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What Is Stage 3 Mesothelioma?

Stage 3 is an advanced stage of pleural mesothelioma cancer. Multiple types of mesothelioma exist, but only the pleural variant has an official staging system. In this stage, tumors have spread throughout the pleural lining of the lungs on one side of the chest, including the centralized immune glands known as mediastinal lymph nodes.

The primary tumor in stage 3 can affect nearby structures such as the diaphragm, heart sac, chest wall layers and central chest region between the lungs, known as the mediastinum. The most significant difference between stage 3 and stage 4 mesothelioma is that tumors have not yet spread to distant organs.

Stage 3 Mesothelioma Facts
  • The two-year survival rate is between 26% and 30%.
  • Tumor-removing surgery is still a possibility.
  • Symptoms include frequent chest pain and difficulty breathing.
  • Emerging treatments through clinical trials may extend survival.

When doctors diagnose mesothelioma stage 3, the treatment options are more limited than in earlier mesothelioma stages. Surgery is still possible but less likely to be successful, and the disease progression negatively impacts prognosis and survival. 

However, doctors specializing in stage 3 pleural mesothelioma can help patients find clinical trials and experimental treatments that may improve survival rates and quality of life. Presently there is no cure for this rare cancer, but researchers are continually discovering new therapies that may extend mesothelioma patients’ lives.

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Stage 3 Mesothelioma Symptoms

In stage 3, symptoms are much more noticeable and intense compared to stage 2 mesothelioma. Unfortunately, because of the long latency period of mesothelioma, many patients do not notice symptoms until stage 3 of the disease. 

These symptoms are primarily associated with pleural mesothelioma but may also appear in other variants such as peritoneal or pericardial mesothelioma.

The most common symptoms of stage 3 mesothelioma include:

  • Shortness of breath
  • Pain in the chest or abdomen
  • Recurring dry cough
  • Fatigue
  • Fever
  • Fluid buildup
  • Weight loss

As the tumors continue to grow and spread throughout the chest, symptoms will become more problematic. Stage 3 symptoms vary from patient to patient depending on where the cancer is spreading and if the tumor mass damages vital organs. Some patients may experience referred pain felt in the neck, back or shoulders.

A tumor invading the chest wall may cause increased chest pain, while tumors forming around the lung may lead to increased breathing difficulties. Pleural mesothelioma tumors also cause increased pleural fluid, which puts pressure on the lungs. Symptoms and characteristics of stage 3 mesothelioma vary based primarily on cancer type.

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Characteristics of Stage 3 Mesothelioma by Type

The characteristics of stage 3 mesothelioma include: tumor size, location and cell type. They present in different ways depending on the cancer origin and the staging system used to measure disease. These characteristics and differences help doctors determine the best course of treatment for each patient. 

In most cases, symptoms are more severe than in stage 2, treatment options are more limited and cancer has invaded nearby tissues and organs. However, compared to stage 4, tumors have not yet metastasized to distant areas of the body. Also, many therapy options, such as chemotherapy and radiation, can help prevent metastasis and extend survival.

Stage 3 Pleural Mesothelioma

Stage 3 mesothelioma tumor progression
Stage 3 mesothelioma tumors spreading on the lung.

Doctors use mesothelioma staging to determine the extent of cancer, but the pleural variant is the only one with an official staging system. The American Joint Committee on Cancer developed this measurement tool, called TNM, which was last updated for pleural mesothelioma in 2018. 

The TNM staging system measures the tumor spread, lymph node involvement and level of metastasis. Characteristics of stage 3 include cancer progression further from its origin into

  • Stage 3A: Tumors have grown into nearby structures, including the diaphragm and mediastinum on one side of the chest. Cancer has spread to nearby lymph nodes and possibly layers of the chest wall and the heart sac (pericardium). Surgery to remove all visible tumor growth may still be an option.
  • Stage 3B: This category is split into two variations depending on the size of the primary tumor and spread to the lymph nodes. Surgery is not usually an option. Chemotherapy often is the best treatment.

Stage 3 Peritoneal Mesothelioma

Stage 3 peritoneal mesothelioma tumor progression
Stage 3 mesothelioma tumors spreading the abdominal area.

Peritoneal mesothelioma is the second-most common form of the disease. Instead of a formal staging system to measure progression, physicians typically use the existing Peritoneal Cancer Index to grade tumors in the abdomen. In addition, the PCI helps doctors determine the stage in many other abdominal cancers.

The PCI ranges from 0 to 39, measuring the spread of tumors across 13 different abdominal sectors. A score between 21 and 30 indicates stage 3 peritoneal mesothelioma. The characteristics of this stage are tumors localized within the abdomen, with some spread to nearby lymph nodes.

Dr. Daniel Landau, mesothelioma specialist & medical content reviewer for Asbestos.com
“If a doctor refers to peritoneal mesothelioma as stage 3, it usually means tumors have spread throughout the abdominal lining and to nearby lymph nodes.”
Dr. Daniel A. Landau
Oncologist and hematologist

Stage 3 Pericardial and Testicular Mesothelioma

Doctors and researchers do not clearly define stage 3 pericardial or testicular mesothelioma due to their rare nature. 

