Mesothelioma Prognosis

A prognosis is the predicted course an individual’s disease is likely to take. Mesothelioma prognosis is generally poor, with only around 10% of patients surviving 5 years after diagnosis. However, each patient’s prognosis is unique, with overall health, mesothelioma cell type, ability to undergo life-extending treatments, and many other factors playing a role.

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What Is a Mesothelioma Prognosis?

A prognosis is a prediction of the outcome or course of a mesothelioma patient’s disease.

A mesothelioma prognosis may depend on:

  • How advanced the patient’s mesothelioma is
  • Chance of recovery
  • Chance of the cancer coming back (relapse)
  • How fast the disease may progress
  • How long the patient is expected to live

Mesothelioma is a deadly form of cancer with a poor prognosis. However, each case is unique, and some mesothelioma patients survive longer.

Prognosis of Early-Stage Mesothelioma

To describe how advanced someone’s mesothelioma is, doctors use staging, with stage 1 as the earliest and least advanced and stage 4 as the last stage most advanced.

Early-stage mesothelioma patients are generally defined as those diagnosed with stage 1 or stage 2 mesothelioma. At these early stages, mesothelioma is still localized, meaning it is contained in the area of the body where it originated, and it is relatively small in size.

Early-stage mesothelioma patients in otherwise good health often make excellent surgery candidates. Because tumor removal (resection) is the most effective life-extending treatment for mesothelioma, early-stage patients usually have a much better prognosis than later-stage patients.

Late-Stage Mesothelioma Prognosis

Late-stage mesothelioma is usually defined as stage 3 and stage 4 mesothelioma. Stage 3 is also known as regional disease. Some stage 3 mesothelioma can still undergo resection.

The malignant mesothelioma prognosis for patients diagnosed in these more advanced stages is poorer — especially in stage 4 patients, whose mesothelioma has spread to other organs. Stage 4 is also called distant spread.

Once cancer has metastasized, it becomes nearly impossible to cure. However, some stage 3 and 4 mesothelioma patients may still be able to receive life-extending treatment, such as radiation and chemotherapy, to improve their quality of life and extend how long they live.

Quick Facts About Mesothelioma Prognosis

  • According to the Centers for Disease Control and Prevention (CDC), mesothelioma patients have a median survival of about 1 year from the time of diagnosis.
  • The average survival time for malignant mesothelioma of all types is 12-21 months.
  • One of the main reasons for mesothelioma’s poor prognosis is that over 65% of patients (according to data from the National Cancer Institute) are diagnosed after the cancer is already advanced.

Understanding a Mesothelioma Prognosis

The purpose of a prognosis is to give a doctor and patient a thorough understanding of the patient’s disease. This gives the individual with mesothelioma an idea of what to expect and lets them work with their care team to create the best treatment plan for them.

However, a prognosis is a prediction — not a certainty.

To make this prediction, a mesothelioma specialist will turn to data from past mesothelioma cases similar to the patient’s (same type and stage of mesothelioma at diagnosis, overall health, age, etc.).

Doctors usually stage mesothelioma using a staging system in order to get a good idea of how far the cancer has progressed. In the United States, the tumor-node-metastasis (TNM) staging system is the most widely used for most cancers, including pleural mesothelioma.

Under the TNM system, doctors determine how advanced a patient’s mesothelioma is by:

  • How large the tumors are
  • Whether cancer cells have reached the lymph nodes
  • Whether the mesothelioma has spread to distant parts of the body

Doctors may use other designations, such as localized, regional, or distant, or simply refer to the cancer as early or advanced. How advanced a patient’s cancer is and other factors determine a patient’s prognosis.

Prognosis vs Diagnosis

Prognosis and diagnosis can be easy to mix up, but they are quite different.

Before a doctor gives a patient their prognosis, they must make a diagnosis. A mesothelioma diagnosis is the identification and confirmation of a patient’s mesothelioma. It usually requires a piece of the cancer tissue obtained through a biopsy.

Once a mesothelioma specialist diagnoses a patient with mesothelioma, he or she assesses how advanced the patient’s mesothelioma is and other relevant factors. They can then obtain a prognosis — the estimated course a patient’s cancer will take.

A doctor may use several terms to give a patient a better idea of what their prognosis means for them.

Life Expectancy

The average amount of time doctors expect a patient to live after diagnosis is known as mesothelioma life expectancy. Life expectancy is typically part of a patient’s mesothelioma prognosis and is often measured in months.

