The prognosis of people diagnosed with
pleural mesothelioma, a rare cancer of the lining of the lung, is
generally poor but it is slightly better than that of patients fighting
some other types of mesothelioma.About 10 percent of pleural mesothelioma patients live longer than
three years after being diagnosed. Of those survivors, half can expect
to live five years beyond diagnosis. Most mesothelioma patients
typically survive less than a year after learning they have the
disease.
One study found that the average pleural mesothelioma patient lives
for about 12 to 17 months after a diagnosis. This is longer than the
prognosis of the average mesothelioma patient, whose life span is
generally four to 18 months.
Many factors affect the prognosis of patients with pleural
mesothelioma, which is the most common form of mesothelioma cancer.
Chief among those factors is early detection and diagnosis. The
sooner pleural mesothelioma is confirmed by a doctor, the sooner an
appropriate treatment program, can be developed. If it is diagnosed
early enough a doctor may be able to employ curative treatment
techniques, which will have a huge positive impact on prognosis. If it
is not diagnosed early enough, then the available treatment options may
be limited to those that are considered palliative in nature,
treatments that reduce the impact of symptoms but are not expected to
have a major impact on the overall prognosis of a patient.
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Fundamentally, early detection and diagnosis is one of the more
important determinants of a prognosis. However, there are a number of
other factors a doctor will take into account when developing a
prognosis:
- the stage it is in
- the size and location of the tumor or tumors
- the cell type of the tumor
- a patient's symptoms
- a patient's age
- a patient's overall health
- a patient's gender.
- course of treatment
- a patient’s life style
Proper treatment
is also a major component of prognosis. Treatment typically means a
combination of surgery, chemotherapy and/or radiation therapy, and it
can improve someone's quality of life along with life expectancy.
Prognosis and the Stages of Pleural Mesothelioma
Because pleural mesothelioma is the most common form of
mesothelioma, it is by far the most researched. Unlike less common and
less researched forms of mesothelioma, researchers have developed a
staging system intended to assist doctors in developing a course of
treatment and help determine a patient’s prognosis.
The staging system ranges from Stage 1 to Stage 4. Each stage in the
system represents progression of the cancer. As pleural mesothelioma
progresses from Stage 1 to Stage 4 the tumor grows larger and begins to
move into other areas of the body. As this happens, it becomes much
more difficult to treat and therefore has a significant impact on a
patient's prognosis.
Unfortunately, the early stages of pleural mesothelioma, Stage 1 and
Stage 2, either have no symptoms at all or the symptoms are so mild
that they are often attributed to other, more common conditions. In
most cases, once symptoms are noticeable and un-attributable to other
conditions, the cancer has progressed into the later and more difficult
to treat stages, Stage 3 and Stage 4.
How Cell Types Affecting Prognosis
In addition to diagnosing the stage of pleural mesothelioma cancer, a
doctor will determine the type of cell that makes up the tumor.
Because each cell type can be an indicator of how aggressive the tumor
will spread and how well it will respond to treatment, doctors need to
know the cell type before developing a treatment plan and a prognosis..
Analyzed cells from the tumors will point to one of three main types of mesothelioma cells: epithelial, sarcomatoid or biphasic.
About half of all mesothelioma cases, including pleural
mesothelioma, are epithelial. This type of tumor is made up of fairly
uniformcells that are small or medium in size. The more organized cell
structure can lend itself well to more treatment options, leaving open
the possibility of potentially curative surgery. Epithelial tumors
therefore have the best prognosis overall.
Nonepithelial tumors can be significantly more aggressive and more
difficult to treat, leading to a worse prognosis. One study found that
men over the age of 50 — a demographic representing the majority of
mesothelioma patients — survived a median of 12 to 18 months with
epithelial tumors, but only nine to 12 months with nonepithelial
tumors.
Nonepithelial tumors are split into two subtypes: sarcomatoid and
biphasic. The sarcomatoid subtype, which accounts for 10 to 20 percent
of pleural mesothelioma cases, is the most aggressive form of the
cancer. It spreads quickly and reacts poorly to both chemotherapy and
is very difficult to surgically remove. The biphasic subtype, reported
in 30 to 40 percent of mesothelioma cases, is a mixture of the other
two. This means treatment and prognosis rely heavily on how much of the
tumor is epithelial versus sarcomatoid. If a majority of the tumor is
made up of the sarcomatoid cell type it is more likely to spread
aggressively and less likely to respond favorably to treatment.
Treatment Strategies that Can Impact Prognosis
Taking action against pleural mesothelioma, whether in the form of
conventional treatments or lifestyle changes, can change your prognosis
and increase your life span. When developing a treatment strategy,
your doctor will determine if you are elegible for potentially curative
treatments or palliative treatments. Your doctor can determine if you
are eligible for these treatments by evaluating the stage and cell type
of your cancer, while keeping in mind your gender, age and overall
health.
If you are eligible for a potentially curative treatment, your
treatment plan will usually be a form of multimodal therapy. Multimodal
therapy is any combination of surgery, chemotherapy and radiation
therapy. Alone, each of these treatments can improve life expectancy.
Combining them, however, has been proven to be very effective and is
associated with a higher survival rate than any one treatment alone.
- Surgery: The two most common types of surgery for pleural mesothelioma are extrapleural pneumonectomy and pleurectomy/decortication. Extrapleural pneumonectomy (EPP) removes the entire cancerous lung and affected nearby tissue. The loss of a lung has a significant impact on quality of life, but it can be effective in removing all or most of the tumor. Pleurectomy/decortication (P/D), on the other hand, leaves the lung intact and only removes the affected lining of the lung and lining of the chest cavity. Generally, P/D patients have a better prognosis after surgery and a better quality of life than those who undergo EPP.
