Mesothelioma Life Span

Because there are many factors involved in determining a mesothelioma patient's life span, calculating an exact number can be difficult. Many people tend to think of life span as the expected survival time after a disease is diagnosed, but a patient's life span is measured from the moment the disease begins to form.
Mesothelioma patients are unique because of the disease's long latency period. The process of developing mesothelioma actually begins when someone first inhales or ingests asbestos fibers, often several decades before symptoms appear and the cancer is diagnosed. As a result, there is no way for doctors – or even patients – to determine the exact moment when mesothelioma tumors develop.
Most patients live up to a year after being diagnosed, but there are also mesothelioma survivors who lived for many years and are still leading productive lives.

Determining Life Span

There are a number of factors and mitigating circumstances that must be examined from patient to patient. Among them are: how far along the cancer is when it is detected; the cell type of the cancer; the patient's overall health; and past health, such as whether the patient was a smoker. In one way or another, all those variants affect the life span of someone battling this lethal ailment.

One important factor when assessing the life span of mesothelioma patients is its inordinately long latency period. Once asbestos fibers are in place to render a human body unhealthy, the mesothelioma they sometimes create can lie dormant for a period of 20 to 50 years. That is the typical time between asbestos exposure that begins the syndrome and its eventual diagnosis. That means that the true life span of a mesothelioma victim can be measured in decades; decades in which there are no symptoms, no pain or discomfort, and no detectable signs of the disease.
It is true that once mesothelioma is diagnosed, the medical prognosis is usually bleak. Pleural mesothelioma, if untreated, has an average life expectancy that ranges between four months and 18 months after symptoms appear. Peritoneal mesothelioma yields a five- to 13-month outlook, on average, if not treated.

Other Factors of Life Span

Another important factor that needs to be understood when assessing these statistics, and which has the tendency to skew them downward, is the relatively advanced age of the average mesothelioma patient. Most people diagnosed with mesothelioma are between 50 and 70 years old, with about 75 percent of patients in their mid-60s.
Therefore, the life expectancy for these individuals is understandably much shorter than for those who have other types of cancers and who may be much younger when their ailments are initially diagnosed.

Other important aspects that impact life span for victims

1. The form or location of the mesothelioma
2. The type of mesothelioma
3. Whether or not the cancer was detected early or late, i.e. the actual stage of the cancer
4. Whether it has metastasized, i.e. spread to other parts of the body
5. The presence or absence of other diseases or disorders, including abnormal blood values (red, white and platelet blood counts)
6. And the general health, lifestyle and functional status of the patient.

Treatments, Life Span and Mesothelioma Survivors

The kinds of treatments sought, applied and responded to can have an important impact on the life span of a mesothelioma patient. Standard medical approaches include surgery, chemotherapy, and radiation. In some studies, multimodality therapy, which is a combination of two or more of the three traditional treatments, produces significant survival extensions among patients with other favorable prognostic factors.
Between 5 and 10 percent of people with mesothelioma live at least five years after being diagnosed – far longer than the average statistics suggest. Some live much longer than that.

Survivor Stories

Paul Kraus is an Australian factory worker who was diagnosed with peritoneal mesothelioma in 1997, 35 years after occupational exposure to crocidolite asbestos. Kraus applied several different therapies and lifestyle changes, including shifting to a vegetarian diet, consuming nutritional supplements, and employing ozone therapy, which adds a specific form of oxygen to his blood with the intent of creating a cancer-killing oxygenated environment in his body. He still has mesothelioma but is pain-free and alive.
At the extreme limit of mesothelioma survival is the case of acclaimed American scientist Stephen J. Gould, who lived for almost twenty years after being diagnosed with the disease. He died of an unrelated condition.

Traditional and Experimental Therapies

There are many experimental therapies being investigated to slow the progress of mesothelioma. Some show promise in extending life spans, including photodynamic therapy (PDT), while newer, targeted drugs that have shown to be effective in killing cancer cells and gene therapy which attempts to replace or repair the defective genes in cancerous tumors.
Some non-traditional therapies that have been reported to extend the life expectancy of mesothelioma patients include meditation, yoga, acupuncture, and various holistic medicines and natural supplements.
Medical advancements continue to refine methods of detecting and managing the disease. As a result, the life span of its sufferers is gradually improving. As more research is done and more alternative treatment options continue to be explored, mesothelioma patients are being offered a wider range of choices that may ultimately modify their prognosis and significantly extend their life spans.