The overall life expectancy for malignant mesothelioma of all types is 12-21 months.

Survival Rate

The percentage of people with mesothelioma who survive for a certain amount of time is known as the mesothelioma survival rate.

A patient’s survival rate is often measured in 1-, 3-, and/or 5-year increments after diagnosis and helps inform a patient’s prognosis.

According to the American Cancer Society (ACS), only 10% of pleural mesothelioma patients will live 5 years after diagnosis. Some of these patients will have been cured.

Death Rate

The mesothelioma death rate, or mortality rate, measures the ratio of deaths to the population of all mesothelioma patients.

The death rate is often used to see larger trends in a population, such as whether prevention or treatment measures are becoming more effective. Statistics, such as a sharp decrease in the mesothelioma death rate in recent years, enable a doctor to predict prognosis more accurately.

According to a 2017 report by the CDC, from 1999-2015, the mesothelioma mortality rate in the United States was roughly 8 deaths per million people.

The report noted, “Despite regulatory actions and the decline in use of asbestos, the annual number of malignant mesothelioma deaths remains substantial.”

Factors That Affect Mesothelioma Prognosis

Several factors may affect a patient’s prognosis, which is why patients should look to a mesothelioma specialist to get an idea of what they can personally expect.

Factors that affect mesothelioma prognosis include:

  • Age: Younger patients are often able to withstand more rigorous treatments and fight cancer more effectively, making their prognosis better on average.
  • Blood characteristics: Abnormal levels of white blood cells, red blood cells, and platelets are linked to shorter survival time.
  • Cell type: Epithelial mesothelioma is the least aggressive form of cancer cell, often responding better to standard cancer treatments like surgery and chemotherapy.
  • Sex: Women tend to live longer with mesothelioma and respond more positively to treatment than men. Researchers are still trying to determine why this is.
  • Mesothelioma type: Whether mesothelioma is pleural or peritoneal impacts on how it spreads, treatment options, and other important factors.
  • Stage at diagnosis: Early-stage mesothelioma patients often have a much better prognosis than those diagnosed at a later stage. Early-stage patients have the best chance of being able to undergo life-extending surgery.
  • Treatment options: Patients able to undergo surgery often have a much better prognosis than those who cannot. Surgery may greatly increase the effectiveness of some other cancer treatments like chemotherapy.

Other factors such as overall health may also impact mesothelioma prognosis.

Mesothelioma Prognosis by Type

Mesothelioma type has a great impact on the prognosis of a patient’s cancer. Peritoneal mesothelioma (cancer of the lining of the abdomen) has the best prognosis of all mesothelioma types, while pericardial mesothelioma (cancer of the lining of the heart) has the worst.

Pleural Mesothelioma Prognosis

Compared to other mesothelioma types, pleural mesothelioma generally has a better outlook than pericardial mesothelioma but a worse outlook than peritoneal mesothelioma.

Survival Rates for Mesothelioma by Type

Mesothelioma Type

1-Year Survival Rate

5-Year Survival Rate

Pleural 33%

5%

Peritoneal 92%

65%

Data was collected from a study of 10,000 patients published in the Journal of Thoracic Oncology.

Peritoneal Mesothelioma Prognosis

Peritoneal mesothelioma has the best prognosis on average of all mesothelioma types. There may be many reasons for this.

Peritoneal mesothelioma patients may live longer on average because:

  • Treatment: Patients may be better able to withstand more rigorous treatments in the abdominal area compared to the heart and lungs.
  • Cancer progression: Peritoneal mesothelioma seems to progress at a slower rate than other types and tends to remain in the abdomen instead of spreading to other areas of the body.
  • Demographics: Peritoneal mesothelioma patients also tend to be younger and have a higher proportion of females — traits associated with a better prognosis.

According to the 2014 study, Malignant Peritoneal Mesothelioma: Prognostic Factors and Oncologic Outcome Analysis, the median survival for peritoneal mesothelioma patients was 51.5 months for those with the epithelioid cell type who received cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC).

Pericardial Mesothelioma Prognosis

The prognosis for pericardial mesothelioma is extremely poor.

Between its rarity and location near the delicate heart, this mesothelioma cancer has the worst prognosis of all types. On average, 50-60% of pericardial mesothelioma patients do not live more than 6 months after diagnosis.