Only 1% to 2% of mesothelioma cases are pericardial, which means cancer forms within the sac that protects the heart. Therefore, a diagnosis for this disease is unlikely until the late stages, after metastasis to the lungs or chest cavity.

Doctors evaluate testicular mesothelioma tumor characteristics by using staging guidelines for general testicular cancer. For example, doctors more commonly refer to stage 3 testicular mesothelioma as late-stage cancer. This description indicates that cancer has spread beyond the lining of the testicles to other tissues such as lymph nodes or bone.

Stage 3 Mesothelioma Life Expectancy and Prognosis

About 26% to 38% of stage 3 mesothelioma patients live at least two years after diagnosis, and some patients live for many years with successful treatment. However, every patient responds differently to treatment, and survival rates are not the only indicators of a mesothelioma patient’s prognosis.

A prognosis is an estimate of how successfully a patient’s treatment plan will control their disease. Doctors evaluate every aspect of a patient’s medical history, overall health and response to treatment before determining a prognosis. For some patients, a mesothelioma prognosis can improve unexpectedly after trying a new therapy. 

Life expectancy is a measure of how long someone will live after their diagnosis. For stage 3 mesothelioma patients, life expectancy depends on how well they respond to treatment and the extent of lymph node involvement. When malignant tumors spread to lymph nodes, cancer cells can enter the lymphatic system and create new tumors in distant parts of the body. 

Survival statistics do not apply to each patient and can’t predict a person’s prognosis. In addition, successful responses to surgery and post-surgery therapies help patients live past their life expectancy. Factors that can affect survival are different for each patient and include age, gender, cancer cell type, response to treatment and overall health.

Mesothelioma survivor Russell Lamkins celebrating his 70th birthday
“When I was first diagnosed with stage 3 inoperable cancer and told I had a year to live, I figured I’d better hurry up and finish projects I was working on. But now my goal is to make it to the 10-year mark. “
Russell Lamkins
Diagnosed with pleural mesothelioma in 2014

Mesothelioma Stage 3 Survival Rates

Patients with late-stage testicular mesothelioma have a median survival time of about two years. Pericardial mesothelioma patients with a late-stage diagnosis have an average survival of about 10 months, but some live much longer after surgery or chemotherapy.

The American Cancer Society uses information from the National Cancer Institute to provide updated survival statistics for mesothelioma. The data tracks patients for a certain number of years and classifies them by their mesothelioma type and stage.

2-year survival rate 5-year survival rate Median Survival
Pleural Mesothelioma 23% 12% 16 months
Peritoneal Mesothelioma 74% 52% 56 months
Source: American Society of Clinical Oncology, 2021

How Lymph Nodes Affect Cancer

Lymph nodes play a vital role in the spread of cancer. Lymph nodes help filter the blood, blocking bacteria and viruses from spreading through the body. When cancer cells invade lymph nodes, they can enter the bloodstream and spread into distant organs. Once cancer spreads to other organs, doctors characterize it as metastasis and surgery is no longer helpful.

Beginning treatment soon after diagnosis is essential to preventing metastasis and extending life expectancy. Early treatment is critical for removing cancerous growths before they spread to other areas of the body.

Patients with stage 3 mesothelioma may have varying degrees of lymph node involvement. Those with minor lymph node involvement often live more than two years, while patients with more cancerous lymph nodes have an average life expectancy of around 13 months.

Even if cancer has not spread to the lymph nodes, surgery may not be an option for some stage 3B patients. Patients with stage 3B mesothelioma may have cancer in vital structures such as the diaphragm or pericardium, where surgery is not a viable option.

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What to Do After a Stage 3 Mesothelioma Diagnosis

After receiving a mesothelioma diagnosis, the most crucial step is finding a team of well-equipped specialists to treat this rare cancer. It is essential to seek treatment as soon as possible following a stage 3 mesothelioma diagnosis.

Working with doctors who have successfully treated patients through surgery and the latest therapies gives you the best chance of improving your mesothelioma prognosis. Additionally, improving overall health through proper nutrition and exercise can help extend your mesothelioma life expectancy. 

Joining a mesothelioma support group is a great way to connect with resources such as clinical trials and physicians who specialize in this rare cancer. These specialists know the intricacies of mesothelioma, and they understand the challenges patients face. Not all hospitals or major metropolitan cancer centers have doctors who focus on mesothelioma.

Treatment for Stage 3 Mesothelioma

Watch: 14-year mesothelioma survivor Tamron Little explains the importance of joining a support group.

Support groups, such as the one The Mesothelioma Center at Asbestos.com offers, help patients and their families come to terms with their mesothelioma diagnosis and provide resources for improving quality of life and mental health awareness.

How Is Stage 3 Mesothelioma Treated?

A multimodal treatment plan using tumor-removing surgery, chemotherapy and radiation therapy has produced the best survival rates for people with stage 3 pleural mesothelioma.

These tumors are locally advanced, but removal may be possible with extensive surgery and aggressive cancer treatment in specific circumstances.

