the Mesothelioma Prognosis

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.

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