Testicular Mesothelioma Prognosis

Little is known about the extremely rare testicular mesothelioma. However, survival rates for the disease are typically high if caught before metastasis occurs.

49% of testicular mesothelioma patients can expect to live at least 5 years after diagnosis.

Mesothelioma Prognosis by Stage

In the case of a pleural mesothelioma diagnosis (the only mesothelioma type that has an official staging system), doctors will stage the cancer under the TNM system to determine how far it has progressed and give the patient a better idea of their prognosis.

Stage at diagnosis is one of the main factors influencing a patient’s mesothelioma prognosis.

Stage 1 Mesothelioma Prognosis

As the earliest stage, stage 1 mesothelioma has the best prognosis and the most treatment options. All other factors being equal, patients diagnosed during stage 1 have the longest life expectancy.

A 2019 study of 888 pleural and peritoneal mesothelioma patients found the median life expectancy of stage 1 patients was 20 months compared to 15 months for all 888 patients.

According to the American Cancer Society, 20% of mesothelioma patients diagnosed during the localized stage (similar to stage 1) lived at least 5 years after diagnosis.

Stage 2 Mesothelioma Prognosis

Stage 2 patients can also expect a comparatively good mesothelioma prognosis since their cancer has not spread to distant parts of the body and can often be surgically removed.

According to a mesothelioma literature review published in West Virginia Medical Journal, the average survival time for malignant mesothelioma of all types is 6-13 months overall and 6-18 months with treatment.

Stage 2 pleural mesothelioma patients can expect survival times on the upper end of that range.

According to the American Cancer Society, 12% of mesothelioma patients diagnosed during the regional stage (similar to stage 3) lived at least 5 years after diagnosis.

Stage 3 Mesothelioma Prognosis

Patients diagnosed at stage 3 have a relatively poor outlook. However, survival rates are better for stage 3 patients who can still have their tumors surgically removed.

Stage 3 pleural mesothelioma patients who get treatment often survive somewhere in the middle of the 6-18-month range reported by the literature review in the West Virginia Medical Journal.

Stage 4 Mesothelioma Prognosis

Mesothelioma patients diagnosed at stage 4 have the poorest prognosis. However, some stage 4 patients may extend their lives with chemotherapy and other treatments.

Unable to undergo the most effective life-extending treatment, surgery, stage 4 mesothelioma patients are often expected to live less than 12 months.

The ACS found that only 8% of pleural mesothelioma patients lived for 5 years after being diagnosed at a distant stage (same as stage 4).

Mesothelioma Prognosis and Lifestyle

Lifestyle factors — especially those that influence overall health — may influence a patient’s mesothelioma prognosis.

Mesothelioma patients may be unable to undergo life-extending surgery simply because doctors fear their bodies may not survive the rigorous operation. Poor health may also affect how well patients recover from cancer treatment.

Lifestyle factors that may affect mesothelioma prognosis include:

  • Poor nutrition or lack of exercise: Patients may develop health problems like diabetes and heart disease due to poor eating habits and/or not getting enough exercise. Such conditions may lower a patient’s overall health and even make them unfit for certain cancer treatments.
  • Stress: High stress levels may worsen overall health and delay recovery from treatments.
  • Smoking: Smoking decreases overall patient health, making it harder — or impossible — to undergo and recover from invasive treatments.

While lifestyle factors can have a big impact on an individual’s malignant mesothelioma prognosis, changing these factors may improve prognosis in some cases.

Mesothelioma Remission

Remission is the term doctors use to describe cancer that can no longer be detected in a patient’s body. However, going into remission does not mean a patient has been cured.

Mesothelioma is an incredibly aggressive cancer, and even the most thorough surgeries, chemotherapy sessions, and radiation treatments do not eliminate every cancer cell in a patient.

Some rare mesothelioma patients who receive early and effective treatment may, nonetheless, live for years without any signs of cancer. Eventually, however, the mesothelioma nearly always returns.

Mesothelioma Recurrence

Mesothelioma recurrence is a return of a patient’s mesothelioma after that patient went into remission.

A few remaining mesothelioma cells may lie dormant in a patient’s body for months or even years after treatment, going unnoticed by cancer detection technology.

Eventually, however, these cells begin to divide again, restarting the process of tumor growth.

With current medical technology, doctors, unfortunately, have no way to prevent this process, but they will closely monitor mesothelioma patients who have gone into recession and attempt to delay the process for as long as possible. New biological treatment may change this.

