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Mesothelioma – What is a Stage 4 Prognosis?

It is important for people that have been diagnosed with Mesothelioma, and their families, to learn all about this disease and the survival prospects related to their prognosis. One aspect of medical care is the classification of Mesothelioma according to the various stages of progress of this disease. Expected average survival times at each stage also depend on a variety of factors, such as whether or not the cancerous cells can be removed.

Stages of Mesothelioma

Currently, there are 4 stages of development recognized in the treatment of Mesothelioma. Each stage of this fatal disease carries a predictive prognosis for average life expectancy. Physical exams, imaging tests, and biopsies are used to calculate the stages of Mesothelioma. A formal staging system is only available now for the most common affliction, pleural mesothelioma.

One large international study used data from participants suffering from pleural mesothelioma. This particular study, conducted by cancer.org, compiled statistics recorded from 1995 to 2009. The data collected reflected the average time it took for half of those patients to die during each of 4 stages related to the progression of the disease. Survival times for patients who could undergo surgery to remove cancerous cells were longer, while in cases where there was spreading of cancer cells and secondary tumors, the expected lifespan was shorter. The medians are a center point; half the patients lived for a shorter time and half lived longer than these median survival times.

In general, results were as follows:

Stage     Median Survival

I               21 months

II             19 months

III            16 months

IV            12 months

Understanding a Stage 4 Mesothelioma Prognosis

Knowledge about the expectations and potential relief available when there is a diagnosis of Stage 4 Mesothelioma is helpful for the suffering patients and for their loved ones. Median survival expectation for Mesothelioma patients at Stage 4 is only 12 months. Bear in mind, this is an average life expectancy; some patients will die sooner, others later.

What Happens at Stage 4?

At this level of progression, the cancer cells and secondary tumors may have migrated to other areas of the body. This would include larger sections of the chest wall, the diaphragm, heart lining and even in lymph nodes that are located away from the lung area. This is the most advanced stage of this disease. It is the hardest to treat and, in general, surgery is not an option. Most forms of treatment at Stage 4 are directed towards making the patient comfortable by easing symptoms and reducing pain. Chemotherapy and medications are useful for this period of treatment.

At this stage, any of several events may have occurred. The cancer may have spread from one side of the pleura lining of the chest to the other or into deeper layers of the wall of the chest, muscles or ribs. It may have grown into the peritoneum through the diaphragm, or it could be found in other organs like the heart, heart lining, spine or other areas near the original site. Also, it may have spread to lymph nodes, but not yet to distant sites. As it spreads, it is harder to locate and halt the disease.

Understanding Medical Terms

It also is important to understand the medical terms associated with Stage 4 Mesothelioma. The American Joint Committee on Cancer (AJCC) offers a method of description used by the medical community that helps to describe the growth and spread of pleural mesothelioma. This system is based on 3 areas of concern for treatment of this disease at Stage 4.

1.T = the extent that the main tumor has spread.

2.N = the extent that the cancer has spread to regional lymph nodes, the first place the cancer may spread. The lymph nodes consist of bean-shaped collections of immune system cells.

3.M = this indicates if the cancer has spread to other organs in the body; primarily the nearby pleura, lungs, and the peritoneum.

Doctors may determine the patient’s prognosis based on these factors. For treatment however, the doctors will generally just use a simpler value – is the cancer likely to be resectable or not. If so, all tumor cells that are visible can be removed by surgery. Generally, by Stage 4, it is too late to remove the cancer surgically. At earlier stages, surgical procedures may be effective, depending upon how far the tumor has spread.

Surgical approaches also take into consideration other factors, including its subtype, where it has spread, and the health of the patient. For surgery, only epithelioid and mixed/biphasic tumors are viewed as resectable. Even if surgery is conducted, in most cases, some cancer cells are overlooked or are not visible for removal. This is why other treatment forms like radiation therapy or chemotherapy may be used in addition to surgical procedures.

Additional Factors of Prognosis

While Stage levels are the primary factor used when doctors predict a patient’s outlook, other factors may contribute to lengthening survival times. There are many indications of a longer lifespan expectation that are associated with Stage 4 Mesothelioma, including the following:

  • Gender – females tend to fare better than males
  • Youth – younger patients may experience a better chance to have an extended lifespan
  • Performance Status – patients that are able to carry out normal daily life tasks have a better outlook
  • Epithelioid subtype – this can be beneficial if the type is one that can be resectable
  • No chest pain
  • Not having significant weight loss; overall health is good
  • Normal blood LDH levels
  • Red and white blood cell and blood platelet counts that are normal

Treatment Response

It is helpful also to understand what to expect as response to treatment procedures. By the time Mesothelioma cancer has reached Stage 4, it is the most difficult to treat. It has spread beyond the original point of origin to other areas of the body, and some cells may remain hidden and thus be overlooked during surgical treatments. The few remaining treatment procedures may not remove all tumors. The patient may also be too weak for aggressive surgeries. Their individual response to treatments is another unknown factor that will affect lifespan prognosis.

Stage 4 (also expressed as Stage IV) Mesothelioma is considered to be a terminal stage of this disease. However, advancements in palliative treatments continue to be developed. These newer treatments may allow the patient to live longer and enjoy a better quality of life during this final stage. Many patients diagnosed at Stage 4 outlive lifespan estimates by many years following their initial diagnosis. Palliative treatments, like chemotherapy and radiation treatments that are offered when surgery is not an option, can dramatically slow tumor growth and reduce tumor size.

Stage 4 Mesothelioma Symptoms

People suffering from Mesothelioma should understand the range of symptoms that may indicate this late-stage. While these are common to many ailments, if the patient has already been diagnosed with any stage of this disease, the following problems may signal additional progression of the disease.

  • Shortness of breath
  • Chest pain or tightness of chest
  • Fever
  • Night sweats
  • Abdominal pain
  • Fluid buildup in the chest or abdomen
  • Weight loss or Anorexia
  • Fatigue/Malaise

Dealing with Stage 4 Prognosis

Current research is ongoing, along with clinical trials for persons in Stage 1, 2 and 3. Stage 4 is the final stage, and most options for care during this stage are limited to palliative treatments to lessen symptoms and pain. Understanding this stage of a deadly disease can be very helpful to the patient and their loved ones.

By knowing what to expect and by the symptoms and treatments associated with Stage 4 Mesothelioma, patients and their families can manage care better and make the most of the final days. With this knowledge, some fear and dread is eliminated, even though the result will remain the same. With proper treatment, lifespan expectancy may be lengthened, and the patient can create and enjoy additional time with their loved ones than otherwise may occur. The end result will not be changed, but quality of life during Stage 4 can be improved.

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