During the early stages of mesothelioma, the cancer is contained in or near the point of origin. Patients are rarely diagnosed at this point, but for those fortunate enough to be diagnosed early, several treatment options are available to improve prognosis and extend survival.
Patients diagnosed with mesothelioma at stages 1 or 2 — also expressed with Roman numerals as stage I and II — have a more favorable prognosis than late-stage patients.
This is mainly because there is less of the cancer present in its early stages. Therefore, surgery, radiation and chemotherapy can all be more effective at controlling the disease and prolonging life.
In stage 1 pleural mesothelioma, tiny tumors develop along the lining of one lung. Stage 2 develops when the tumors start spreading to the underlying lung tissue or the diaphragm. The lungs and lymph nodes do not contain cancer cells at these early stages.
Stage 1 is the only mesothelioma stage divided into two categories: 1a and 1b. This distinguishes the layer of the pleural lining where tumors begin to form. Tumors on the parietal pleura, which is the outer layer closest to the chest wall, are given a stage 1a diagnosis. When tumors also involve the visceral pleura, which is the outermost layer of the lung, a diagnosis of stage 1b is given.
A 2017 review of 1a and 1b patient survival found no significant difference between these tumor stages, compelling researchers to consider revising stage 1 into a single category without subcategories.
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Compared to patients in other stages of mesothelioma, patients diagnosed in the early stages have the most treatment options available. A multimodal approach combining surgery, chemotherapy and radiation therapy is recommended for stage 1 and 2 patients in sufficiently good health to handle the aggressive treatment plan. Patients who undergo multimodal therapy may live years beyond the average mesothelioma prognosis.
The two most common surgery options for mesothelioma patients are a pleurectomy/decortication (P/D) procedure and an extrapleural pneumonectomy (EPP). The recommended surgery will depend on the extent of disease spread, overall health of the patient and the physician’s medical opinion.
Chemotherapy is usually given after a patient recovers from surgery to kill any remaining cancer cells thatare suspected to be present. Some treatment plans use chemotherapy to shrink tumors before surgery. Many chemotherapy drugs can result in side effects such as fatigue, hair loss and nausea.
Doctors traditionally use radiation therapy after surgery to prevent local recurrence. New research suggests applying radiation therapy before surgery might significantly improve survival rates for certain patients. Radiation therapy has also helped manage recurring mesothelioma tumors over extended periods of time. If the cancer returns, your doctor might recommend radiation therapy to keep the tumor under control.
Eligibility varies for mesothelioma clinical trials, but many early stage patients qualify because the cancer hasn’t negatively impacted their overall health as when it is found at more advanced stages. These voluntary research studies test chemotherapy drug combinations, immunotherapy treatments, genetic therapies and treatment combinations not yet approved by the U.S. Food and Drug Administration for mainstream use.
There is no definitive staging system for peritoneal mesothelioma, but patients diagnosed before the tumors spread outside the lining of the abdomen have a better outlook.
Peritoneal mesothelioma patients in the early stages of the cancer may benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, also known as HIPEC. This multimodal treatment combines the process of heating chemotherapy drugs and delivering them to the abdomen directly following surgery.
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Mesothelioma is rarely diagnosed in the early stages of development because symptoms seldom arise that would prompt someone to get medical attention. The cancer has an unusually long latency period, meaning it can take decades after initial asbestos exposure before the cancer even beings to develop. Stage 1 cases, in particular, often are discovered accidentally.
Symptoms for stage 1 and 2 are mild and resemble less serious lung conditions such as pneumonia. Stage 1 patients may not experience any symptoms, while those diagnosed with stage 2 may feel chest pain or have difficulty breathing as a result of tumor growth or trapped pleural fluid.
Other early symptoms include:
The survival difference between the first two stages isn’t as significant as the variances between stages 2, 3 and 4. Early stage patients who undergo surgery may live longer than three years, according to the research of mesothelioma specialists Dr. Raja Flores and Dr. Valerie Rusch.
Mesothelioma is considered a heterogeneous disease, meaning no two cases are alike. Certain patients respond better to treatment and will far surpass the average survival statistics.
Catching the cancer early is a major factor that helps people with stage 1 or 2 live much longer than people with late-stage mesothelioma.
Joining the team in February 2008 as a writer and editor, Michelle Whitmer has translated medical jargon into patient-friendly information at Asbestos.com for more than eight years. Michelle is a registered yoga teacher, a member of the Academy of Integrative Health & Medicine, and was quoted by The New York Times on the risks of asbestos exposure.