Improving Prognosis for Mesothelioma

A malignant mesothelioma prognosis is generally poor but may be improved through treatment. Lifestyle changes may also help mesothelioma patients live as long and as well as possible.

Improving Prognosis Through Treatment

Many mesothelioma patients respond well to a combination of surgery, chemotherapy, and/or radiation, surviving for months or even years after treatment.

The ability to undergo these potentially life-extending treatments is one of the biggest factors influencing a patient’s mesothelioma prognosis.

Mesothelioma Prognosis After Surgery

Mesothelioma patients in good health may be able to undergo surgery to remove as much of their cancer as possible.

According to the ACS, “surgery is more likely to have long-term benefits in early-stage cancers, where there’s a better chance that most or all of the cancer can be removed.”

However, after surgery, some cancer cells may be left behind, growing and dividing again. This makes mesothelioma surgery’s overall effectiveness difficult to determine.

Still, surgery combined with chemotherapy and/or radiation seems to lead to the longest survival times for most mesothelioma patients.

Mesothelioma Prognosis After Chemotherapy

Chemotherapy is most effective at extending the lives of mesothelioma patients when combined with surgery to either shrink tumors or delay the cancer’s regrowth.

However, some patients who cannot undergo surgery still experience tumor shrinkage or slowed growth with chemotherapy alone.

A 2015 study published in the journal Surgical Oncology reported that 19 peritoneal mesothelioma patients who underwent chemotherapy and surgery had a 100% 1-year survival rate and a 91% 3-year survival rate.

Mesothelioma Prognosis After Radiation

Radiation therapy may help shrink mesothelioma tumors before surgery or kill remaining cancer cells after surgery.

However, it may be difficult to treat mesothelioma with radiation therapy because the cancer does not grow as discreet tumors at which doctors can aim radiation.

Improving Prognosis Through Healthier Lifestyle

Patients should give themselves every advantage to get the best mesothelioma prognosis possible.

Mesothelioma patients may improve their prognosis by:

  • Eating well: Mesothelioma patients should be especially careful to follow the recommendations of care staff regarding their diet. Getting the right nutrition can boost the immune system, giving patients undergoing treatment the best chance of survival and recovery.
  • Exercising: Exercise has many benefits, including stress reduction, improved blood flow, and an increased chance of preventing secondary health issues like bedsores. Not all patients under treatment can muster the energy to exercise. Light aerobic exercise is usually the best tolerated.
  • Managing stress: A patient’s recovery time and overall health may be affected by too much stress, so patients should practice stress management with activities like meditation, mindfulness, yoga, and regular exercise.
  • Not smoking: Smoking harms a patient’s health in many ways, making it more difficult to maintain health during mesothelioma treatment or tolerate chemotherapy. Smoking may even reduce a patient’s health to the point where they cannot undergo life-extending surgery.
  • Seeking life-extending treatment: Many mesothelioma victims receive their diagnosis at a late stage, lowering the chance that they can undergo life-extending treatment. Individuals with a history of asbestos exposure should remain vigilant to increase their chance of an earlier diagnosis. They should take advantage of curative treatments as soon as possible.

Doctors are studying current and new treatment options daily. Emerging cancer treatment options may soon give mesothelioma patients far better survival rates or even a cure.

Beating the Odds of Your Mesothelioma Prognosis

A mesothelioma prognosis generally means doctors will not be able to cure the disease and that it will progress quickly. However, every case is different.

Some mesothelioma survivors have lived for several years with their cancer. Even though many of the factors influencing a mesothelioma prognosis are not controllable, there are steps patients can take to increase the odds of living longer than their prognosis.

Mesothelioma Support Team
Reviewed by:Dr. Mark Levin

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD has nearly 30 years of experience in academic and community hematology and oncology. In addition to serving as Chief or Director at four different teaching institutions throughout his life, he is also still a practicing clinician, has taught and designed formal education programs, and has authored numerous publications in various fields related to hematology and oncology.

Dr. Mark Levin is an independently paid medical reviewer.

Stephanie KiddWritten by:

Editor-in-Chief

Stephanie Kidd grew up in a family of civil servants, blue-collar workers, and medical caregivers. Upon graduating Summa Cum Laude from Stetson University, she began her career specializing in worker safety regulations and communications. Now, a proud member of the American Medical Writers Association (AMWA) and Editor-in-Chief of the Mesothelioma Justice Network, Stephanie serves as a voice for mesothelioma victims and their families.

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