After a diagnosis of mesothelioma by your doctor, one of the first discussions with the medical team will be about the prognosis of the case. Medical professionals often use a lot of terminology that non-medical lay people do not understand, and prognosis can be one of those terms. Your prognosis often dictates a substantial amount of what will happen in terms of treatment and outlook for your mesothelioma case.
When discussing the prognosis for a mesothelioma diagnosis, the doctor or medical team is referring to the likely outcome or course of the disease. Prognosis is also used when describing the chance of recovery or recurrence of the disease when it comes to a specific patient. A prognosis is often defined as good, favorable, bad, or poor based on specific factors associated with the patient and the mesothelioma cancer they are facing. A prognosis gives the patient a good idea of what to expect in terms of survival rates and helps to determine what treatment options are best for the case. Generally speaking, in many cases the prognosis for a mesothelioma diagnosis is poor, as there is no official cure for this illness; however, there are factors that may impact the diagnosis for the better.
Common Terms Used in Discussing Prognosis
When a doctor discusses the prognosis of a mesothelioma diagnosis, there are some terms that come up more often than others in the conversation. Some of these terms include the following:
The term “life expectancy” refers to the average age that a person is expected to live based on their age, location, and other demographic information. Mesothelioma often decreases a person’s life expectancy by years or even decades depending on when they are first diagnosed. Typically, the effects on a person’s life expectancy are dictated by the age of the person when they get mesothelioma and how long they live with the disease.
When discussing “survival rates,” the medical team is referring to how long patients typically live after receiving a mesothelioma diagnosis. Generally speaking, a prognosis is determined based on the survival rates of similarly situated patients who have also received mesothelioma diagnoses. For example, The National Cancer Institute found that between 2007 and 2013 the five-year survival rate for patients with mesothelioma was around nine percent.
Conversely, the “death rates” or mortality rates refer to how many people die from the disease. The death rates also often help determine a patient’s prognosis. When looking at mortality rates, medical professionals often factor in a patient’s age, race, gender, and state of residence to determine a mortality rate of similarly situated patients.
What Affects a Prognosis?
There are many factors that may ultimately impact a patient’s prognosis after a mesothelioma diagnosis. Some of these factors are internal, while others are external decisions made by the patient and their medical team. Prognosis is often affected by the following:
Prognosis by Type
The prognosis of a mesothelioma diagnosis can vary based on the type of disease. Pleural mesothelioma affects the lining of the lungs. Generally, the prognosis for this type of mesothelioma is termed bad or poor; however, some treatments like surgery and chemotherapy have been linked to a better survival rate.
Peritoneal mesothelioma affects the lining of the stomach, and generally the prognosis for this type of mesothelioma is better, and patients can receive a favorable prognosis if caught early enough. Survival rates are much longer for this type of mesothelioma, and this increases even more if the patient chooses to undergo treatment like surgery or hyperthermic intraperitoneal chemotherapy to directly target the affected area.
Rarer mesothelioma types, such as pericardial or testicular mesothelioma, also have varying prognoses. Pericardial mesothelioma affects the lining of the heart, and the prognosis is often poor for this type of the disease. In many cases, patients are not even aware that they have pericardial mesothelioma, and it is diagnosed postmortem. Conversely, testicular mesothelioma has a much better prognosis for patients, with common survival rates over five years.
Prognosis by Stage
The stage of mesothelioma when a patient is diagnosed also affects the overall prognosis for the medical case. This is arguably the most important factor examined when determining a prognosis for mesothelioma because the earlier that the illness is discovered the more treatment options are available. Stage 1 mesothelioma typically has the best prognosis, as the disease is caught early and most treatment options are usually available. Stage 2 mesothelioma has a slightly worse prognosis, but again most treatment options are available to help improve the prognosis for the patient. The prognosis for Stage 3 mesothelioma is worse than Stages 1 or 2, especially if the cancer has metastasized to other areas of the body. The worst prognosis is for Stage 4 mesothelioma, where the survival rate is the lowest and most treatment options are no longer available.
