Mesothelioma Survival Rates
All cancer cases are different, even in the same type of cancer there are many differences (especially regarding the nature of mutation) which along with individual factors like genetics, specificity of the immune system, environment, individual’s psychological approach towards the disease decides the survival rate. Although the majority of those diagnosed with mesothelioma may not live more than two years, nevertheless, many may expect to survive longer than five years. And then there are reported cases when a person continued to live even after 10-15 years of initial diagnosis – the so-called long-term survivors. Further, there is gender differences, and the survival rate in women is much higher, usually three times greater.
So why cancer is such a fatal disease? Cancer is a condition in which one or another body tissues starts growing uncontrollably, and they grow quite fast. This uncontrolled growth damages the surrounding and even far away organs, which ultimately leads to death. Mutated cancer cells are different in a way that they may also migrate to different parts of the body, and not only survive there, but may even thrive there – something that does not happen with healthy cells. Thus cells of the outer lining of lungs (called mesothelium) would never migrate or grow inside the liver, but malignant (cancerous/mutated) mesothelium cells may migrate to the liver and propagate there, thus disrupting its function.
Mesothelioma is the disease of the outer covering/lining of internal organs, like the outer covering of the lungs, liver, intestines, urinary bladder, testicles, and so on. When cancer occurs in the thin outer lining of internal organs, it becomes thick and big and thus causing pressure on the nearby organs. Worst, some of the mutated cells break away from the place and travel to other parts of the body and get seeded there. Once cancer has spread to far away parts it becomes challenging to treat.
One of the reasons that cancer like mesothelioma has short survival rate is that it remains almost symptoms less in the initial stages when cancer has just begun growing, and it is localized. Symptoms only start occurring when the tumor is big and starts disrupting the working of nearby organs, and at that time it has generally spread to other organs too – it is called metastasis. Thus survival rate depends on how widespread is cancer, something described in the staging of cancer (including mesothelioma).
Stages of mesothelioma
Staging is mesothelioma, or in fact, any cancer is significant and is the first thing that a specialist would do after the diagnosis, as both the prognosis and choice of treatment depends on it. Thus in stage one prediction is good and the doctor may think about the surgical removal of the tumor, while in stage 4 surgical procedure may have no value and mesothelioma may be treated with chemotherapy and other drugs. In staging, the doctor would consider the size of the tumor, whether it has spread to lymph nodes and if it has migrated to other parts of the body.
Two most commonly used systems to classify mesothelioma is the TNM system and number system. The TNM system is more informative while number system is easier to understand. In the TNM system, T (1 to 4) stands for tumor size, N (0 to 3) for nodes (lymph nodes), and M (0 or 1) for metastasis (a spread of cancer to other parts). Thus T2N1M0 means that tumor is quite big and it has spread to nearby lymph nodes, but it has not spread to other organs.
However, for ease of understanding doctors would generally tell the patient in which stage mesotheliomas is, that is a 1-4 stage. Stage 1 means that tumor is small, stage 2 says it is bit bigger and can be seen in nearby lymph nodes, stage 3 means that it is big and has spread to regional lymph nodes, while stage 4 says that mesothelioma is big and it has spread not only to regional lymph nodes but also to other parts of the body.
Although it is extremely rare to catch cancer in its earliest stages, nonetheless, it may happen sometimes. Most initial stage of cancer is called carcinoma in situ, it means that cancer has still not occurred, but doctors can see specific changes that show that a person may develop cancer if not treated. It is sometimes called stage 0.
Stage four of mesothelioma
Stage four is the last and most advanced stage, generally called deadly stage. In this stage mesothelioma is big, it can be seen in nearby lymph nodes and has even spread to other parts of the body. Thus cancer can be seen everywhere in the chest or abdominal cavity.
Since in stage 4 cancer is not localized, surgical treatment would not help. Even radiotherapy may have limited usefulness. In this stage, doctors would treat a patient with chemotherapy, as drugs can penetrate almost any part of the body. However, this does not mean that there is no hope at this stage, as individual differences still matter, and some people may go on living for long even with stage 4 cancer, though chances of long-term survival are very slim.
For most people treatment at this stage would be palliative, that is giving medications to overcome pain and other symptoms. Most people with stage 4 mesothelioma would not live more than 12 months. However, statistics show that about 7% may live for more than five years, meaning that hope is always there and the person should never give up. Moreover, with the improvement in cancer treatment, this long-term survival rate for advanced cancer would only get better.
The survival rate in mesothelioma
About half of those diagnosed with mesothelioma may expect to live more than two years if diagnosed early enough, while 10-16 percent may live for five years or more. If a person is diagnosed in the more advanced stage, the prognosis is worse, and only about 17-30% patients may live longer than two years, and about 7-8 percent may still expect to live longer than five years.
