Stage 3 mesothelioma is an advanced stage of the disease, as cancer has spread beyond its source. Treatment options are more limited, and patients face a prognosis of about 16 months.
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- More patients have been diagnosed with stage E-3 mesothelioma than any other stage.
- Stage S often indicates it spread to other organs, including lymph nodes.
- Symptoms for stage 3 are usually more severe and majorly impact quality of life.
- Medical therapy is still an option, although plans often focus on symptom relief.
Because of the long latency period and late onset of symptoms, most mesothelioma patients are not properly diagnosed until the disease progresses to stage 3. At this stage,cancer has metastasizedspread to where the tumor originated still localized on one side of the body.
Because of the more distant spread, treatment options may be limited, with some patients receiving only palliative care. With fewer treatment options, patients have a poor prognosis for an average of only 16 months.
Stage 3 Mesothelioma by Type
With all types of mesotheliomas, patients face fewer treatment options and a worse prognosis as the disease progresses. In recent years, more clinical trials have focused on finding effective treatments, even for late-stage mesothelioma, with several studies showing promising results for patients with pleural and peritoneal mesothelioma.
Stage 3 Pleural Mesothelioma
Pleural mesothelioma is the only form of disease that has a staging system. Doctors can rely on several systems, but the TNM (tumor-node-metastases) system is the most used and frequently updated. The TNM system determines the size of the tumor, if cancer has spread to the lymph nodes, and where else in the body cancer has spread. In the latest publication, researchers decided to divide stage 3 pleural mesothelioma into two categories based on their tumor thickness and morphology data and their impact on overall survival.
TNM System Stage 3 Mesothelioma Features
Stage 3A Mesothelioma
- The tumor has grown into nearby tissues, but resection is possible.
- Tumors have spread to ipsilateral lymph nodes and deeper into adjacent tissues such as the endothoracic fascia, mediastinal fat, soft chest wall tissues, or part of the pericardium.
- Mesothelioma has not spread to other breasts or distant areas of the body.
- It May be classified as T3N1M0
Stage 3B Mesothelioma
- Mesothelioma is too advanced for the tumor to be surgically removed.
- Cancer cells have spread to lymph nodes in the contralateral chest but not to distant sites in the body.
- It May be classified as T1N2M0, T2N2M0 or T3N2M0
Other staging systems, Brigham and Butchart, similarly identify stage 3 in terms of metastases but do not divide stage 3 into these subtypes.
Stage 3 Peritoneal Mesothelioma
As a rarer form of mesothelioma cancer, peritoneal mesothelioma does not have a clear staging system. Doctors often rely on more general mesothelioma staging information, which describes this stage as localized to one side of the body, with tumors spreading to nearby organs and lymph nodes. At this stage, researchers have determined that the spread to organs in the chest wall and abdomen, including the appendix, kidneys, and pancreas, can also spread to the lungs and thyroid gland.
More recently, mesothelioma doctors have also used thePeritoneal Cancer Index (PCI)to help determine the size of existing tumors and where they may have spread. PCI divides the abdomen into 13 different regions, which doctors can score from zero to three based on the size of tumors found through imaging scans or laparoscopy. Doctors will collect legion points to determine the estimated stage. Researchers suggest a score between 21 and 30 may indicate stage 3 peritoneal mesothelioma.
Because pericardial mesothelioma is rare, there is no widely accepted staging system for this form of cancer.
Stage 3 Mesothelioma Symptoms
Compared to earlier stages, patients diagnosed with stage 3 mesothelioma experience more pronounced and severe symptoms that can significantly affect the quality of life. As cancer spreads further, they may develop new symptoms as it spreads to other body parts. Palliative care can offer patients with stage 3 mesothelioma relief from worsening symptoms and improved quality of life.
Stage 3 Mesothelioma Symptoms
- Chest pain
- Fluid accumulation in the lungs, abdomen, or heart
- Difficulty breathing
- shortness of breath (shortness of breath)
- Weight loss
Stage 3 Mesothelioma Prognosis
Patients with mesothelioma at any stage face a rather dire prognosis. For stage 3, patients have an average life expectancy of about 16 months. In addition to stage, a few factors can affect an individual’sprognosis, such as the type and type of mesothelioma cell, age, genetics, and overall health. Together, these factors influence the recommended treatment plan.
Some patients have succeeded in prolonging their lives with treatment, and new clinical trials testing proven therapies have given hope even to advanced-stage mesothelioma patients.
Stage 3 Mesothelioma Treatment
By stage 3, patients’ treatment options can be severely limited depending on how far cancer has spread. Doctors may rely on a multimodal approach to cancer treatment, such as chemotherapy and radiation therapy, to prevent further spread and potentially shrink existing tumors. Newer therapies, such as immunotherapy, have also successfully prolonged patient survival. For many, however, palliative care to reduce symptoms is the focus of treatment at this advanced stage.
At this stage, most patients no longer have curative surgery as an option because the tumors have spread too far, although some may seek palliative surgery to reduce symptoms. For example, fluid accumulation in the lungs (pleural effusion) or elsewhere in the body is a common symptom at this stage. Procedures such as pleurodesis or paracentesis can relieve fluid pressure and improve the quality of life for patients with pleural and peritoneal mesothelioma.
One of the most effective forms of chemotherapy for patients with peritoneal mesothelioma is hyperthermia intraperitoneal chemotherapy (HIPEC), which can increase life expectancy by 50% or more in some cases. But at this point, most doctors believe the cancer is too advanced for aggressive treatment to be effective. Instead, patients can receive traditional chemotherapy combinations such as pemetrexed and cisplatin, which can be used curatively or palliatively.
In more advanced stages, doctors are less likely to recommend radiation therapy. Radiation is considered a targeted, localized treatment. Since stage 3 mesothelioma indicates that cancer has spread to one side of the body, radiation will not be effective. However, in some cases, it may be recommended as a palliative treatment to shrink the tumor and reduce symptoms. Some studies have reported that radiation therapy may reduce symptoms such as chest pain and shortness of breath.
In recent years, more clinical trials have focused on finding new, effective treatments for advanced stages of mesothelioma. One prospective study focused on combining photodynamic therapy, a targeted treatment using light, with surgery for patients with late-stage mesothelioma. This new treatment extended overall survival to 3 years, with an average of 1.2 disease-free years. The researchers also found a median survival of 7.3 years in the group of patients without lymph node metastases, nearly 2.3 years before disease progression.
Clinical trials also test different combinations of standard treatments, such as chemotherapy drugs and surgical techniques. One clinical trial showed that radical pleurotomy followed by chemotherapy and radiation can increase life expectancy for stage 3 patients by an average of 21 months, with 28% of patients surviving five or more years.
Although operations such as pleurotomy are often not considered an option in advanced stages, researchers are still discovering new ways to treat this, offering hope to patients diagnosed in later stages.