Stage 3 mesothelioma patients may also benefit from emerging treatments such as immunotherapy, which they can access through experimental clinical trials.

Treatment for Stage 3 Mesothelioma

Watch: Registered nurse Sean Marchese of The Mesothelioma Center discusses treatment options for people with stage 3 mesothelioma.

Surgery

At stage 3, tumors have likely spread to surrounding tissues and lymph nodes. However, tumor-removing surgery may still be a possibility. Pleural mesothelioma patients may be eligible for extrapleural pneumonectomy surgery. This extensive procedure removes the entire affected lung, its pleural lining, the diaphragm and the heart lining, known as the pericardium.

Some stage 3 mesothelioma patients may qualify for the less drastic but more meticulous pleurectomy and decortication procedure, depending on the spread of tumors. It removes the lining of the lung, pericardium, diaphragm and any tumor masses growing inside the chest cavity, leaving the lung intact.

Chemotherapy

In general, mesothelioma surgeries have better survival rates when combined with chemotherapy. Most patients receive chemotherapy drugs in combination through an intravenous line, or IV. Chemotherapy can begin as soon as a patient recovers from surgery. Doctors may also administer mesothelioma chemotherapy before or during surgery.

One chemotherapy technique attempts to shrink tumors before a patient’s operation. In a 2020 report published in General Thoracic and Cardiovascular Surgery, a stage 3 mesothelioma patient responded well to chemotherapy and improved to stage 2. After aggressive surgery, the patient was alive and undergoing another round of chemotherapy to fight off a recurrence.

Radiation Therapy

Radiation therapy may also be administered after surgery to prevent local recurrence, a term used to describe cancer regrowth. Not every stage 3 mesothelioma patient is eligible for radiation, but it has helped avoid tumor growth in many cases. Some research has reported improved survival when radiation therapy is applied before surgery to shrink tumors.

Palliative Care

Stage 3 mesothelioma patients who are not in good enough health to undergo aggressive treatments have other options that can improve symptoms. Because symptoms are more intense in stage 3, palliative care options are essential for mesothelioma patients. They can improve their quality of life with palliative therapies.

While these treatments will not cure mesothelioma cancer, they usually help patients feel better and live longer. Doctors use palliative chemotherapy and radiation to lessen cancer-related pain and extend survival. Palliative surgery drains fluid buildup around the tumor, which helps with difficulty breathing.

Immunotherapy & Clinical Trials

Voluntary research studies may provide the best hope for stage 3 mesothelioma patients. Immunotherapy and gene therapy are two constantly evolving areas in cancer treatment. In 2020, the U.S. Food and Drug Administration approved multiple immunotherapies for mesothelioma. 

Specialists at specific treatment centers offer mesothelioma clinical trials and experimental treatments to improve prognosis and extend life expectancy. Patients should ask their mesothelioma specialists about appropriate clinical trials in their area and the requirements for enrolling in a research trial. 

Integrative Therapies for Mesothelioma

Complementary therapies, such as acupuncture, yoga and nutritional counseling, are often integrated with conventional stage 3 mesothelioma treatments. They may improve overall health, decrease symptoms or boost the immune system.

Some late-stage patients choose to forego conventional treatments for alternative therapies. However, a 2017 study published in the Journal of the National Cancer Institute shows cancer patients who rely on alternative medicine alone have a significantly lower survival rate.

Help Covering Treatment Expenses

Treatment for mesothelioma is costly. The average price of tumor-removing surgery is estimated at around $120,000, while chemotherapy sessions can cost up to $12,000 a month. Private insurance or Medicare won’t always cover all the costs, so financial assistance is essential for many mesothelioma patients.

Grants are available to help cover travel expenses to the top mesothelioma cancer centers. Additional financial aid may be available through asbestos trust funds and legal claims. A qualified mesothelioma attorney can help answer any questions you may have and explain your options for compensation.

People We’ve Helped
“I belong to a group of cancer patients who live with a grim prognosis. I know I have no cure — yet — but am encouraged with every new study, mesothelioma treatment approval and inspiring survivor story.”
Emily Ward
Pleural Mesothelioma Survivor

Common Questions About Stage 3 Mesothelioma

Is stage 3 pleural mesothelioma curable?

There is no mesothelioma cure for any stage of the disease. A small number of stage 3 patients are eligible for surgery, which can extend survival. However, in this stage, care is palliative and focuses on reducing symptoms and improving quality of life.

What are the signs of stage 3 mesothelioma?
  • Shortness of breath
  • Coughing or wheezing
  • Chest pain or discomfort
  • Fever of night sweats
  • Unexplained weight loss
How can stage 3 life expectancy be improved?

Factors affecting mesothelioma life expectancy in stage 3 include:

Lifestyle changes, such as diet and exercise, can improve overall health and extend survival for patients undergoing chemotherapy and radiation in stage 3 mesothelioma.

Are stage 3 mesothelioma patients eligible for clinical trials?

Mesothelioma clinical trials for patients in stage 3 are available in many treatment centers across the United States. Patients in this stage typically have more options than patients in stage 4 who have metastatic cancer.


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