Stage 3 mesothelioma diagnosis means tumors that have spread to nearby tissues and organs as well as distant lymph nodes. Treatment options may be more aggressive at this stage. Prognosis and life expectancy depend on treatment response, but 2-year survival rates dip to 26-30 percent.
In stage 3, the mesothelioma cancer remains contained near the point of origin in the lining of the lungs (pleura) in a pattern known as a local spread.
Tumors have spread throughout the pleural lining on one side of the chest and to nearby lymph nodes on the same side of the body as the main tumor.
The diaphragm, the heart sac, the area between the lungs (mediastinum) and layers of the chest wall near the main tumor may be affected. The biggest difference between stage 3 and stage 4 mesothelioma — the most advanced stage — is tumors have not yet spread to distant organs.
Most doctors, oncologists and researchers stage mesothelioma using the American Joint Committee on Cancer’s TNM system, which was updated January 2018. According to that system, stage 3 mesothelioma is divided into two parts: 3A and 3B.
Stage 3A: Tumors have grown into nearby structures, including the coating of the lung, diaphragm and mediastinum on one side of the chest. The cancer has spread to nearby lymph nodes and possibly layers of the chest wall and the heart sac (pericardium). Surgery to remove all visible tumor growth is still an option.
Stage 3B: This category is split into two variations depending on the size of the main tumor and spread to the lymph nodes. If the cancer is contained enough to the point of origin or to nearby structures, it may be possible to remove tumors with surgery. In the most advanced point of TNM stage 3, the mesothelioma has grown too far to be removed completely with surgery, even if nearby lymph nodes are not affected.
Stage 3 Mesothelioma Facts
Two-year survival rate is between 26-30 percent
Tumor-removing surgery still a possibility
Symptoms include frequent chest pain and difficulty breathing
Emerging treatments through clinical trials may extend survival
At stage 3B, the cancer may have grown into the muscle of the chest wall, ribs, spine or organs between the lungs such as the esophagus, windpipe and thymus. Tumors may also spread through the diaphragm into the lining of the abdomen (peritoneum), to the lung lining on the other side of the chest or through the heart sac into the heart itself.
It is essential to seek treatment as soon as possible following a stage 3 mesothelioma diagnosis.
Once the cancer invades the lymph system or enters the bloodstream, there is a chance it may spread throughout the chest cavity and to distant organs, making it much more difficult to treat.
There is no formal staging system for peritoneal mesothelioma, the second-most-common form of the four types of mesothelioma. If a doctor refers to peritoneal mesothelioma as stage 3, it usually means tumors have spread throughout the lining of the abdomen and to nearby lymph nodes.
As the tumors continue to grow and spread, the symptoms will become more problematic.
Symptoms vary from patient to patient depending on how the cancer is spreading.
A tumor invading the chest wall may cause increased chest pain, while tumors forming around the lung may lead to increased breathing difficulties.
Surgery and palliative treatments can help manage pain and reduce the severity of symptoms.
Diagnosing Stage 3 Mesothelioma
While TNM is the most widely used staging system for pleural mesothelioma, doctors sometimes turn to the Brigham staging system or Butchart staging system when evaluating cancer spread.The three staging systems have slightly different definitions of stage 3 mesothelioma.
TNM Staging System: Stage 3 mesothelioma is divided into two subcategories. In 3a, the cancer has spread to nearby lymph nodes and to structures such as the fatty tissue in the mediastinum. Tumor-removing surgery is still a possibility with 3a, while surgery for 3b depends on the size and extent of the main tumor. The cancer has not spread to distant organs or distant lymph nodes.
Brigham Staging System: Tumors have spread into the area between the lungs or invaded the chest wall or diaphragm. The cancer has spread to distant lymph nodes. Growth is significant enough where surgery is no longer a viable option.
Butchart Staging System: Tumors have spread to the diaphragm or the lining of the abdomen. Cancer cells have traveled to distant lymph nodes outside the chest.
Stage 3 tumors are considered locally advanced, but surgical removal may be possible with extensive surgery.
A treatment plan using tumor-removing surgery, chemotherapy and radiation therapy has produced the best survival rates for people with stage 3 pleural mesothelioma.
Surgery
At stage 3, tumors have likely spread to surrounding tissues and lymph nodes. Pleural mesothelioma patients may be eligible for an extrapleural pneumonectomy (EPP), an aggressive surgery which removes the affected lung and its lining.
Depending on the spread of tumors, some stage 3 mesothelioma patients may qualify for the less drastic but more meticulous pleurectomy and decortication procedure (P/D), which removes the lining of the lung along with any tumor masses growing inside the chest cavity.
Common mesothelioma surgeries, such as EPP and P/D, show better survival rates when combined with chemotherapy.
Most patients receive combinations of chemotherapy drugs through an IV. Chemotherapy can begin as soon as a patient recovers from surgery. But they may also be administered before or during surgery.
Radiation therapy may also be administered after surgery to prevent local recurrence. Some research suggests an increased survival rate when radiation therapy is applied before surgery to shrink tumors.
Stage 3 patients who are not in good enough health to undergo aggressive treatments can improve their quality of life with palliative therapies.
While these treatments aren’t expected to cure your cancer, they usually can help you feel better. Palliative chemotherapy and radiation might be used to lessen cancer-related pain, while palliative surgery drains fluid buildup around the tumor, which helps with difficulty breathing.
Voluntary research studies may provide the best hope for stage 3 mesothelioma patients. Immunotherapy and gene therapy are two constantly evolving areas in cancer treatment. Although neither is FDA approved for mesothelioma, clinical trials testing immunotherapy drugs and new therapies in human genetics are showing promising results.
Complementary therapies, such as acupuncture, yoga and nutritional counseling, are often integrated with traditional mesothelioma treatments to improve overall health or boost the immune system.
Some late-stage patients choose to forego traditional treatments for alternative therapies such as herbal medicine and homeopathic supplements.
However, a 2017 study from Yale School of Medicine shows cancer patients who rely on alternative medicine alone have a significantly lower survival rate.
Life expectancy for stage 3 mesothelioma patients depends on response to treatment and the extent of lymph node involvement.
If surgery is successful and a patient responds well to post-surgery therapies, they can surpass the average 16-month survival period.
How Lymph Nodes Affect Cancer
Lymph nodes play a key role in the spread of cancer because the lymphatic system can transport cancer cells to distant organs. Once this occurs, the cancer is generally considered inoperable and terminal.
That’s why beginning treatment soon after diagnosis is essential to living longer. The key is to remove as much of the cancerous growth as possible before it spreads to other areas of the body.
Patients with minor lymph node involvement often live more than two years, compared to a 13-month average for patients with more extensive involvement of nearby lymph nodes.
Even if the cancer has not spread to the lymph nodes, surgery may not be an option for some stage 3b patients if tumors have grown too far to be removed completely.
“When I was first diagnosed with stage 3 inoperable cancer and told I had a year to live, I figured I’d better hurry up and try to finish this house quickly. But now, things have changed. My goal is to make it to the 10-year mark.”
— Russell Lamkins, diagnosed with pleural mesothelioma in 2014
Survival statistics cannot predict how long a person will live.
All patients with stage 3 mesothelioma have varying factors, including age, gender, cancer cell type, response to treatment and overall health, that can affect prognosis and life expectancy.
Certain patients respond particularly well to treatment and outlive their prognosis by years.
Karen Selby joined Asbestos.com in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators.
