Stage III Mesothelioma

Where Stage III Mesothelioma is Located

At stage III, the cancer has spread throughout the lung lining and chest on one side of the body. Curative surgery is usually still an option, if the cancer is resectable, along with other treatments such as radiation and chemotherapy.

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  • Treatment with surgery is recommended to patients in good health.
  • Frequent chest pain is a typical symptom.
  • Treatment focuses on pain relief and extending life expectancy.

Stage III is a progressed stage of mesothelioma that responds to surgery and traditional cancer treatment. Prognosis depends on response to treatment and the extent of lymph node involvement.

In this stage, tumors have spread throughout the lining of the lungs and chest cavity on one side of the body. The diaphragm and lining of the heart may be affected, as well as the chest wall or nearby fatty tissue. Cancer cells have spread to lymph nodes near the main tumor, but not to the lining of the opposite lung, distant lymph nodes or other organs in the body.

Mesothelioma can progress to this point in several ways. As the main tumor grows and puts pressure on nearby tissues and organs, it can grow directly into these structures. This is called local spread.

Cancer cells also can break off of the tumor and attach to the walls of lymph vessels, which transport immune cells to lymph nodes throughout the body. Once the cancer invades the lymph system or enters the bloodstream, there is a chance it may later spread to distant organs. This is called distant spread, and when it occurs the cancer advances to stage IV.

To detect whether mesothelioma has spread, doctors use imaging tests like MRIs and PET/CT scans. These tests will show the size and location of the main tumor and will display any locations in the body where the cancer has spread.

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Symptoms

Symptoms of stage III may be mistaken for a lung infection like bronchitis or pneumonia. Shortness of breath, dry coughs, chest pain, tightness in the chest, and fever may be noticeable at stage III. The symptoms of stage III mesothelioma are caused by tumors growing on the affected lung lining and throughout the chest cavity. Symptoms may vary from patient to patient depending on how the cancer is spreading. A tumor invading the chest wall may cause increased chest pain, while tumors forming around the lung may cause breathing difficulties.

  • Fever
  • Weight loss
  • Shortness of breath
  • Tightness of chest
  • Dry cough
  • Chest pain

Treatment

Stage III tumors are considered locally advanced, but surgical removal is possible with extensive surgery. Chemotherapy and radiation therapy are used to further rid the body of cancer cells following surgery. A treatment plan using curative surgery, chemotherapy and radiation therapy has produced the best survival rates for people with stage III mesothelioma. Multimodal therapy is recommended to stage III patients who are in good enough health to handle the aggressive treatment approach.

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Extrapleural Pneumonectomy

At stage III, tumor spreading to surrounding tissue and lymph nodes requires an extrapleural pneumonectomy surgery (EPP) to remove all the cancer. The affected lung and its lining are removed during surgery. The lining of the heart and half of the diaphragm are removed, as well as affected lymph nodes. Recovery usually requires a two-week hospital stay.

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Chemotherapy

Once recovered from surgery, chemotherapy can begin. Most patients receive systemic chemotherapy through an intravenous drip. Less commonly, heated chemotherapy is circulated through the chest cavity during surgery. Chemotherapy drugs like cisplatin, carboplatin, pemetrexed and gemcitabine are most often used to treat mesothelioma.

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Radiation Therapy

Radiation therapy is also administered after surgery. However, new research has found an increased survival rate when radiation therapy is applied before surgery to shrink tumors. If the cancer returns, radiation therapy might be recommended to keep the tumor in control. Chemotherapy may be recommended again if the cancer returns.

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Palliative Care

Most stage III patients can improve their quality of life with palliative therapies, which aim to relieve troublesome symptoms. While these treatments aren't expected to cure your cancer, they usually can help you feel better. Palliative chemotherapy and radiation, for example, might be used to lessen cancer-related pain.

One palliative therapy involves draining excess fluid buildup around the tumor, a common problem with several types of mesothelioma. The name of this procedure depends on the location where it is performed.

  • Thoracentesis, for pleural mesothelioma, drains fluid from the chest
  • Paracentesis, for peritoneal mesothelioma, drains fluid from the abdomen
  • Pericardiocentesis, for pericardial mesothelioma, drains fluid from around the heart

Draining the excess fluid often helps with pain and difficulty breathing, but the results will likely be temporary. Because the procedure does not stop fluid production, you may need to get it again if symptoms return.

Alternative and Complementary Therapies

Numerous long-term mesothelioma survivors added alternative and complementary therapies to their traditional treatment plan. Some complementary therapies improve overall health or boost the immune system, such as dietary therapy and yoga. Certain ones may help cancer symptoms or reduce side effects caused by cancer treatments. And others, like certain herbs, are proven to improve survival rates when combined with chemotherapy.

Diagnosis

Diagnosed with Stage III Mesothelioma? Consider the Following:

  • Unlike stage IV, stage III is still surgically treatable. If you qualify for surgery, it could significantly extend how long you live.

  • Get a second opinion from a mesothelioma specialist. Not all oncologists have experience treating mesothelioma. Work with a doctor who specializes in the type of cancer you are facing.

  • Think about joining an online mesothelioma support group. It meets on the second Wednesday of every month at 8 p.m. EST. Connecting with other people who have mesothelioma, especially people who’ve lived with the cancer longer than expected, is comforting and supportive.

  • Mental and emotional health is just as important as physical health. A stage III mesothelioma diagnosis is difficult to process and accept. It is common for people facing mesothelioma (and their caregivers) to feel sad or anxious. Reach out for help when you need it. Counseling is often available to cancer patients for free at cancer centers.

  • Lifestyle and overall health can affect survival. Take good care of your health with a nutritious diet and gentle exercise (such as walking or tai chi). Don’t smoke and make sure to get plenty of sleep.

Prognosis

The prognosis of stage III is significantly better than stage IV, but depends on how a person responds to treatment. If surgery is successful and a patient responds well to post-surgery therapies, they can surpass the average one-year survival. People with stage III mesothelioma who have curative surgery usually live longer than 16 months. Certain stage III patients respond well to treatment and live years past the average prognosis.

Pleural mesothelioma expert Dr. David Sugarbaker helped conduct a phase II clinical trial that reported a median survival of 19.3 months for stage III/IV patients who had an extrapleural pneumonectomy surgery.

Other studies find that the extent of lymph node involvement has a small impact on survival. Patients with minor lymph node involvement often live longer than 17 months. Patients with more extensive involvement of nearby lymph nodes live at least 13 months.

It is important to emphasize that survival statistics cannot predict how long any one person with mesothelioma will live. Certain patients respond particularly well to treatment and end up outliving their prognosis by years.

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