There are very long survivors too. A small number of patients may continue to live longer than 15 years after the initial diagnosis. Prognosis depends on various factors like age, gender, location of cancer, type of mutation, individual characteristics of the patient, and so on. Thus hope is always there, and one must never give up on treatment. In some cases, experimental drugs or alternative therapy may also help.
What affects the survival rate in mesothelioma
Age– it is an important factor in prognosis. Younger is the age at the time of diagnosis better is the forecast. Thus 55 percent of those diagnosed before the age of 50 may expect to survive one-year post-diagnosis, on the other hand, mere 30% may live more than one year when diagnosed after the age of 75 years. Reason for better survival is not only in the stronger body or better immunity, but younger patients are also a better fit for more aggressive treatment, they can better tolerate a surgical procedure. Whereas, a surgical procedure may not be an option at all in the older patients. However, mesothelioma is rarely diagnosed in people before the age of 50.
Gender is another predictor of survival rate, with epidemiological data indicating that women can expect much longer lifespan after diagnosis of mesothelioma then men. Analysis of data suggests that women may have an almost threefold better survival rate in comparison to men. Thus on average, less than 7 percent of men may survive longer than five years, while for women this number is higher than 15 percent.
There are many reasons why women can survive for longer than men with mesothelioma. But the biggest reason perhaps is that men are more probable to be exposed to higher doses of asbestos due to the nature of their job. More men work in mines, heavy industry, defense sector, and factories in comparison to women. On the other hand, women are more probable to be exposed to asbestos indirectly through the tiny asbestos fibers brought home by spouses or family members on their clothes or other ways. However, there is no clear explanation as to why women live longer with mesothelioma. Research indicates that women may expect to live longer than men even when diagnosed in more advanced stages of mesothelioma. Thus it must have something to do with female hormones too. Further, women are more commonly diagnosed with peritoneal mesothelioma, which has a higher survival rate and a better prognosis.
Ethnicity or racial background also matters. Research shows that Blacks and Hispanics have better survival rate with mesothelioma. One reason for it is that Blacks or Hispanics are much less probable to be diagnosed with just any type of cancer and not the only mesothelioma. Although race may not play much role in short-term survival, this difference becomes evident with time. Thus the five-year survival rate among whites is less than 8% while for Blacks it is higher than 12%. Further, research indicates that blacks survived for longer despite being less aggressively treated, blacks were also more probable to refuse surgical treatment (although surgical treatment has a better survival rate).
Survival also depends a lot on the cancer site. Thus peritoneal mesothelioma has a much better survival rate in comparison to pleural mesothelioma. Reason for better survival in peritoneal mesothelioma is that it is better treated. Peritoneal mesothelioma can be treated with hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC is a method that involves giving heated cancer drugs, which results in better penetration of drugs thus increasing their effectiveness. Before the advent of HIPEC, there was not much difference in survival rate between pleural and peritoneal mesothelioma. However, nowadays five-year survival rate with peritoneal mesothelioma is almost five-times higher when compared to pleural mesothelioma.
Stage of mesothelioma diagnosis affects the survival rate. Mesothelioma diagnosed at earlier stages can be treated much more effectively. Hence, much better survival rate. In early stages treatment would be a combination of surgical removal of the tumor, using radiotherapy to kill the remaining cells and then giving anti-cancer drugs (chemotherapy) to kill or subdue to cells that have escaped surgery and radiotherapy.
Finally, histological characteristics of mesothelioma are one of the most critical factors in predicting the future with cancer. Three main types of mesothelioma are epithelial, sarcomatoid, and biphasic (mix of epithelial and sarcomatoid). Epithelioid mesothelioma has best prognosis or survival rate while sarcomatoid has the worst survival rate. Average survival rate with epithelioid form is 12-24 months while for sarcomatoid it is mere 6-months. For biphasic type prognosis is better than sarcomatoid but worse than epithelioid.
Finally, it must be understood that science is not standing in one place, and researchers are now starting to understand why some patients survive much longer than others. Thus even in the same type of mesothelioma (let’s say pleural mesothelioma, epithelioid form), many sub-types exist. Some advanced tests can identify these sub-types; these tests can find more about the type of mutation that has caused that particular type of mesothelioma. Survival rate with a specific type of mutations may be much better than others even in the mesothelioma of same histological type. Therefore, the latest research shows that BAP1 mutation has almost 7-fold higher survival rate in comparison to other variations.
In conclusion, it can be said that mesothelioma is a rare type of cancer that is quite aggressive and has a poor survival rate. Nonetheless, things are fast improving, treatment and diagnostics are getting better. Now the medical specialists are much better at predicting outcomes in comparison to a few decades back. A better understanding of types and sub-types of mesothelioma also translates into better treatment approach and survival rate. Though slowly, but survival rate with mesothelioma is improving. Finally, it must be understood that some individuals can survive much longer than predicted and hope is always there. The secret of longevity with mesothelioma or any type of illness is never to give up, continue treatment, continue to discover various options.