What Is the Prognosis for Mesothelioma?

The prognosis for mesothelioma patients is poor, with most people living less than a year after a diagnosis of mesothelioma cancer. The current five-year survival rate for the cancer is 12%. Factors affecting a mesothelioma prognosis include the stage of the disease, the patient’s overall health and the type of mesothelioma treatments received.

A mesothelioma prognosis is what doctors describe as a patient’s outlook. It is individual and also based on the average survival of other patients. Statistics play a role in prognosis, but every mesothelioma case is unique.

  • Survival Rates: Mesothelioma survival rates measure how long most people live with mesothelioma. Your prognosis is primarily based on the cancer’s average survival rates. The median mesothelioma survival rate is 12 to 21 months with treatment.
  • Life Expectancy: This term refers to the average age a person or population is expected to live based upon their location and other demographics. Mesothelioma can shorten a person’s life expectancy by several years or decades. It all depends on their age at diagnosis and how long they live with mesothelioma.
  • Death Rate: A cancer’s death rate, also called mortality rate, describes how many people die from the cancer. It plays a role when doctors estimate a patient’s prognosis. Mesothelioma mortality rates are often defined in relation to patient age, gender, race and state of residence.

Cancer treatment is one factor that patients can control. Ongoing treatment can help keep cancer under control. Some patients live more than a decade after therapy.

Factors Affecting Prognosis

The most important factors of a mesothelioma prognosis are origin site, cell type and stage. General health and other personal factors also play a role.

Mesothelioma Tumor Location

Research shows about 40% of pleural mesothelioma patients survive at least one year. Roughly 9% of patients with pleural type survive more than five years.

Peritoneal mesothelioma patients survive approximately six to 12 months without treatment. Patients eligible for surgery have a better prognosis. About half of peritoneal patients live longer than five years. These patients often receive surgery with heated chemotherapy.

The prognosis for the pericardial form is generally poor. About half of patients survive six months. Rare cases of five-year survival involve surgery and chemo. Testicular is the rarest type, and the prognosis is generally better. Average survival is around two years, but some patients may live more than a decade.

Histologic Cell Type

The types of mesothelioma cells that make up the tumor can impact your prognosis. Histology is the study of cell type and structure. Its role in mesothelioma involves how cell structure affects treatment. Identifying which cells are present is an essential part of diagnosing mesothelioma.

  • Epithelioid Cells: Patients with this cell type tend to live longer than those with other cell types. People with epithelioid tumors live an average of 200 days longer.
  • Sarcomatoid Cells: These cells are associated with the poorest prognosis because they are considered more aggressive and harder to treat. The average prognosis is six to eight months.
  • Biphasic Cells: The prognosis for this type depends on the ratio of sarcomatoid to epithelial cells. The more epithelial cells, the better the prognosis.

Biological factors may impact the typical prognoses associated with cell types. In a 2020 study from Oncology Reports, epithelial cell type correlated with a specific protein. Those with lower protein levels had a better prognosis. These patients also had more prolonged survival.

Cancer Stage and Metastasis

The cancer stage impacts prognosis because treatment becomes less effective in later stages. Doctors measure cancer stage by how far and deep tumors have spread.

Stage 1 patients who undergo surgery have a median life expectancy of 22.2 months. Stage 4 mesothelioma patients who undergo treatment have a median life expectancy of 14.9 months.

The four stages of mesothelioma include:
  • Stage 1A: Cancer has not yet reached the lymph nodes.
  • Stage 1B: Cancer has advanced into the chest wall, mediastinum or pericardium.
  • Stage 2: Cancer has spread to nearby lymph nodes.
  • Stage 3A: Cancer has reached the chest wall, heart lining and a lymph node on the same side.
  • Stage 3B: Cancerous cells have spread to lymph nodes opposite of the origin. The tumor may extend into one or multiple areas near the chest, spine or heart.
  • Stage 4: Metastasis sites typically include the liver, kidneys, bone, abdominal lining, inner lung or pleural lining on the other lung.

In the final stage, mesothelioma metastasis occurs if tumors spread to distant sites. About 10% to 50% of stage 4 mesothelioma cases develop distant metastases. Mesothelioma is more likely to spread near its origin.

Patient Health and Demographics

Younger people have a better prognosis with mesothelioma than older people. More than half of patients diagnosed under age 50 live at least a year with mesothelioma. Less than a third of patients diagnosed over age 75 live that long.

Gender has a significant impact on mesothelioma prognosis. Women with mesothelioma live longer than men.

Race also plays a role in mesothelioma prognosis. In 2013, the five-year survival rate was 8.7% for white patients and 10% for Black patients.


Average mesothelioma prognosis with treatment
Average life expectancy of mesothelioma patients who undergo treatment

Treatments that improve prognosis include surgery, chemotherapy and radiation. Newer options are immunotherapy and Tumor Treating Fields.