Prognosis by Cell Type
The type of cells that make up a mesothelioma tumor can also impact the prognosis in a case. Of the different cell types, epithelioid mesothelioma has the best survival rate and prognosis. These cells spread slower than others and are generally more responsive to treatment. On the other hand, sarcomatoid mesothelioma cells have the worst prognosis, as they are aggressive in spreading and are not as responsive to treatment like radiation or chemotherapy. Biphasic mesothelioma cells typically fall somewhere in the middle, with the prognosis varying based on which cell type is dominant within the mesothelioma tumor.
Studies have found that a patient’s nutrition can also impact the prognosis of a mesothelioma case. Poor nutrition in patients often results in a lower survival rate and poorer prognosis, while good nutrition tends to extend the survival rate and improve a patient’s prognosis. This is important because the risk of malnutrition increases with the progression of cancer, such as mesothelioma, which often results from some forms of treatment like chemotherapy. Weight loss before or after cancer treatment has been correlated to a worse survival rate, and consequently a worse overall prognosis.
However, a recent study found that mesothelioma patients who prioritized their nutrition during treatment improved their overall survival rate and prognosis. In this study, patients who increased their body weight by five percent during mesothelioma treatment lived about sixty percent longer than those who did not. Overall, a higher body mass index is associated with a better prognosis for mesothelioma patients than a lower BMI.
Medical specialists have recommended the following tips to help patients with mesothelioma improve their nutrition during and after treatment:
- Making nutritious smoothies,
- Optimizing meals – either multiple small meals each day or eating on a schedule,
- Snacking with a purpose on more nutritious options
If a mesothelioma patient notices that they are losing weight during treatment, they should speak with their oncologist and medical team about ways to improve their nutrition and prognosis.
Lastly, a patient’s demographics can play a large role in their overall prognosis after a mesothelioma diagnosis. For example, age plays a large role in prognosis, as the older a patient is the lower their survival rate for the disease. Gender may also play a role, as females typically have a higher survival rate and better prognosis than male patients. Race, state of residence, and prior medical history can all be factors in determining the overall prognosis for a mesothelioma case.
How to Improve a Mesothelioma Prognosis
Over the last few years, medical professionals have been working on new techniques to help improve the prognosis of mesothelioma patients. In addition to improving nutrition, two of the best ways to improve a prognosis is with early detection and treatment. Early detection is a critical method of improving prognosis because it allows a medical team to catch the mesothelioma tumor at an early stage. As discussed earlier, the lower the stage of mesothelioma the better the prognosis. This is important for anyone who has handled asbestos regularly during their career or knows that they encountered the substance in a meaningful way during their lifetime so that they get checked regularly for mesothelioma tumors as they age. This disease often takes years or even decades to manifest in a person’s body, which is why vigilance is key for early detection.
Engaging in treatment is another way to significantly improve the prognosis for a mesothelioma diagnosis. There are many different types of treatment available for this disease, which may be done individually or as part of a multimodal treatment plan. Some of the most common treatment types for mesothelioma include the following:
One of the most common treatments for mesothelioma is chemotherapy. Chemotherapy drugs kill cancer cells and prevent them from multiplying in a person’s body. As a result, this treatment option often shrinks mesothelioma tumors and limits new growth. This treatment often helps limit the spread of mesothelioma, thereby increasing patient survival rates and prognosis. Depending on the details of the case, chemotherapy can be done as an individual treatment or as part of a multimodal plan.
There are two main types of chemotherapy treatment: systemic and intracavitary chemotherapy. Systemic chemotherapy can be done intravenously, by injection, or in pill form. The medication travels throughout the bloodstream and reaches all parts of the body where the blood flows. As a result, this form of chemotherapy can kill healthy cells along with diseased cells, which is why a common side effect of this treatment is hair loss.
Intracavitary chemotherapy is a more targeted form of this treatment and often happens during surgery. A medical professional injects the chemotherapy directly into the affected area, such as the lining of the lungs or the abdomen. This often results in fewer side effects for the patient and allows the medical team to give a larger dose than with systemic treatment. If this option is done as hyperthermic, it means that the chemotherapy has been heated before injection, which some studies have indicated improves the effectiveness.
