Stage 1 Mesothelioma

What Is Stage 1 Mesothelioma?

Stage 1 mesothelioma is the earliest of mesothelioma’s four stages. These stages come from the tumor-node-metastasis (TNM) staging system — a globally recognized method for determining how far a patient’s cancer has spread.

Stage 1 mesothelioma may refer to two types of mesothelioma:

• Pleural mesothelioma: Malignant (cancerous) pleural mesothelioma is the only officially-staged type, using the TNM cancer staging system. At this stage, the cancer is only on one side of the chest and remains in the lining of the lung tissues. It has not yet spread to nearby lymph nodes or to distant parts of the body.
• Peritoneal mesothelioma: Peritoneal mesothelioma may also be categorized as stage 1 using a modified TNM staging system proposed by medical professor Tristan D. Yan and his associates. Stage 1 peritoneal mesothelioma has not spread past the lining of the abdomen.

Doctors know too little about pericardial mesothelioma to properly stage it. The disease may, instead, be described as localized, regional, or distant using the older LRD staging system or simply, early or advanced.

Additionally, treatment options for stage 1 mesothelioma are more promising because there are more options, including curative surgery. Symptoms in stage 1 are less advanced than later stages and are easier to control and manage. Unfortunately, because symptoms can be vague and gradual in onset, it is very rare to receive a stage 1 diagnosis.

How Stage 1 Mesothelioma Develops

Mesothelioma is notorious for its long latency period — the time that passes between being exposed to a cancer-causing substance and when symptoms first appear. After a patient is exposed to asbestos, the main cause of malignant pleural mesothelioma, this latency period lasts about 20-50 years.

Stage 1 mesothelioma develops after asbestos fibers get stuck in the lining of the lungs (pleura) or abdomen (peritoneum). These fibers irritate nearby cells, eventually damaging DNA and triggering out-of-control cell growth. This unchecked growth forms tumors on the lining of the organs.

The TNM staging system describes stage 1 pleural mesothelioma’s development using sub-stages.

Stage 1 pleural mesothelioma has two sub-stages of development:

• Stage 1A Mesothelioma: Stage 1A of the TNM staging system describes a pleural mesothelioma diagnosis in which cancer is only on one side of the chest, remaining only in the thin membrane covering the chest cavity. It has not yet reached the lining of the lungs (the pleura).
• Stage 1B: Stage 1B is slightly more advanced, describing pleural mesothelioma that remains localized to one side of the chest, but which has spread to the pleura as well as the chest wall lining.

As stage 1 mesothelioma develops, it may begin to cause mild symptoms that are still difficult to identify as signs of mesothelioma.

Stage 1 Mesothelioma Symptoms

Many patients do not experience any mesothelioma symptoms during the earliest stage of the disease.

However, some patients may experience the following stage 1 mesothelioma symptoms:

• Dry, persistent cough
• Chest pain
• Shortness of breath
• Tightness of the chest
• Body aches
• Fever
• Slight difficulty breathing

Fluid buildup in the chest (pleural effusions) may begin during stage 1, causing the above symptoms. However, these vague, mild symptoms are often mistaken for less serious illnesses such as a cold, flu, pneumonia, or bronchitis.

How to Identify Stage 1 Mesothelioma

Most mesothelioma patients have no symptoms very early into the disease’s progression, making it extremely difficult to identify stage 1 mesothelioma without medical equipment.

Stage 1 mesothelioma is usually discovered by accident in the course of doing tests for another medical issue or as part of regular cancer screening for a high-risk patient.

Patients may greatly increase their chances of catching mesothelioma early by telling their doctor about any asbestos exposure history they may have.

Stage 1 Mesothelioma Diagnosis

Doctors rarely make a mesothelioma diagnosis at stage 1 because patients either experience no symptoms or vague symptoms. This is because the tumor hasn’t spread yet, so the more severe symptoms haven’t started.

