Prognosis and survival for mesothelioma

A prognosis is the doctor’s best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors.

The doctor will look at certain aspects of the cancer as well as characteristics of the person (such as their age and sex). These are called prognostic factors. The doctor will also look at predictive factors, which influence how a cancer will respond to a certain treatment and how likely it is that the cancer will come back after treatment.

Prognostic and predictive factors are often discussed together. They both play a part in deciding on a prognosis and a treatment plan just for you. Only a doctor familiar with your medical history, the subtype, stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to make a prognosis.

The following are prognostic and predictive factors for mesothelioma.

The subtype of mesothelioma is an important prognostic factor for mesothelioma.

Epithelioid is the most common subtype of mesothelioma. It has a better prognosis than the other subtypes.

Sarcomatoid has the least favourable prognosis. This subtype of mesothelioma spreads more quickly than the epithelioid subtype.

Mixed (also called biphasic) tumours have both epithelioid and sarcomatoid cells. Tumours with more epithelioid cells have a better prognosis than tumours with more sarcomatoid cells.

Stage 1 and stage 2 mesothelioma have a better prognosis than stage 3.

Mesothelioma that has spread to the lymph nodes (stage 3 or 4) has a less favourable prognosis.

If doctors think that they can remove most or all of the mesothelioma that they can see with surgery, it is called resectable. If mesothelioma can’t be removed with surgery, it is called unresectable. Resectable mesothelioma has a more favourable prognosis than unresectable mesothelioma.

After surgery, the tissue removed is sent to a lab. A technologist looks at it under a microscope to see if there are cancer cells in the healthy tissue that was taken out along with the tumour (called the surgical margin). A negative surgical margin means that there are no cancer cells at the edges of the tissue removed during surgery. A positive surgical margin means that cancer cells are found at the edges.

Positive surgical margins have a higher risk of recurrence and a less favourable prognosis than negative surgical margins.

People who have chest pain with pleural mesothelioma have a poor prognosis. This is because the chest pain may mean the cancer has grown past the point where it can be removed with surgery.

Performance status is the measure of how well a person can do ordinary tasks and carry out daily activities. People with a poor performance status have a less favourable prognosis than people with a good or fair performance status.

People who have lost a lot of weight before their diagnosis have a less favourable prognosis than people who have not lost much weight.

People older than 60 who are diagnosed with mesothelioma have a poorer prognosis than younger people.

Men diagnosed with mesothelioma have a poorer prognosis than women diagnosed with the same cancer. We need more research and can’t say at this time what the prognosis is for transgender, non-binary and gender-diverse people.

People with mesothelioma who have a higher than normal platelet count (called thrombocytosis) have a less favourable prognosis than people with a normal platelet count.

People with a higher than normal white blood cell count (called leukocytosis) also have a less favourable prognosis than people with a normal white blood cell count.

People with a lower than normal red blood cell count (called anemia) have a less favourable prognosis than people with a normal red blood cell count.

Albumin is the main protein found in plasma. It helps maintain blood volume. People with low levels of albumin have a less favourable prognosis than people with a normal albumin level.

Lactate dehydrogenase (LDH) is an enzyme in almost all of the body’s cells. When cells are damaged or destroyed, LDH is released into the blood. A higher than normal level of LDH means that there is tissue or cell damage somewhere in the body.

People with mesothelioma who have a higher than normal LDH level have a less favourable prognosis than people who have normal or low LDH levels.