Mesothelioma Stage 1

Summary

Stage 1 mesothelioma is the earliest stage of asbestos-caused cancer. Tumors have developed in the mesothelium but remain localized. In stage 1, patients have curative treatment options that can improve life expectancy by several months or years.

Overview of Stage 1 Mesothelioma

  • Least advanced stage of the 4 mesothelioma stages
  • Only pleural mesothelioma is officially staged 1-4, but similar staging criteria can be applied to the other disease forms (peritoneal and pericardial)
  • Referred to as a “localized” mesothelioma as it remains contained to its primary location
  • Stage 1 diagnosis is rare as most cases are diagnosed at stage 3
  • Patients rarely show symptoms in stage 1
  • Stage 1 mesothelioma has the best prognosis of all 4 stages
  • Doctors treat stage 1 mesothelioma with aggressive surgeries that remove tumors and tissues or organs

What is Stage 1 Mesothelioma?

Stage 1 mesothelioma is the earliest of 4 mesothelioma stages. It refers to the least-advanced level of disease progression whereby the tumors are still contained to the mesothelium—the tissue lining of the lungs, abdomen or heart.

When tumors develop in the mesothelium, they eventually start to grow and spread to distant sites beyond the point where they first formed—the primary location. The process of mesothelioma spreading to sites beyond the primary location is called metastasis. Because stage 1 mesothelioma has no metastasis yet, it is still considered resectable—removable by surgery.

Doctors detect and diagnose early-stage mesothelioma with various types of imaging scans. X-rays, CT scans, PET scans and MRIs all help doctors look inside the patient and see how far the mesothelioma has spread. By piecing together different image results, doctors can tell that the mesothelioma has not yet spread outside the primary location. With images, doctors also know the exact location to conduct surgery.

Stage 1 Mesothelioma Prognosis and Life Expectancy

The general prognosis (disease outlook) for mesothelioma is poor. However, if you’ve been diagnosed with stage 1 mesothelioma, then your prognosis is relatively good. Overall, the average life expectancy of mesothelioma patients is 12-21 months. Stage 1 pleural mesothelioma patients are at the higher end of this range.

The average life expectancy for stage 1 mesothelioma 21 months. Patients can significantly improve their prognosis with radical surgeries, chemotherapy and radiation therapy.

MJN Brief

For patients who are deemed good candidates for surgery (meaning they are healthy enough), life expectancy can improve even more. One study found that the 30-month survival rate for stage 1 patients who underwent resectable surgery for pleural mesothelioma was 60%. Some patients have even lived beyond the 5-year mark thanks to curative surgeries.

 

Stage 1 Mesothelioma Symptoms

Most patients show no signs or symptoms of mesothelioma during stage 1—a medical term called asymptomatic. With no signs or symptoms to report, it makes it very difficult for doctors to detect and diagnose mesothelioma at such an early stage. As a result, it’s extremely rare to be diagnosed with stage 1 pleural mesothelioma.

If you have been diagnosed with stage 1 pleural mesothelioma, here are some signs or symptoms you may be experiencing:

  • Dry, persistent cough
  • Chest pain
  • Fluid buildup in the chest (pleural effusions)
  • Shortness of breath
  • Slight difficulty breathing

With vague or undetectable signs, stage 1 pleural mesothelioma is commonly confused for pneumonia, bronchitis, emphysema or chronic obstructive pulmonary disorder (COPD). Because the mesothelioma hasn’t spread yet during stage 1, doctors rarely suspect malignancy (cancer) to be the cause of these general symptoms.

One of the ways that doctors may be led towards a mesothelioma diagnosis at stage 1, is if they can detect abnormal tissue masses or pleural effusions from a chest X-ray. Ninety percent of pleural mesothelioma patients experience pleural effusions, and it is considered an important indicator during diagnosis.

It’s important for all patients to report their history of asbestos exposure to their doctor. Because asbestos is the only known cause of mesothelioma, information about your work history involving asbestos products is critical information your doctors need to know in order to diagnose this rare cancer.