Even when someone with mesothelioma happens to get an imaging test done, the small stage 1 mesothelioma tumor may be hard to see.

However, two image scan features may alert doctors to stage 1 mesothelioma:

• Abnormal tissue masses in the chest area
• Pleural effusions

Seeing either of these in a chest X-ray may prompt a mesothelioma doctor to investigate further and perform a biopsy, hopefully leading to an early diagnosis.

Stage 1 Diagnosis and Staging Systems

When doctors are able to confirm that a patient has mesothelioma, they use a staging system to determine how far the disease has progressed.

Today, the most widely accepted mesothelioma staging system is the TNM system.

However, other systems exist, each with their own way of describing stage 1 or early-stage pleural mesothelioma.

Stage 1 Pleural Mesothelioma Diagnosis by Staging System

• Butchart System: The disease remains contained in the pleura.
• Brigham System: The disease can be surgically removed and has not yet spread to the lymph nodes.
• TNM System: The disease remains on one side of the chest in the lining of the chest wall. The pleura may be cancer-free (1A) or cancer may have spread to the pleura (1B).

While the Brigham system is not often used anymore, the Butchart system remains popular in some parts of the world.

Stage 1 Mesothelioma Prognosis

A mesothelioma prognosis describes the likely course the disease will take. Patients diagnosed with stage 1 pleural mesothelioma have a good prognosis, meaning they have a longer life expectancy based on higher survival rates.

As the earliest stage, stage 1 mesothelioma has the most treatment options. Catching the disease in its earliest stage allows doctors to provide treatments which can greatly extend your lifespan.

Stage 1 Mesothelioma Life Expectancy

Life expectancy describes the average amount of time a patient can expect to live after being diagnosed. Naturally, patients diagnosed during stage 1 have the longest life expectancy by stage.

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

Stage 1 Mesothelioma Survival Rate

A mesothelioma survival rate measures the percentage of people with the disease who survive for a certain amount of years after diagnosis.

As with life expectancy, patients diagnosed with stage 1 mesothelioma can expect comparatively high survival rates.

The tables below reflect mesothelioma life expectancy data from a 2017 study published in Lung Cancer International. Taken from over 11,000 patients from 1973–2011, it shows how the stage at diagnosis affects survival rates.

The study translated the TNM staging system into the LRD system in the following way:

• Localized: Stage 1 mesothelioma
• Regional: Stage 2, 3, and 4 mesothelioma that has not spread to distant body parts
• Distant: Advanced stage 4 mesothelioma that has spread to other parts of the body

This translation was applied to both pleural and peritoneal mesothelioma.

Survival Rates for Pleural Mesothelioma by Stage

Survival Rates for Peritoneal Mesothelioma by Stage

Stage 1 mesothelioma patients live longer, in part, because their early diagnosis allows them to seek critical life-extending treatment that may be unavailable to later-stage patients.

Stage 1 Mesothelioma Treatment

Stage 1 mesothelioma patients are usually good candidates for curative mesothelioma treatments — medical procedures performed to extend a patient’s life.

Surgery

In general, stage 1 patients are good candidates for mesothelioma surgery. At this stage, surgeons are usually able to completely remove all visible parts of a tumor.

Studies show that patients who receive surgery during stage 1 of pleural mesothelioma have survival rates between 10 and 24 months, although some patients have survived much longer.

However, many factors may influence whether a patient is a candidate for surgery:

• Stage: Tumors that are relatively small and contained in one area (localized) are more likely able to be surgically removed.
• Cell type: Many doctors believe only epithelioid and mixed/biphasic cell types may be resectable.
• Location: Tumors that form close to vital organs may be too risky to remove through surgery.
• Patient health: Surgery for mesothelioma can be dangerous and incredibly taxing on the body. Even if a patient is diagnosed early, if they are in poor health, surgery may not be offered as it would be unsafe.

