Medically Reviewed by: Muaiad Kittaneh, MD, FACP, MBA | May 20th, 2020
There are four stages of pleural mesothelioma. Peritoneal and pericardial mesothelioma doesn’t have a formal staging process. With stage 1 pleural mesothelioma, the patient has the most treatment options available. Doctors will use one of three different staging systems to determine how far the tumors have spread. Of the three systems, the most commonly used for pleural mesothelioma is called the TNM system. When cancer is at this early stage, the patient may not notice any symptoms. Usually, when a doctor diagnoses mesothelioma, it’s at stages 3 or 4, when symptoms are more prevalent.
As with other forms of cancer, stage 1 mesothelioma is the least advanced stage and often carries the best prognosis. At this stage, the tumors are localized, meaning they haven’t spread to other parts of the body.
When caught early, this type of cancer can be treated with a multimodal plan of surgery, chemotherapy, radiation, or immunotherapy. Although there’s no cure, doctors can remove the majority of cancerous cells through resection (surgery to remove the tumors), as well as prevent the growth of new ones. Life expectancy, when treated, can span from 21–40 months.
Unfortunately, mesothelioma is seldom diagnosed in stage 1. This is mainly due to the fact that symptoms do not present themselves until the disease has already begun to spread throughout the body. Even when symptoms are present, they can mirror those of less severe conditions like pneumonia. In the secluded instances when it’s caught early, it’s usually by accident and the patient is being examined for another reason.
Financial Assistance for Treatment
Details surrounding stages can differ depending on their location in the body.
This cancer is staged like many other cancers on a 1 through 4 scale. For pleural mesothelioma cases, doctors use one of three staging systems — the Butchart system, the Brigham system, or the TNM system.
The TNM system is recommended when staging pleural mesothelioma. T refers to the size of the primary tumor, N refers to the number of affected nearby lymph nodes, and M refers to the extent of metastasis (spread).
Stage 1A
Stage 1B
Of the approximately 3,300 cases of this disease diagnosed per year, only about 660 cases occur in the peritoneum. Due to the rarity of this form of the disease, there is not an established staging system for peritoneal mesothelioma. Doctors typically use the American Joint Committee on Cancer (AJCC) 1 through 4 staging scale or the Peritoneal Cancer Index (PCI) when diagnosing this type of disease.
PCI has become the preferred method for staging peritoneal mesothelioma. It scores the extent and spread of the cancer on a 0 through 39 range. A patient’s PCI can help doctors assess whether or not they are eligible for treatment. Lower scores typically exhibited in stage 1 mesothelioma indicate less aggressive cancer, smaller tumors, and an overall better prognosis. Patients with low PCI scores tend to be candidates for invasive treatments. At stage 1, the PCI ranges between 1 and 10.
When tumors develop on the lining of the heart sac, it’s called pericardial mesothelioma. This is extremely rare, accounting for less than 5 percent of all cases. As a result, there is not a formal staging system for this form of the disease. Doctors can use the AJCC staging scale; however, because the pericardial form is so aggressive, it is often diagnosed in advanced stages or after the patient has passed away.
As with other aggressive cancers, patients with stage 1 mesothelioma typically exhibit few or no symptoms. It is for this reason that most patients go undiagnosed at this stage. When symptoms do manifest, they may be mistaken for other conditions, such as pneumonia or the flu.
Stage 1 symptoms can include:
Survival rates for any form of cancer are calculated using statistics from other patients with the same or similar conditions. The rate demonstrates how long other patients have typically survived after their diagnosis.
Patients with stage 1 mesothelioma who receive treatment generally have a survival rate between 21 and 40 months. However, because this is illness is scarce, research is scarce and every case is unique. Survival rates also vary by histologic subtypes. Some genetic factors may alter the overall prognosis of the patients. Improved treatment options have also correlated to improved survival rates.
Doctors typically treat stage 1 with a multimodal treatment plan that includes a combination of surgery, chemotherapy, radiation, and immunotherapy. While stage 1 patients generally have the greatest range of treatment options, they must be healthy enough to undergo a radical treatment plan.
Patients may also be eligible for clinical trials. Researchers hold clinical trials as a means to test new treatments and emerging drugs. Talk to your doctor about whether clinical trials are a good solution for you.
Our team of authors collaborates with the advocate team, focusing on writing about asbestos exposure and mesothelioma to spread awareness. They are dedicated to supporting families within the mesothelioma community.
Dr. Muaiad Kittaneh, MD, FACP, MBA, is a medical oncologist and assistant professor at Loyola University of Chicago. His journey in healthcare includes Internal Medicine training at Advocate Christ Medical Center/University of Illinois of Chicago, where he excelled as Chief Resident. Dr. Kittaneh further honed his expertise at the University of Miami.
Dr. Kittaneh has conducted extensive research and assisted in many clinical trials. His notable contributions have been published in journals across the United States, which focus particularly on breast, melanoma, and gastrointestinal cancers. As an expert medical reviewer, Dr. Kittaneh plays a crucial role in shaping and evaluating Mesothelioma Hub’s content, ensuring accuracy and relevance in the field.
American Cancer Society. (2018). About Malignant Mesothelioma. Retrieved on July 19, 2018, from https://www.cancer.org/content/dam/CRC/PDF/Public/8733.00.pdf
Bonomi, Maria; et al. (2017). Clinical Staging of Malignant Mesothelioma: Current Perspectives. Retrieved on July, 25th, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571821/
Faig, Jennifer. (2015). Changing Pattern in Malignant Mesothelioma Survival. Retrieved on July, 25th, 2018, from https://www.sciencedirect.com/science/article/pii/S1936523314001363
Mayo Clinic. (2019). Mesothelioma. Retrieved on September 30th, 2019, from https://www.mayoclinic.org/diseases-conditions/mesothelioma/symptoms-causes/syc-20375022
National Cancer Institute. (2019). Malignant MEsothelioma Symptoms, Tests, Prognosis,. and Stages (PDQ®)—Patient Version. Retrieved on July, 25th, 2018, from https://www.cancer.gov/types/mesothelioma/patient/about-mesothelioma-pdq#section/_26