The Four Stages of Mesothelioma: What Each Stage Means for Treatment, Prognosis, and Legal Timing

Mesothelioma is not a very common form of cancer. Only about 3,000 individuals in the United States are diagnosed with it. The disease appears to have a 5-year relative survival rate of 12% and a median survival period of 12 to 21 months. Out of 80% male patients who have mesothelioma, the average age of occurrence is 72 years, and 75% have pleural mesothelioma.

According to North Carolina mesothelioma wrongful death lawyer William M. Graham, being diagnosed with mesothelioma after asbestos exposure caused by another party’s negligence can make an individual eligible to file a personal injury claim or workers’ compensation claim.

When diagnosed with mesothelioma, you start asking yourself questions regarding the treatments, life expectancy, and other relevant matters. One of the major aspects in the treatment process that the doctor takes into account is the stage of the cancer. When identified, the cancer stage serves as the baseline for what actions should be taken after.

The development of mesothelioma is almost a direct result of asbestos exposure. Since the effects of such exposure are latent, it is a common occurrence for the disease to be detected after an extended amount of time has passed since the introduction of asbestos materials.

Let’s look at the step-by-step guide to the four stages of mesothelioma to understand how to effectively deal with the disease.

How Staging Works

For pleural mesothelioma, which occurs in the lining surrounding the lungs, doctors rely on the TNM staging system.

T stands for the tumor’s size and extension. N represents involvement of the lymph nodes that are close by. M stands for any distant metastases. All three factors put together make up stages 1 to 4.

There is quite a range in terms of the prognosis at these stages. Median overall survival goes from approximately 21 months at stage 1 to 12 months at stage 4, as can be seen in data compiled in StatPearls.

Stages 2 and 3 have median survival figures of 19 and 16 months, respectively. This variation is attributed to the early signs of the disease being relatively minor and are often misinterpreted.

Stage 1: Localized Disease and the Widest Treatment Window

In the first stage, the cancer is within the pleura of one lung and is localized. The cancer has not spread to other parts of the body, including the lymph nodes, lungs, diaphragm, and chest wall.

Symptoms of stage 1 mesothelioma are very few and include dry cough, slight difficulty in breathing, and mild general fatigue. These symptoms can be easily passed off as simply being part of aging and catching a common cold. This reason is why stage 1 cancer is particularly difficult to diagnose and is usually not detected during regular medical tests.

This stage is when you have the widest choice. The procedures available for you at this point include surgery in the form of either an extrapleural pneumonectomy or a pleurectomy with decortication in addition to chemotherapy or even radiation.

Stage 2: Limited Spread, Surgery Still on the Table

At stage 2, the growth has spread to the outside. This could mean that the growth has extended to the lungs or the diaphragm. As of now, the cancer has advanced to the lymph nodes located in the chest.

The onset of early mesothelioma will become more obvious and feature symptoms such as chest tightness, dyspnea, and fatigue.

In clinical terms, pleural effusion is the buildup of fluid in the chest cavity and it is for this reason that one needs to see a doctor.

Daily activities can still be done at this level, but again, the degree of the activity will depend on how far the tumors have invaded the surrounding tissues.

Stage 3: Locally Advanced Disease and a Change in Strategy

Stage 3 is an important stage in the development of patients. At this stage, the malignancy has already extended beyond the organ itself into the other organs of the body, namely the chest wall, esophagus, pericardium, and lymph nodes from both sides of the chest. Metastasis to remote organs has not been observed and the tumor can be too large for an operation.

At this stage, symptoms have already become more severe. They include persistent chest pain, difficulty breathing, weight loss, problems with eating, and repeated effusion requiring draining. Surgical curing of the disease does not seem like an appropriate solution anymore but there are specialized hospitals where operations on this disease are carried out occasionally. Regimens for wide-ranging treatment of pleural mesothelioma may include the use of chemotherapy drugs such as pemetrexed and cisplatin. Alternatively, immunotherapy may be combined with chemotherapy. All these therapies can vary according to the patient’s health and personal needs.

The clinical study known as CheckMate 743 unveiled that patients diagnosed with unresectable pleural mesothelioma and who followed a combination of nivolumab and ipilimumab experienced a mean survival period of 18.1 months. As a response to these conclusions, the drug was granted FDA approval for certain categories of patients in 2020.

Stage 4: Metastatic Disease and a Palliative Focus

At stage 4 the disease is moving from the lungs to some other organ or tissue such as the brain, liver, bones and other body parts. Progression to this stage means a surgical operation is no longer an option. The goals of care maintenance at this point are to decrease suffering and enhance comfort.

Dyspnea, chest/abdominal pain, weight loss, and fatigue may be common symptoms, with pleural effusion requiring frequent drainage. On average, the survival time without treatment may be one year, but some patients under immunotherapy drug combinations have survived far beyond.

According to the National Cancer Institute, a person should explore the option of participating in a clinical trial at any stage of cancer, particularly at stage 4, where immunotherapy has been studied in clinical trials.

Why the Stage Also Governs Legal Timing

In most cases, the stage is determined at the first consultation when one is diagnosed with cancer. The problem that arises here is the fact that the countdown has already begun, and with the advancement of the condition, the available time for treatment becomes less.

Stage is irrelevant to one’s legal standing in the case. A person who is diagnosed with stage 4 cancer has the same legal standing as a person who is diagnosed with stage 1 cancer.

The only thing that stage classification does is give the involved parties an idea regarding how to handle the disease. When one is diagnosed early, he or she has time to carefully think all the available choices and plan accordingly. When the patient is in stage 3 or 4, he/she needs to study his/her options in relation to the time available and the current treatment regimen.

The cancer stage alters the type of legal claim one can make. If the patient dies before the filing of a personal injury claim, the relatives may pursue a wrongful death claim instead.

Staging Is Orientation, Not a Ceiling

These four stages are just a common language and not a prediction of anyone’s fate.

The survival statistics mentioned by the American Cancer Society are an average of statistics that were gathered a few years ago from patients [who were diagnosed earlier]. Every person’s survival depends on the kind of cancer they have, the health status, and the treatment facility attended. Access to new drugs also influences the patient’s survival.

Some people with stage 4 cancer survive much longer than expected. And some people with stage 1 cancer experience difficulties reducing their survival period.

Staging assists you in making an estimation of your situation, forces you to frame more targeted questions and makes you appraise various available options of treatment. Knowledge of the stage of one’s cancer helps an individual become familiar with the fact that legal deadlines are quite independent from other deadlines.