Common stage 1 mesothelioma surgery options include:

• Extrapleural pneumonectomy (EPP)
• Pleurectomy with decortication (P/D)
• Cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC)

Although surgery is often effective for stage 1 patients, it may leave behind cancer cells that are not visible to surgeons. These cells quickly re-form tumors. As such, most doctors will also recommend chemotherapy or radiation to destroy the remaining cancer.

Chemotherapy

Chemotherapy, a type of cancer treatment that uses special drugs to kill cancer cells, is often used alongside surgery in stage 1 mesothelioma treatment plans.

Chemotherapy may be used for stage 1 mesothelioma treatment to:

• Prevent mesothelioma cells from spreading before, during, or after surgery
• Kill off remaining cancer cells left behind after surgery

Many patients respond well to a combination of surgery and chemotherapy, potentially remaining disease-free for several months and surviving for years after treatment.

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.

Radiation Therapy

Radiation, a therapy that uses radiation to control or kill cancer cells, is sometimes used to treat mesothelioma.

Radiation therapy may be used for stage 1 mesothelioma treatment to:

• Kill remaining cells at the tumor site after surgery
• Shrink tumors to make surgery easier
• Prevent mesothelioma cells from being spread around the body during surgery

Before performing an EPP, mesothelioma specialists often use a practice called Surgery for Mesothelioma After Radiation Therapy (SMART). This approach seems to be effective at extending patient life.

A 2014 25-patient study published in the Journal of Thoracic Oncology found that, of the pleural mesothelioma epithelial cell type patients who underwent SMART, 84% had a 3-year survival rate.

Other Treatment Options

Stage 1 mesothelioma patients in good health usually turn to traditional treatment options to get the best results.

However, not all patients diagnosed early are good candidates for curative treatment options. These individuals may turn to clinical trials and the emerging therapies they offer in hopes of extending their lives.

Some emerging mesothelioma treatments include:

• Anti-angiogenesis
• Gene therapy
• Immunotherapy
• Photodynamic therapy

Patients seeking clinical trials should be aware of their cancer’s stage since many trials only test treatments on patients whose mesothelioma has progressed a certain amount.

Localized vs Advanced Stages of Pleural Mesothelioma

When comparing stage 1 pleural mesothelioma to its later stages, the primary difference is how much the mesothelioma has spread.

Stage 1 is still considered localized, meaning the tumor is contained to the part of the body where it started. With pleural mesothelioma, this means it’s contained in one of the layers of the pleura, the thin, doubled-lined layer that covers and protects the chest cavity.

In the more advanced stages of mesothelioma, the tumors spread to other parts of the body.

Improving Your Stage 1 Mesothelioma Prognosis

The rare patient who receives a stage 1 mesothelioma diagnosis has an advantage when it comes to treatment options. However, even when caught in its earliest stages, mesothelioma is an aggressive disease with a poor overall prognosis.

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

Stage 1 mesothelioma patients may work toward a better prognosis by:

• Eating well: Many peritoneal mesothelioma patients may struggle to meet their nutritional needs as their cancer progresses. However, getting the right nutrition boosts the immune system, giving patients undergoing treatment for any type of mesothelioma the best chance of survival and recovery.
• Exercising: Exercise may decrease stress, improve blood flow, and help prevent bedsores and other secondary health problems.
• Managing stress: High stress levels may affect overall health and patient recovery from treatments.
• Not smoking: Smoking decreases overall patient health, making it harder — or impossible — to undergo and recover from invasive treatments. Smoking may also lead to another cancer diagnosis, decreasing life expectancy.
• Seeking life-extending treatment: Many mesothelioma victims are diagnosed late in their cancer progression, leaving them unable to undergo radical treatments that may extend their lives by several months or even years. Patients diagnosed early should take advantage and seek curative treatments while they are able.

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.

Treatments at any stage can improve life expectancy and quality of life. Talk to your health care team about what you can do to improve your prognosis, including seeking a second opinion and participating in clinical trials.