Although stage 3 mesothelioma is considered a locally advanced stage of the asbestos-related cancer, treatments that focus on extending life expectancy are usually still an option, including surgery, chemotherapy and radiation.
In stage 3 — commonly expressed with Roman numerals as stage III — the cancer remains contained near the point of origin, known as a local spread. For pleural mesothelioma, this means tumors have spread throughout the lining of the lungs and chest cavity on one side of the body.
Tumor-removing surgery still an option
Median survival rate is around 16 months
Frequent chest pain is a typical symptom
Emerging treatments through clinical trials may extend survival
The diaphragm, lining of the heart, nearby fatty tissue and lymph nodes near the main tumor may be affected, but not the lining of the opposite lung, distant lymph nodes or other organs in the body.
It is essential to seek treatment as soon as possible following a stage 3 mesothelioma diagnosis. Once the cancer invades the lymph system or enters the bloodstream, there is a chance it may spread throughout the chest cavity and to distant organs (stage 4), making it much more difficult to treat.
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By stage 3, symptoms are much more noticeable and intense compared to stage 2 mesothelioma. As the tumors continue to grow and spread, the symptoms will worsen and become more problematic.
The most common stage 3 symptoms include:
Shortness of breath
Tightness or pain in the chest
Recurring dry cough
Symptoms 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 lead to increased breathing difficulties.
Surgery and palliative treatments can help manage pain and reduce the severity of symptoms. It is important to seek treatment as soon as possible before the cancer progresses into stage 4, when symptoms are most severe and no longer limited to the areas where tumors first developed.
Stage 3 tumors are considered locally advanced, but surgical removal is possible with extensive surgery. A treatment plan using aggressive surgery, chemotherapy and radiation therapy has produced the best survival rates for people with stage 3 pleural mesothelioma.
At stage 3, tumors have spread to surrounding tissues and lymph nodes. Pleural mesothelioma patients may be eligible for an extrapleural pneumonectomy (EPP), an aggressive surgery which removes the affected lung and its lining.
Depending on the spread of tumors, some stage 3 patients may qualify for the less drastic but more meticulous pleurectomy and decortication procedure (P/D), which removes the lining of the lung — called the pleura — along with any tumor masses growing inside the chest cavity.
Common mesothelioma surgeries such as EPP and P/D show better survival rates when combined with chemotherapy. Most patients receive combinations of chemotherapy drugs through an intravenous drip (IV). Chemotherapy can begin as soon as a patient recovers from surgery, but may also be administered before or during surgery. Chemotherapy drugs are effective in killing cancer cells, but are accompanied by debilitating side effects.
In a 2016 multicenter clinical trial, immunotherapy vaccine CRS-207 produced a 94 percent disease control rate when combined with chemotherapy.
Radiation therapy may also be administered after surgery. However, 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.
Stage 3 patients who are not in good enough health to undergo aggressive treatments can improve their quality of life with palliative therapies. While these treatments aren’t expected to cure your cancer, they usually can help you feel better. Palliative chemotherapy, immunotherapy and radiation might be used to lessen cancer-related pain, while palliative surgery drains excess fluid buildup around the tumor, which helps with difficulty breathing.
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These voluntary research studies may provide the best hope for stage 3 mesothelioma patients. Immunotherapy and gene therapy are two areas constantly evolving. Although neither is FDA approved for mesothelioma, clinical trials testing immunotherapy drugs and new therapies in human genetics are showing promising results.
Complementary therapies such as acupuncture, yoga and nutritional counseling are often integrated with traditional mesothelioma treatments to improve overall health or boost the immune system. Some late-stage patients choose to forego traditional treatments for alternative therapies such as herbal medicine and homeopathic supplements. However, a 2017 study from Yale School of Medicine shows cancer patients who rely on alternative medicine alone have a significantly lower survival rate. Cancer patients are sometimes desperate and can become victims of unscrupulous persons offering “cures” for cash. Patients and their families need to use caution when pursuing such alternative approaches.
Prognosis for stage 3 mesothelioma patients depends on response to treatment and the extent of lymph node involvement. If surgery is successful and a patient responds well to post-surgery therapies, they can surpass the average 16-month survival.
Beginning treatments soon after diagnosis can be essential to a longer life expectancy. The key is to remove as much of the cancerous growth as possible before it spreads to other areas of the body.
Lymph nodes play a key role in this, as the lymph system can transport cancer cells to distant organs. Once this occurs, the cancer is generally considered inoperable and terminal.
When I was first diagnosed with stage III inoperable cancer and told I had a year to live, I figured I’d better hurry up and try to finish this house quickly. But now, things have changed. My goal is to make it to the 10-year mark.”
— Russell Lamkins, diagnosed with pleural mesothelioma in 2014 Read Russell’s Story
Patients with minor lymph node involvement often live longer than 17 months, compared to 13 months for patients with more extensive involvement of nearby lymph nodes.
Survival statistics cannot predict how long a person will live. All patients with stage 3 mesothelioma have varying factors that can affect prognosis and life expectancy, including age, gender, cell type, response to treatment and overall health.
Certain patients respond particularly well to treatment and end up outliving their prognosis by years.
Matt Mauney is an award-winning journalist with nearly a decade of professional writing experience. He joined Asbestos.com in 2016, and he spends much of his time reading, analyzing and reporting on mesothelioma research articles to ensure people in the mesothelioma community know the latest medical advancements. Prior to joining Asbestos.com, Matt was a reporter at the Orlando Sentinel. Matt also edits some of the pages on the website. He also holds a certificate in health writing from the Centers for Disease Control and Prevention.
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