Stages of Mesothelioma: What you can expect at each stage, and what you can do about it

Stage 1: The surgery that saved my life

I worked at the steel mill, back when it was still running. I was a press machine operator, and it was pretty much always hot and dusty, every day. I didn't think much of it at the time—that was just how you made steel, I thought. The white dust was everywhere, and it got so you didn't really notice it anymore. When I retired, I didn't want to look at or even think about steel again.

But I had to think about it when my doctor told me I had Stage 1 mesothelioma—which was good news, he said, because “Stage 1” meant they could remove it. ...I wasn't looking forward to the surgery, but I didn't let myself think about the other choice.

I had to go out of state, where a doctor, a young guy, he cut out the part of my lung with the cancer, and then cut out all around it to be safe. It hurt like hell when I was in recovery, and I did not like what the chemo did to my nerves and my stomach, but here I am today.

Stage 1 mesothelioma patients have a better prognosis than most mesothelioma patients, because in Stage 1, the cancer has not yet spread through the blood and lymph systems. Surgery is invasive, and patients with heart problems face great risks when they undergo any surgery. But if the doctor recommends surgery, and catches the cancer early enough, while it is in its early stages, mesothelioma patients can and do survive.

Depending which staging system you use to chart the cancer's growth (Butchart, TNM, or Brigham), you can be in more than one stage at a time. The Butchart system focuses on pleural mesothelioma, whereas the TNM system can be used for all types of cancer, and the Brigham System determines stages according to two questions: can the mesothelioma be removed surgically, and is it present in the lymph nodes.

Usually, Stage 1 mesothelioma patients' surgeons remove the tumor (or tumors) and some of the tissue surrounding the tumor. Doctors tend to follow up surgery with radiation therapy (using rays to destroy cancer cells) and chemotherapy (drugs to fight the cancer) once the patient has recovered from the operation.

Stage 2: We caught it in the nick of time

When the doctor told me I had mesothelioma, and that it had spread, I thought it was all over. A guy I had worked with doing drywall years ago—my wife's cousin, actually—he had gotten mesothelioma about five years back, and I mean, he wasn't sick a year before he went from being in the “pray for the sick” part of mass to the “pray for the souls of” part. I just assumed that was how it would go for me, too.

My wife was more optimistic, and she really kept on him, with “what are you gonna do for my Joseph” and asking for second opinions, and all this. She never gave up hope. She was right, too—they could remove it, and they did, even though it had spread by the time they found it. The doc says I'm a success story. ...I don't know what the future holds, but for now I'd agree.

At Stage II, the cancer has spread to at least one nearby organ, but it is still possible to remove the tumors with surgery.  According to the Butchart Staging System, mesothelioma has reached Stage II when the cancer has spread to a nearby location.

The Brigham Staging System considers mesothelioma in Stage II when the tumors are removable, but they have spread to a lymph node, which means there is still a risk of metastasis (cancer showing up in distant places on the body) after the tumors have been removed.

TNM, the cancer staging system based on tumor size (T), presence of cancer in the lymph nodes (N), and metastasis (M), defines Stage II mesothelioma as when the tumors have spread to the lymph nodes nearest to the primary tumor, and to other nearby places (this is considered “regional” rather than “localized,” according to the SEER staging system) . 

Stages III and IV: The doctor kept talking about “quality of life”

By the time the doctor found the cancer, Marie was too sick and the tumors were too big for them to do anything about it. I was so angry, but she was just.... tired. She was just so tired, and she needed to be on so many drugs to keep her from feeling the pain. You know, if they catch it early enough, you can have surgery, and then chemo, and this and that... they just didn't catch it early enough.

The doctor kept talking about Marie's “quality of life,” which I guess meant the pain pills? Or that she would only be sick from the cancer, not from chemo? He did what he could, the doc, he didn't get her sick. For a while, I felt like it was me, it was my fault, bringing home the dust on my clothes. But I knew it wasn't true. It wasn't my fault, wasn't my boss's, wasn't Marie's. Nobody's but the companies'.

Each staging system has a separate definition of what Stages III and IV are, but in every staging system, mesothelioma in stages III and IV is too advanced to operate on, which means that the tumors have spread, through the lymph nodes and bloodstream, to places on the body such as the brain, heart, bones, etc.

The difference between Stage III and Stage IV in the Butchart system is that in Stage III, the cancer has spread into the abdominal cavity, past its “regional” areas in and around the mesothelium. In Stage IV, as Butchart system defines it, the mesothelioma has spread through the bloodstream to distant parts of the body.

The difference between Stage III and Stage IV in TNM is that in Stage III, the tumors have moved from the mesothelium to places such as the heart, ribs, and other locations in the abdominal cavity. In Stage IV of TNM, mesothelioma has spread to both sides of the body (TNM focuses on size, lymph nodes, and location), including lymph nodes.

In the Brigham Staging System, mesothelioma has reached Stage III when the tumors have spread to places in the abdominal and pleural cavities where they cannot be safely removed, and tumors may or may not be present in the lymph nodes. By Stage IV in the Brigham system, the tumors have moved (metastasized), and have reached vital organs such as the heart, stomach, and brain.

In Stage III, surgery, chemotherapy and radiation are still options, but they are used more to relieve the patient's pain (from tumors pressing on organs, or from fluid in the lungs) than to try to get rid of the cancer. A patient whose mesothelioma was diagnosed as stage III has options, but it is, for the most part, too late to operate.

At any stage, it is important to know your options

Doctors treat mesothelioma as aggressively as they can, given the patient's health and the progression of the cancer. And lawyers do the same. The stage at which your mesothelioma was diagnosed may determine your treatment options, but it does not determine your legal options.

It is important, though, to seek legal help as soon after diagnosis as possible. Weitz & Luxenberg can help you solve your financial problems, caused by the burden of mesothelioma treatments, much sooner the sooner you seek help.

http://www.cancer.gov/cancertopics/factsheet/Detection/staging