- Chemotherapy: Chemotherapy drugs are designed to target cancer cells in order to stop their spread or kill them entirely. Chemotherapy alone is not as successful in mesothelioma as it can be in other cancers, but it can improve prognosis when properly combined with surgery and/or radiation therapy.
- Radiation Therapy: Radiation therapy uses high-energy x-rays or other radiation in order to stop the growth of cancer cells. Alone, it can be effective in providing relief from symptoms in mesothelioma patients. To improve prognosis, however, it should be combined with other forms of treatment.
Impact of Age and Gender on Prognosis
Besides the characteristics of the mesothelioma itself, your doctor
will also take into account your symptoms, age, gender and overall
health.These factors can affect your treatment options, prognosis and
life expectancy.
A patient's initial symptoms may affect prognosis and life
expectancy. Studies have shown that patients tend to live longer if
they initially show no corresponding weight loss or chest pain. These
two symptoms can mean that the tumor has grown within the chest cavity,
causing internal complications that may be more difficult to resolve.
Patients under the age of 50 who are relatively healthy tend to
respond better to treatment and have fewer complications. This can play
a major role in overall prognosis. Often, older patients or those with
pre-existing medical conditions do not have the same treatment options
as younger, healthier patients. Surgery, for example, may be too
risky, and recovery time for such treatment may be much longer. One
2010 study by The Society of Thoracic Surgeons tracked the survival
times for men with epithelial tumors and distinguished if they were
older or younger than 50 years old. Those over 50 had a median survival
of about 15 months, while the younger patients lived a median of about
22 months.
In addition to age, gender can play a key role in prognosis, as
women have been found to survive longer than men. Although the vast
majority of mesothelioma patients are men, long-term survivors tend to
be women. The same 2010 study explained that this observation is not
entirely understood, in part because there are so few female patients
that their prognostic factors are difficult to generalize. However, the
study did point to a number of possible explanations: women tend to be
younger at the time of diagnosis; women are more likely to develop
epithelial tumors than nonepithelial; and women tend to respond better
to treatments such as surgery.
Lifestyle Changes to Help Prognosis
Patients may choose to make personal lifestyle changes to boost prognosis, such as implementing dietary changes,
regular exercise and quitting smoking Adopting healthier eating habits
can boost overall well-being while easing pleural mesothelioma
symptoms. One 2007 study suggested that a ketogenic diet such as Atkins
or South Beach is helpful for fighting brain cancer because it is
effective in reducing overall caloric intake while also reducing
overall glucose levels. Tumors require glucose to grow rapidly.
The addition of certain fruits, vegetables, herbs and other foods
can boost nutrient levels and immunity in the body. These are
especially important in the recovery phase after surgery, chemotherapy
or radiation therapy. Among foods to add to a diet to improve prognosis
are:
- Broccoli and other cruciferous vegetables for antioxidants
- Fruits for vitamins, minerals, antioxidants and other nutrients
- Garlic for antibiotics
- Mushrooms to increase immune system response to cancer cells
- Nuts for protein, fiber and healthy fat
Exercise can also be beneficial for pleural mesothelioma patients.
The National Cancer Institute recommends keeping exercise levels up
during cancer treatment and recovery. It stated that three to five
hours of exercise each week can improve quality of life for cancer
patients by reducing fatigue, elevating mood and minimizing treatment
symptoms such as nausea.
Additionally, smokers should consider quitting. Smokers have not
been found to have higher rates of mesothelioma, and smokers who do
develop mesothelioma do not have any worse a prognosis than nonsmokers.
However, smoking does have a huge impact on lung function, which is
already compromised by mesothelioma. Quitting smoking has noticeable
effects on lung function and can therefore help reduce common symptoms
such as difficulty breathing.
Although pleural mesothelioma patients tend to receive a poor
prognosis, it is important to understand why they received that
prognosis and what they can do to extend their life expectancies. When
weighing your options, consider conventional treatments — surgery,
radiation therapy and chemotherapy — but also keep in mind the effects
of holistic approaches such as diet and exercise.
Learn more about how you can improve your prognosis and increase
your life span. Request a free book from the Mesothelioma Center by filling out this form. Choose between four books that discuss nutrition, dealing with mesothelioma and becoming a survivor.
Sources
- Agency for Toxic Substances and Disease Registry.(2006). Cigarette Smoking, Asbestos Exposure, and Your Health. Retrieved from http://www.atsdr.cdc.gov/asbestos/site-kit/docs/CigarettesAsbestos2.pdf
- American Cancer Society. (2011). Malignant Mesothelioma. http://www.cancer.org/Cancer/MalignantMesothelioma/DetailedGuide/malignant-mesothelioma-staging
- Boffa, D.J. &Rusch, V.W. (2006). Surgical and multimodality approaches to the management of operable malignant mesothelioma. In K. O'Byrne & V. Rusch (Eds.), Malignant Pleural Mesothelioma (267-296). Oxford: Oxford University Press.
- Edwards, J.G., Abrams, K.R., Leverment, J.N., Spyt, T.J., Waller, D.A., & O'Byrne, K.J. (2000).Prognostic factors for malignant mesothelioma in 142 patients. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1745842/pdf/v055p00731.pdf