Surgery allows some patients to live years beyond the average one-year survival. About 20% of pleural patients have early-stage disease. These patients are more likely to qualify for surgery.

About half of mesothelioma patients who undergo chemo have tumor shrinkage. Some people see no new tumors for extended periods. Adding targeted therapy may improve survival by 12 to 18 months.

Clinical trials can improve prognosis through experimental drugs. These trials test the safety and benefit of new therapies. Some patients respond better to medicines still under investigation.

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Improving Prognosis

You can choose to be proactive and take steps to improve your prognosis. Although you can’t change your age or cancer stage, you can choose to seek treatment and a healthy lifestyle.

Clinical trials offer a chance to try new drugs or combinations of treatments. These may be more effective for you than conventional therapies.

A healthy lifestyle has a significant impact on prognosis. These changes can include exercising and a healthy nutrition plan. Gentle exercise and a balanced diet can ease side effects and cancer symptoms.

Support resources can help cancer patients overcome other challenges with a cancer diagnosis. Participating in support groups can reduce anxiety and emotional distress. They can also ease fatigue and pain.

“I would tell anyone who gets diagnosed with this disease, don’t just take the first advice you get and give up. Look around and see what is out there. “
Gene Hartline
Diagnosed with pleural mesothelioma in 2016

Remission and Recurrence

Doctors evaluating cancer prognosis also consider the chances of recovery. Remission is having no signs or symptoms of active cancer. It involves partial or full tumor decrease.

  • Remission is partial when the cancer shrinks in size. Partial remission usually involves at least a 50% reduction in tumor size.
  • Remission is complete when the cancer disappears entirely.

Complete remission is rare with mesothelioma. Partial remission is more common. Patients can live for years in partial remission.

Unfortunately, mesothelioma tends to recur even after remission. When mesothelioma returns, it tends to form near the original site.

Clinical Trials

Many clinical trials look for patients with mesothelioma recurrence. Doctors test new and innovative therapies on patients whose cancer has returned. These are second-line therapies that control cancer when it recurs.

Some clinical trials also investigate new ways to measure prognosis. In 2021, researchers examined a protein called programmed death-ligand 1 (PD-L1). They found that it plays a central role in an immune response. It may also help predict prognosis.

Survivors Who Surpassed Their Prognosis

Although recurrence is common, people diagnosed with mesothelioma are overcoming their initial prognoses.

It’s important to keep hope alive. Some survivors live years or even a decade or more past their initial prognosis.

Chris Gibney
Pleural mesothelioma survivor

Diagnosed in 2005, Chris Gibney far surpassed his pleural mesothelioma diagnosis. In March 2017, he and his wife welcomed a group of exchange students from Germany to their home. Gibney credits his excellent medical team and a family support group for surviving more than a decade past his prognosis.

Beth Mixon
Peritoneal mesothelioma survivor

At the time of Beth Mixon’s peritoneal mesothelioma diagnosis in 2000, the majority of patients lived less than two years after treatment. Despite a grim prognosis, Mixon is still going strong 17 years after an aggressive cytoredutive surgery.

Kasie Coleman
Peritoneal mesothelioma survivor

Diagnosed with peritoneal mesothelioma in 2010, Kasie Coleman underwent several cycles of chemotherapy and HIPEC treatments. Her cancer went into remission in 2012.

Common Questions About Mesothelioma Prognosis

What is the prognosis for mesothelioma?

The prognosis for malignant mesothelioma is poor. The 5-year pleural mesothelioma survival rate is 9.6% and the 5-year survival rate for peritoneal mesothelioma is 65%. However, emerging treatments and mesothelioma awareness are improving patient life expectancy.

Is mesothelioma always fatal?

Mesothelioma is not always fatal. A small number of patients have outlived their prognosis by more than a decade and died of another cause.

How can mesothelioma clinical trials improve prognosis?

Mesothelioma clinical trials support research with the goal of improving prognosis and finding a cure. These trials improve prognosis by discovering more effective treatment options.

How can a mesothelioma specialist improve prognosis?

Mesothelioma specialists have spent years learning about mesothelioma treatment, and they know how to treat the cancer better than general oncologists. Working with a specialist is the best way to improve your prognosis.

Will a positive COVID-19 diagnosis affect my mesothelioma prognosis?

The SARS-CoV-2 virus that causes COVID-19 significantly affects the respiratory tract and can cause permanent damage. Pleural mesothelioma patients have compromised lung function due to cancer surrounding the lungs and chest cavity. A COVID-19 diagnosis can worsen the prognosis for mesothelioma patients due to an increased risk of respiratory complications.

Could having the COVID-19 antibodies impact my prognosis?

The presence of COVID-19 antibodies in your blood indicates a previous infection of COVID-19 and a lower chance of reinfection. It may mean you have built some immunity to the disease and it might positively affect a mesothelioma prognosis. However, the World Health Organization cautions that the degree of COVID-19 protection is currently unknown.