Stage 1 Mesothelioma Treatment Options

Stage 1 mesothelioma patients have many important treatment options. With the best outlook of all four stages, doctors view stage 1 pleural mesothelioma as a manageable and treatable disease in most patients. By detecting it this early, doctors can remove the mesothelioma completely and prevent it from recurring—coming back after treatment. It’s possible for stage 1 pleural mesothelioma patients to achieve remission, which is when there are no visible signs of mesothelioma.

No two cases of mesothelioma are the same, and treatments are individualized to each patient. While all patients treated by mesothelioma specialists get placed on a personalized treatment plan, there are standard approaches to treating stage 1 pleural mesothelioma, which include the following options:

Extrapleural Pneumonectomy

The most radical and aggressive surgery option for pleural mesothelioma patients, the extrapleural pneumonectomy (EPP) involves removing the affected lung. During the EPP, the surgeon removes the diseased lung, the pleura, part of the diaphragm, the pericardium and the nearby lymph nodes. EPP is only conducted on patients who are healthy enough to withstand such a drastic surgery, which are usually younger patients with no other health conditions.

The philosophy behind the EPP is that by removing the diseased pleura, surrounding tissues and the lung, you can prevent the disease from recurring in distant sites where microscopic cells may have spread to (such as into the lung, the pericardium or the chest wall). However, there is controversy over the whether the pros outweigh the cons with this aggressive surgery, which is why stage 1 pleural mesothelioma patients have another surgical option.

Pleurectomy With Decortication

Developed as an alternative to the EPP, the pleurectomy with decortication (P/D) is a lung-sparing surgery. During the P/D, the surgeon removes the diseased pleura, which is the lining that covers the heart. The pleura is where the tumor has formed in stage 1 pleural mesothelioma. By removing it, surgeons can prevent the mesothelioma from spreading outside the pleura and into the lung tissues or other distant sites.

There is debate in the medical community over which of the two surgeries offers the patient a better chance at long-term survival. Different studies have shown different results, but when compared, they all indicate that there is a similar survival rate for both surgery types. The ultimate decision about which surgery is better—EPP vs. P/D—is up to the patient and his or her medical team.

Chemotherapy and Radiation Therapy

Chemotherapy and radiation therapy are important parts of stage 1 pleural mesothelioma treatments. Both therapies can be given to patients in conjunction with surgery as a way to prevent mesothelioma cells from spreading to distant sites. Chemotherapy (anticancer drugs) is given to patients for several weeks following surgery to kill off remaining cells left behind.

Radiation therapy can also be used after surgery to kill remaining cells at the tumor site after surgery. Otherwise, radiation therapy can be given before surgery to shrink tumors and prevent seeding—when mesothelioma cells move around during surgery. When radiation therapy is administered before an EPP procedure, it’s called SMART—surgery for mesothelioma after radiation therapy. The SMART approach is showing promising results in extending the life expectancy of patients.

Stage 1 Mesothelioma Specialists

All patients should visit a mesothelioma specialist to confirm their diagnosis. Mesothelioma specialists have decades of experience researching and treating this rare cancer type. General oncologists do not have the expertise to accurately diagnose and treat mesothelioma because it is so highly complex.

If you’ve been diagnosed with stage 1 pleural mesothelioma, then you may be eligible for compensation. Mesothelioma patients are victims of asbestos exposure and can file claims against negligent manufacturers. Compensation can cover treatment costs as well as travel expenses to the top cancer centers in the country.

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Sources
  1. Canadian Cancer Society, “Stages of pleural mesothelioma.” Retrieved from: http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/staging/?region=on. Accessed on January 1, 2018.
  2. American Cancer Society, “Malignant Mesothelioma Stages” Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/staging.html. Accessed on January 1, 2018.
  3. General Thoracic and Cardiovascular Surgery, “Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma.” Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153961/. Accessed on January 1, 2018.

Last modified: February 3, 2018