If you’ve had any experience with cancer and cancer diagnoses, you know that the most common way in which doctors refer to the disease and its progress is in stages.
Though these numbers – Stages 1 through 4 – can be frightening, they present a true picture of the disease and the options for treatment and chance for a cure.
Malignant Mesothelioma is indeed measured in stages, just like other cancers. Doctors determine the stages of mesothelioma through a variety of testing options that might include:
• An MRI, CT, or some other type of imaging scan. These methods often provide a conclusive answer.
• Biopsy – When more information is needed to determine not only stage but the best form of treatment, a surgical or needle biopsy may be ordered. This is generally an outpatient procedure but could include an overnight stay if the patient is high risk.
Through the last few decades, the most commonly used system to determine the stages of any type of cancer is the Butchart System. This is also the one most frequently used to stage the pleural form of malignant mesothelioma, the most prevalent form of asbestos-caused cancer.
As previously mentioned, it includes four stages that can be described as follows.
• Stage 1 – In this earliest stage, mesothelioma has affected either the right or left side of the chest cavity/pleura and may also be found in the diaphragm. It is rare that mesothelioma is diagnosed at Stage 1.
• Stage 2 – The mesothelioma can now be been found in the pleura on both sides of the body and may have also spread to the stomach, heart, and esophagus, also on both sides. The lymph nodes may or may not be affected when the patient has Stage 2 mesothelioma.
• Stage 3 – The mesothelioma has reached the abdominal cavity – known as the peritoneum – and may involve the lymph nodes beyond the chest. Many patients are diagnosed when the disease reaches this point because symptoms become most prevalent.
• Stage 4 – The mesothelioma has spread to other organs of the body and has entered the blood stream. At this point, prognosis is grim.
Some oncologists are turning towards a different system for determining the stages of pleural mesothelioma, in particular.
This system, called the Brigham System, deals with “resectability”, a fancy word that refers to whether or not the patient is a candidate for surgery.
There are certainly similarities between the two systems. The stages are as follows.
• Stage 1 – The tumor is still considered resectable and the lymph nodes are not yet affected.
• Stage 2 – The tumor is still resectable but the lymph nodes are now involved.
• Stage 3 – The tumor is no longer resectable and the mesothelioma has spread to the heart, chest wall, abdominal cavity or diaphragm. Lymph nodes may or may not be affected.
• Stage 4 – The tumor is not resectable and the cancer has completely metastasized.
Stage 1 Options
To reiterate, mesothelioma is rarely diagnosed at Stage 1 because of the length of time it takes symptoms of the disease to appear. It is a rare and fortunate individual that is determined to have Stage 1 asbestos-related cancer.
Doctors and scientists hope, however, that with more sophisticated and accurate advance diagnostic procedures that more cases of the disease can be caught at Stage 1.
If you were to be diagnosed at Stage 1, you’d have a host of options available to you for treatment and you may be able to reach a cure or remission as treatments will be more effective. Stage 1 pleural meso is still contained to the lining of the lungs and, therefore, a combination of successful treatments may allow you to survive for many years after diagnosis.
For Stage 1 patients, the first recommendation will probably be surgery to remove the tumor or tumors. This is known as cytoreductive surgery and is usually successful in Stage 1.
Following the surgery might be a round of chemotherapy to ensure that all errant cancer cells have been eradicated.
Radiation may enter the picture as well and may be used before surgery in an attempt to shrink the tumor(s) or could also be used after surgery to help prevent recurrence.
Note that Stage 1 mesothelioma is sometimes divided into 1a and 1b based on the location of the tumors within the pleural lining of the chest.
The pleura has two layers – the parietal and the visceral. The parietal is the outer layer, closest to the chest wall. It is here that most tumors form.
This is considered Stage 1a. Sometimes, however, the tumors form on the innermost layer, the visceral. That is considered Stage 1b and is slighter harder to treat than 1a, simply because it is more difficult to reach the tumors.
Stage 2 Options
If you or a loved one has Stage 2 mesothelioma, you will know that the disease has likely spread at this point, encompassing other parts of the mesothelium and has traveled to the lung on the affected side.
Remember, however, that each case is a little different, despite being all lumped into one “stage”, so your cancer may not be the typical Stage 2. Only your team of doctors can determine the specifics.
In any case, many patients who have Stage 2 malignant pleural mesothelioma can be candidates for surgery. In medical terms, that means your cancer may be “resectable”.
However, whether or not one can undergo surgery to remove the tumor and the surrounding organs (lung, pleura, etc.) will be determined by a number of factors, including the overall health of the patient, how far the tumor has grown, and the subtype of the tumor (i.e. an epithelioid tumor may be removable but a tumor of the sarcomatoid subtype may not be).
If a patient is indeed a candidate for surgery, he or she may still require further treatment for cancer cells that are left behind.
This might mean a round or two of radiation or chemotherapy after the surgery. Also remember that this surgery can be quite complicated and requires a long recovery period, so it is something that should be carefully considered.
However, those who are healthy enough to survive surgery such as the pleurectomy or extrapleural pneumonectomy will certainly enjoy a better prognosis.
