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, and they may live several years after a diagnosis.
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 early stages of the cancer respond well to surgery and other traditional treatments.
In stage 1 pleural mesothelioma, tiny tumors develop along the lining of one lung. Stage 2 occurs 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 outer layer closest to the chest wall are given a stage 1a diagnosis. When tumors spread to the inner layer, a diagnosis of stage 1b is given.
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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. Many chemotherapy drugs 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 that applying radiation therapy before surgery might significantly improve survival rates for many 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 may qualify because tumors have not spread throughout the body. These voluntary research studies test chemotherapy drug combinations, immunotherapy treatments and genetic therapies 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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Other common early symptoms include:
Mesothelioma is rarely diagnosed in the early stages 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 serious symptoms become noticeable. Stage 1 cases, in particular, often are discovered accidentally.
Symptoms for stage 1 and 2 are mild and often resemble less serious lung conditions such as pneumonia. Stage 1 patients may not experience any mesothelioma 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.
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 usually 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 mesothelioma survival rates.
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.
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.