Mesothelioma is an asbestos-related cancer that is both malignant and highly aggressive. It can affect the lining of organs and body cavities including the lungs (pleural mesothelioma), abdomen (peritoneal mesothelioma), heart (pericardial mesothelioma) and testicles (testicular mesothelioma). When the cancer is caught as Stage 1 mesothelioma, it is highly treatable.
The First Stage
Stage 1 mesothelioma is the least-advanced. Pleural and peritoneal mesothelioma are usually the only types of mesothelioma caught at stage 1. It only involves one side of the pleura (lung tissue) or a portion of the peritoneum (abdominal lining) and has not invaded any lymph nodes. Cancer that is detected at stage 1 has the most treatment options and the best prognosis or chance for a good outcome.
Major Characteristics of Stage 1 Mesothelioma
- Cancer is localized on one side or area of the body and has not spread to lymph nodes or other areas of the body
- Symptoms vary from barely noticeable to coughing, fever and chest, chest, abdominal or scrotal pain
- Multiple treatment options provide a relatively hopeful outlook
What to Expect
- Symptoms of Stage I mesothelioma may be confused with other disorders such as pneumonia such as frequent cough, chest pain, shortness of breath, fever and aches.
- After other disorders have been ruled out, diagnosis will be confirmed through imaging studies, blood testing and biopsy
- Curative surgeries may be performed to remove tumor and a healthy portion of tissue. Chemotherapy and/or radiation may also be advised. Most treatments are intended to remove tumor and kill any remaining cancer cells so that cancer will not spread.
- Surgical procedures to increase comfort may also be performed. These surgeries may be done to remove fluid buildup which is causing pain, organ compression and other symptoms.
- If general health is good, the physician may advise more aggressive surgeries and other treatments to improve the patient’s prognosis.
Stage 1 Symptoms
Mesothelioma has a long latency time. This is the time that it takes for cancer to develop after asbestos exposure has occurred. The latency time of mesothelioma may make diagnosis difficult as symptoms may be similar to other disorders.
Symptoms of Stage 1 Mesothelioma be barely noticeable or may include:
- Difficulty Breathing
- Shortness of Breath
- Chest, Abdominal or Testicular pain
- Swelling of the abdomen or scrotum
- Lethargy and weight loss
Diagnosis of Stage 1 Mesothelioma
A diagnosis of mesothelioma at stage 1 will most commonly have a better prognosis than when the cancer is not detected until later stages. The cancer is very small and has not spread beyond the local area or into surrounding lymph nodes.
In most cases, due to the long latency time, the rarity of the cancer and symptoms that may mimic other disorders, mesothelioma will not be the first disease considered. When other diseases have been “ruled out”, a number of tools and procedures will be used to diagnose the cancer.
- Medical history – a complete medical history with patient interview will determine the possibility of asbestos exposure and also identify other health conditions and family history
- Imaging tests – X-ray, CT and PET scanning will show development of tumor and tissue inflammation
- Blood testing – may be used to identify certain proteins that may be present in the blood due to mesothelioma cells
- Biopsy – the main procedure used to verify the presence of mesothelioma cancer.
A biopsy is a surgical procedure in which a small sample of tumor tissue is removed from the affected area. This tissue will then be examined under a microscope to confirm the presence of cancer and to identify the particular types of cells involved.
In the most common types of mesothelioma, a procedure known as thoracotomy will be used for pleural mesothelioma or a laparotomy will be used for peritoneal mesothelioma. Though these are surgical procedures, they are minimally invasive and are often done through camera assisted procedures.
Stage 1 Treatment Options
Stage 1 mesothelioma patients have more treatment options than when the disease is treated at later stages. Stage 1 patients also have a much better prognosis and a greater chance of survival. If the patient is relatively healthy, physicians may choose to treat the cancer aggressively to improve prognosis.
