining of the lungs

Stage 2 Mesothelioma

  • The cancer has metastasized slightly outside the pleura and possibly into nearby lymph nodes.
  • The average life expectancy for stage 2 mesothelioma is about 19 months.

Patients still have many treatment options to increase life expectancy.

*Located in lining of the lungs

Stage 3 Mesothelioma

  • Mesothelioma has metastasized considerably into nearby tissues, organs, or lymph nodes.
  • The average life expectancy for stage mesothelioma is around 16 months.

Most stage 3 mesothelioma patients are no longer eligible for curative surgeries but can still undergo treatments to help slow disease spread and manage symptoms.

*Located in lining of the lungs

Stage 4 Mesothelioma

  • This is the most advanced stage of pleural mesothelioma.
  • The average life expectancy for stage 4 mesothelioma is about 12 months.

At stage 4, the cancer has moved to distant parts of the body. Treatment during this stage is focused on relieving symptoms and giving the patient the best quality of life.

Staging for Other Types of Mesothelioma

There are no official staging systems for the other types of mesothelioma because there is not enough research on these rarer forms of the disease. However, there are ways to note how far other types of mesothelioma have spread.

Diagnosing peritoneal mesothelioma stages is challenging since it can advance suddenly, often remaining in the lining of the abdomen (peritoneum) without spreading to distant organs.

Pericardial mesothelioma forms in the heart lining and is most often diagnosed after death through an autopsy.

Testicular mesothelioma is extremely rare and has no official staging system. Doctors may determine whether the patient’s mesothelioma has spread beyond the lining of the testes to determine their prognosis.

Pleural Mesothelioma Treatments For Each Stage

The stage of pleural mesothelioma plays a large role when doctors consider treatment options. The mesothelioma stage may determine if the cancer is resectable (can be removed by surgery) and if a patient is healthy enough to undergo major surgery or other invasive cancer treatments.

Doctors may decide to focus mesothelioma treatment on life-extending or palliative (symptom-relieving) options depending on the extent of mesothelioma, the patient’s personal wishes, and other factors.

Stage 1 Mesothelioma Treatment

Doctors may recommend closely watching mesothelioma instead of treating it if the disease is developing slowly and not causing symptoms. If the cancer begins to grow more quickly or cause symptoms, the patient’s mesothelioma doctor will determine the best treatment.

Stage 1 mesothelioma may be treated with:

  • Chemotherapy
  • Radiation
  • Surgery
  • Other options

Stage 2 Mesothelioma Treatment

Stage 2 mesothelioma patients are often good candidates for curative (life-extending) surgery if the cancer has not spread far into surrounding tissues.

Treatment options for stage 2 mesothelioma include chemotherapy, radiation, and surgery.

Surgery may be especially beneficial for patients with mesothelioma in the early stages. According to the ACS, surgery is more likely to show long-term benefits in early-stage cancers because there is a better chance that most of the cancer can be removed.

Stage 3 Mesothelioma Treatment

Stage 3 mesothelioma may be more difficult to treat, especially if it has progressed to stage 3B, which indicates a farther spread than 3A. Many cases of stage 3 mesothelioma are no longer resectable.

While the ACS reports that mesothelioma doctors disagree on the effectiveness of chemotherapy or radiation therapy for mesothelioma, they are often used as the main treatment for patients who cannot have surgery. These treatments may extend a patient’s life or alleviate their symptoms.

However, some stage 3 patients are still candidates for curative surgery. The ACS states that surgery may be helpful for late-stage patients, but the benefits are more likely to last a short time.

Stage 4 Mesothelioma Treatment

Stage 4 mesothelioma cannot be removed completely with surgery because the cancer is no longer contained in one area. Chemotherapy is usually the main treatment for stage 4 mesothelioma to relieve symptoms, potentially shrink tumors or slow cancer growth, and improve quality of life.

Patients may also benefit from newer or experimental treatments through clinical trials since treatment for stage 4 mesothelioma is often limited.

Other treatments for stage 4 mesothelioma may include:

  • Immunotherapy
  • Targeted therapy
  • Tumor treating fields (TTF or TTFields)

Patients can also seek palliative treatment to reduce pain and discomfort caused by mesothelioma rather than extend life expectancy.