Another option for treatment to improve a prognosis for mesothelioma is immunotherapy. This treatment works by stimulating the patient’s immune system to attack and kill mesothelioma cells. The drugs help the immune system recognize and strengthen the response to these cells in order to identify and attack them. Some immunotherapy drugs have been approved by the FDA, but for most patients this treatment option is available as part of a clinical trial.
There are two main types of immunotherapies: passive and active treatment. Passive treatment introduces synthetic proteins into the patient’s body that trigger an immune response to help fight the cancer. This option typically requires multiple treatments to work, as the response is only temporary. Active treatment creates a lasting response in the immune system through immune memory. This activates the immune system to continuously act against cancer cells it identifies in the patient’s body. The most common types of immunotherapies specifically for mesothelioma patients include adoptive cell therapy, cancer vaccines, monoclonal antibodies, immune checkpoint inhibitors, and oncolytic viruses.
Radiation is a form of treatment that uses energy to kill cancer cells and limit the growth of mesothelioma tumors. The use of this treatment alone or as part of a multimodal plan has been known to improve the prognosis in patients. This treatment uses ionizing radiation to damage the DNA of mesothelioma cancer cells, as the damage kills the cells and prevents them from reproducing. Typically, radiation is more effective against fast-growing cells than slower-growing cells, but it can also affect healthy cells around the treatment area. Radiation can be used to eradicate cancer cells as well as minimize the symptoms of mesothelioma.
Typically, radiation treatment comes in two main forms: photon beam and particle radiation. Photon beam radiation is more common and uses the same type of energy as an X-Ray machine but at a higher dose. The photons release energy throughout their path through the body, hurting cancer cells and healthy cells alike. Particle radiation uses electrons or protons to deliver energy to the cancer cells and differs from photon beams because the particles only release energy at a specific distance from their source. This can target cancer cells more effectively and reduce damage to healthy cells.
Surgery is one of the most common forms of treatment to improve the prognosis of a mesothelioma patient. This option can be used to initially diagnose mesothelioma, remove cancerous tumors, or relieve accompanying symptoms. It can be done as an individual treatment or as part of a multimodal plan. Diagnostic surgery usually takes the form of a biopsy to confirm a mesothelioma diagnosis. Therapeutic surgery is used to remove as much of the cancerous tissue as possible from the patient. Generally speaking, surgery is used to improve the prognosis of a mesothelioma patient when they are in good health, in the early stages of cancer, and there is little to no metastasis.
Lastly, some patients opt for alternative treatments to manage their mesothelioma diagnosis. These options cannot cure mesothelioma, but they have been known to treat the symptoms associated with this cancer and can either be used on their own or as part of a multimodal plan with more mainstream treatments. Oftentimes, alternative treatments do not improve the overall prognosis for a patient, but they can serve as effective means of palliative care. Some of the most common forms of alternative treatment include the following:
- Chiropractic care,
- Osteopathic medicine,
- Craniosacral treatment,
- Transcutaneous Electrical Nerve Stimulation (TENS),
- Reflexology, and
Other Ways to Improve Prognosis
In addition to common treatment types, there are other ways that a patient may be able to improve their prognosis after a mesothelioma diagnosis. In addition to improving nutrition during and after treatment, clinical trials are another way to potentially improve the prognosis of a mesothelioma case. Clinical trials often offer new forms of medication or treatment that have not been fully approved but may be effective in treating the cancer. Exercising regularly also improves the prognosis of a mesothelioma patient, even if the exercise is not rigorous or at the same level that a patient was doing prior to their diagnosis. Many patients have also found that engaging in holistic and healthy mental health practices also improves prognosis, such as mediation, therapy, and yoga.
Remission and Recurrence
Part of a prognosis after a mesothelioma diagnosis involves the chances of remission or recurrence of the illness. There is no cure for mesothelioma, but remission is possible for this disease. Partial remission means that the tumor size has decreased at least thirty percent or more, while complete remission means that the cancer has been completely removed or destroyed in the body.
Medical follow-up is critical following treatment for mesothelioma, even if complete remission has occurred. Because the asbestos particles that cause mesothelioma are nearly impossible to remove from the body, the chances of recurrence at some point during a person’s life are likely. However, the prognosis of any recurrence is based on the same factors as an initial diagnosis, which is why early detection and treatment are key.