Depending on the type of mesothelioma, Stage 1 Treatment options will be different but for the most common types of the disorder, options generally include:
- Thoracentesis – to remove fluid that has accumulated between lungs and pleura which may reduce symptoms
- Pleurodesis – to obliterate pleural space by forcing adherence of membranes surrounding lungs, preventing fluid buildup in pleural space
- Partial Pleurectomy – to remove tumor and a portion of lung lining, also known as debulking
- Pleurectomy with Decortication (P/D) – to remove tumor and entire pleura or lung lining
- Extrapleural Pneumonectomy (EPP) – the complete of the lung, pleura and a portion of the diaphragm which is more invasive but has a greater chance for a cure
- Paracentesis – to drain and remove fluid buildup which may reduce swelling, pain and other symptoms
- Perinectomy with debulking– to remove tumor and portion of abdominal cavity lining
- Cytoreduction – the removal of the mesothelium lining the peritoneal cavity.
- Omentectomy – removal of the omentum, a fatty, apron-like layer that drapes over the organs which may also be removed as part of another peritoneal surgery
Chemotherapy is technically, treatment with any type of medications, however in cancer, chemotherapy is intended to kill cancer cells.
Traditional chemotherapy – medications targeted to kill cancer cells that are rapidly dividing. Different medications work by different mechanisms and the specific mediation will be chosen based on cellular characteristics determined through biopsy and by area affected. Chemotherapy may be given orally (tablets or capsules), through intravenous (IV) infusion or injected directly into the abdominal cavity. Chemotherapy is often used during Stage 1 mesothelioma treatment in combination with other treatments such as radiation or surgery.
Newer medications – recently discovered medications which target certain genetic information in the DNA of particular cells. Some of these medications are immunomodulatory, enhance the body’s ability to identify these particular cells as abnormal. In addition, targeted therapy is being developed to hone in on cells with certain genetic profiles such as promising medications which treat cancers involving the BRAC cancers. Genetic profiling helps treating physicians identify which of these new medications are likely to be successful in each particular tumor. Many of these newer medications have not yet been approved by the Food and Drug Administration and are only available if the patient qualifies for an investigational study.
Radiation is used to focus concentrated beams of energy, such as x-rays though the body, into the tumor itself. This energy is highly concentrated and focused, often through the use of computer imaging technology so that little outside tissue is affected. Radiotherapy is often limited by the tumor location and the proximity to vital organs such as the lung. Radiation therapy is also used most commonly in conjunction with other treatments.
Palliative treatments are intended to provide relief of troublesome symptoms of the disease. In most cases, palliative treatments will not be needed in stage 1 mesothelioma but may include: chemotherapy for tumor shrinkage and radiation for tumor shrinkage even when the tumor is determined to be inoperable due to tumor location or patient health. Surgery may be removed to eradicate a portion of the tumor which may alleviate symptoms even when cancer is not considered “curable”. In addition, medications may be used as symptomatic treatment or for pain management.
Stage 1 mesothelioma patients have the potential for a better prognosis than later stages of the disease. Large, respected medical conditions list the prognosis for stage 1 mesothelioma as generally having a chance of 60% of the patients having a survival rate of 16 to 24 months, much higher than at other stages. While many cancers cannot ever be considered “cured”, there are also more cases of remission at Stage 1 than at later stages.
Despite the potential for a better prognosis, mesothelioma is rarely diagnosed at stage 1. This is due to the fact that the latency period can be 20 or more years for symptoms to develop. It is also due to the slow development of symptoms which may mimic other health conditions such as indigestion, the common cold or obstructive pulmonary disease. These diseases will be fully investigated before mesothelioma is even considered due to its rarity, which only results in 3,000 new cases emerging each year.
Mesothelioma Staging Systems for Stage 1
Depending on the specific cancer type, one of several staging “systems” may be used including the
TNM system – based on assignation of numbers for (T) tumor size, (L) lymph node involvement and (M) for metastases. In most cases, TNM results will be T=0-1, L=0, M=0.
Butchart System – identifies that tumor is localized in a small area of the pleura or peritoneal cavity and has not spread into lymph nodes.
Brigham System – is older and may identify that cancer is likely to be removable by surgery and the prognosis is good.