Palliative stage 4 mesothelioma treatments may include:

  • Medication to help relieve pain
  • Pleurodesis decreases fluid buildup by sealing the space between the chest cavity and outer lung lining
  • Radiation to help shrink tumors and relieve pain through high-energy rays
  • Thoracentesis/paracentesis to help reduce fluid buildup by removing it with a small needle

Mesothelioma Staging Systems

TNM System

According to the ACS, the TNM System is the most commonly used staging system for pleural mesothelioma. The TNM System is regulated by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC).

The TNM staging system measures cancer progression based on the:

  • Size of the main tumor (T): How far the cancer has spread, whether it has spread to nearby chest areas, and whether it can be removed with surgery
  • Spread to nearby lymph nodes (N): Whether the cancer has spread to nearby lymph nodes
  • Spread (metastasis) to distant sites (M): Whether the cancer has metastasized to the bones, liver, or lung on the other side of the body

Numbers and/or letters after T, N, and M detail the progression of these three factors. For example, T1 describes a tumor that has not spread widely. Once a doctor determines a patient’s T, N, and M categories, they combine them to assign an overall stage (such as stage 2 mesothelioma).

Several other mesothelioma staging systems were previously used to diagnose the disease, including the Brigham system, Butchart system, and SEER staging system. However, most of these systems are no longer used to diagnose mesothelioma.

How is Peritoneal Mesothelioma Staged?

In some cases, peritoneal mesothelioma is staged using the SEER system’s LRD model and is classified by local, regional, and distant metastasis.

In 2011, Professor Tristan D. Yan proposed a unique TNM staging system for peritoneal mesothelioma.

The proposed TNM staging system for peritoneal mesothelioma is based on:

  • How far the cancer has spread beyond the abdomen
  • How far the cancer has spread within the abdomen
  • How much the mesothelioma is affecting the patient’s health

More research is needed before this proposal becomes an official staging system. In the meantime, doctors can stage peritoneal mesothelioma patients using the peritoneal cancer index (PCI).

The PCI involves examining 13 regions of the abdomen and assigning each a score of 0-3 based on the largest tumor size. Scores range from 0 to 39. A higher score indicates that the patient’s peritoneal mesothelioma is more widespread.

Diagnosing Stages of Mesothelioma

Doctors use imaging tests and biopsy results to make a mesothelioma diagnosis.

Imaging tests such as X-rays, MRI (magnetic resonance imaging) scans, and CT (computed tomography) scans can help doctors see the location and spread of a patient’s mesothelioma.

  • CT scans are detailed images of the body used to diagnose mesothelioma. These scans also help doctors find the exact cancer location and spread to determine the mesothelioma stage.
  • MRI scans use powerful magnets to look deep into the body’s tissues. According to the ACS, MRI scans may be helpful when determining if pleural mesothelioma has spread to the diaphragm.
  • PET (positron emission tomography) scans use a camera to detect radioactivity in a patient’s body. Before the scan, patients are injected with a low-dose radioactive sugar absorbed more quickly by cancer cells. The PET scan image can help doctors see if mesothelioma has spread to the lymph nodes or other areas.

Doctors often take PET and CT scans simultaneously to compare areas where the cancer appears to be concentrated (PET scan) with a more detailed image (CT scan).

These imaging tests are a critical part of a mesothelioma diagnosis since they help doctors decide the most effective treatments for each patient’s mesothelioma stage.


Prognosis of Mesothelioma Stages

A mesothelioma prognosis can be greatly impacted by the stage of the cancer. As the cancer spreads to other areas, there is less of a chance that the body will respond well to treatment. As a result, late-stage mesothelioma patients are less likely to achieve long-term survival.

Additionally, patients with late-stage mesothelioma may not qualify for aggressive surgery options that can greatly increase their life expectancy.

Mesothelioma life expectancy describes how long you can expect to live after being diagnosed. Life expectancy depends on a patient’s age, the type and stage of their mesothelioma, and overall health. Patients with early-stage mesothelioma have higher survival rates than those with advanced mesothelioma.

Life Expectancy by Stage

Stage Life Expectancy
Stage 1 21 months
Stage 2 16 months
Stage 3 19 months
Stage 4 12 months



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