Lately, patients with Stage 2 peritoneal mesothelioma – which affects the lining of the abdomen – have seen a better survival rate after being treated with a multi-modal therapy that includes cytoreductive surgery – which removes as much of the tumor(s) as possible – followed by a procedure doctors refer to as HIPEC, Heated Interperitoneal Chemotherapy.
It has also been used rather successfully for other abdominal cancers.
For this procedure, oncologists bathe the abdominal cavity with chemo drugs that are heated in order to increase their efficacy. The medicine is delivered through inflow and outflow catheters that are hooked up to a perfusion system.
The procedure begins with the infusion of saline heated to about 105 degrees and continues as high-dose chemotherapy drugs are added.
The doctor in charge then massages the abdomen so the saline and drugs mix and reach all of the affected areas.
The chemo bath usually lasts for one to two hours. Studies show that as many as 65% of patients treated in this manner make it to the 5-year survival mark.
If you’ve been diagnosed with Stage 2 mesothelioma, ask lots of questions about your options. Educate yourself as to these options and choose those that are right for you and your loved ones.
Stage 3 Options
When an individual is diagnosed with Stage 3 mesothelioma, the tumor is “locally advanced” which means it has spread extensively in the area in which it originated.
Chances are that the lymph nodes are also involved at this point.
Treatment will be largely determined by the overall condition of the patient – considering health conditions beyond the cancer – as well as the age of the patient. Age is often a consideration because it takes so long for mesothelioma to manifest, with the median age of diagnosed patients around 69 years old.
If a patient is in overall good health, an aggressive multi-modal treatment will be recommended. It will most likely start with the suggestion of a procedure called an extrapleural pneumonectomy, a complicated and risky surgery that involves removal of the diseased lung, the lining around it, the diseased lymph nodes, the lining of the heart, and half the abdomen.
It’s a long procedure followed by a very lengthy recovery period. It does carry the risk of death, both during and after the surgery. Still, some patients opt to undergo the procedure when recommended.
The surgery will be followed by chemotherapy with Alimta® or another drug approved for the treatment of mesothelioma. This is meant to kill any remaining cancer cells.
As in other stages, radiation may be recommended to shrink tumors prior to surgery or may be offered afterwards to prevent recurrence.
Those who opt not to have surgery will most likely be treated with both radiation and chemotherapy and may choose to undergo some “palliative” treatments to reduce symptoms of the disease.
For example, many patients will opt for a thoracentesis, a procedure which drains fluid from the chest, reducing pain and easing breathing. Similarly, others choose a pleurodesis, a surgical procedure that introduces a talc-containing substance into the chest, which prevents the fluid from re-accumulating.
Unlike 10-20 years ago, patients at Stage 3 do have a chance to extend their lives for a few years at least, perhaps longer.
If you have been diagnosed with Stage 3 mesothelioma, you must carefully weigh your options to determine which treatments you wish to undergo or if you prefer not to deal with the additional pain and suffering these may cause.
If you’re unsure as to your doctor’s recommendations, get a second opinion about your treatment plan.
Stage 4 Options
Sadly, those individuals who are diagnosed with Stage 4 mesothelioma face a grim prognosis. At this stage, many treatments are ineffective.
Surgery is generally not an option because the cancer has advanced far beyond its primary location and usually involves both sides of the body, the lymph nodes, and other organs and parts of the body including possible the brain, spine, prostate, and pericardium (the lining of the heart).
By now, the patient is in a severely weakened state, generally in a good deal of pain, and usually must wear oxygen or be otherwise assisted in breathing.
The oncologist may suggest radiation or chemotherapy treatments in order to reduce the symptoms involved with Stage 4 mesothelioma and to make the patient more comfortable.
These treatments may also extend the patient’s life, but usually only for a few months. Hence, the patient must decide whether or not he wishes to contend with the often unpleasant side effects of treatments such as chemotherapy since it will only serve to extend his life by weeks, at the most.
Palliative care will be offered to the patient in Stage 4 who opts not to undergo chemo or radiation. Palliative care – also known as supportive care – is used to make the patient more comfortable and may include a pain management plan, respiratory therapies, and procedures such as thoracentesis to remove fluid from the chest.
Patients in Stage 4 (and other stages) may also opt to try out a few alternative or complementary therapies. These include homeopathy, nutritional supplements, acupuncture, massage therapy, meditation, and herbal medications. These can be used alone or sometimes in conjunction with traditional therapies.
Check with your doctor before started any other medications or supplements if you’re undergoing radiation or chemotherapy.
If you’ve been diagnosed with the disease , be sure you are well informed about the stages of mesothelioma. Try to locate a mesothelioma expert in your area, if possible, or considering traveling to a location where you can consult with a top mesothelioma doctor.
If you are unhappy with his/her recommendations for a plan of treatment and are convinced that there’s more to be done, no matter what stage, consider a second opinion.
This is YOUR life and YOUR treatment.
It’s important that you have confidence in your doctor and are onboard with your treatment plan.
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