Mesothelioma Death Rate

Approximately 2,000 to 3,000 people are diagnosed with mesothelioma each year. Because the cancer is rare, many patients and their loved ones are not sure what the cancer is and what exactly a mesothelioma diagnosis entails. Questions about prognosis and the mesothelioma death rate often surface. 

Mesothelioma Mortality Rate

According to the Centers for Disease Control and Prevention (CDC), the malignant mesothelioma death rate in the United States from 1999 through 2005 totaled 18,068 people. The death rate increased from 2,482 deaths in 1999 to 2,704 in 2005, an increase of 222 deaths.
Men are diagnosed with mesothelioma more often than women, and males comprised 80.8 percent of mesothelioma deaths during this timeframe (a total of 14,591). White people comprised 95.1 percent of mesothelioma deaths, totaling 17,180.

Mesothelioma Guide

The most important factor to patients is usually their life expectancy. There are many options available to treat mesothelioma and extend your life span – take our site with you and get your free treatment guide.

Age influenced the mortality rate, as those 75 years old and older comprised the majority of the patients who passed away from mesothelioma (8,858 total deaths). Deaths in patients age 44 or younger totaled 311, or 1.7 percent.

During the time period addressed in the CDC’s study, the state mesothelioma death rate was greater than the national death rate of 13.8 per one million people per year. In six states the mesothelioma death rate was greater than 20 per one million people per year.
The mesothelioma death rate was highest in Maine at 27.5 percent (173 total), followed by Wyoming (22.2 percent, 50 deaths), West Virginia (21 percent, 182 deaths), Pennsylvania (20.8 percent, 1,210 deaths), New Jersey (20.2 percent, 814 deaths) and Washington (20.1 percent, 558 deaths).
Research and extensive studies are conducted daily to improve treatments for mesothelioma patients and search for a cure for the cancer. Through medical advances and developments in clinical trials, more options will continue to be available to combat mesothelioma and improve the mesothelioma death rate in the United States.

Number of U.S. Malignant Mesothelioma Deaths 1999 - 2005

Characteristic	1999	2000	2001	2002	2003	2004	2005	Total
Total	2482	2530	2505	2570	2621	2656	2704	18068
Age
25-34	4	6	7	10	7	11	6	51
35-44	33	34	39	40	38	42	34	260
45-54	138	131	144	106	148	121	118	906
55-64	388	372	361	380	386	400	438	2725
65-74	818	814	748	764	715	674	735	5268
75-84	888	918	942	975	1028	1097	1014	6862
85+	213	255	264	295	299	311	359	1996
Sex
Male	1993	2043	2019	2126	2122	2140	2148	14591
Female	489	487	486	444	499	516	556	3477
Race
White	2353	2398	2405	2447	2481	2535	2561	17180
Black	104	109	75	99	109	97	114	707
Other	25	23	25	24	31	24	29	181

Clinical Trial Information

Additional information about treatment options and ongoing research in clinical trials may be found through a complimentary comprehensive packet offered by Asbestos.com. Click here to receive your copy and learn more.

Mesothelioma Survival Rates

The survival rate of any disease refers to the percentage of patients that live for a specified period of time after diagnosis. It is a summary of life spans based on certain contributing factors, and it can give patients an idea of how long they may expect to live. Survival rates for mesothelioma cancer can vary because of age, gender, race and a number of other demographics.
Overall, survival rates for mesothelioma are low. Only about 40 percent of U.S. mesothelioma patients survive one year. By the second year, less than 20 percent of patients are still alive. And by year four, this drops below 10 percent.

Personalized Survival Rates

Find out survival rates for patients like you. Select your race, sex and age range below to view a personalized chart of survival rates. Keep in mind that these are only statistics. They can provide an estimate for expected lifespan, but it is impossible to exactly predict every individual case.

To maximize your survival rate, make sure you select a doctor specializing in your type and stage of mesothelioma. Our Doctor Match program was created to ensure all patients have access to the best treatment options for them. Visit our Doctor Match page to find out more.

Search Statistics on Mesothelioma Survival Rates

Between 1999 and 2005, slightly more than 18,000 Americans died of malignant mesothelioma, a rare disease that typically attacks the lining of the lung or the lining of the abdomen but can also develop in the lining of the heart or testicles. This works out to one person in the United States dying of mesothelioma every 3.4 hours. Most of these deaths were white men over the age of 45.
The National Institute for Occupational Safety and Health (NIOSH) studied what this meant in terms of years lost from life expectancy. It accounted for average ages and life expectancies of all mesothelioma patients who died between 1999 and 2004. By doing so, NIOSH determined that in this six-year period, mesothelioma deaths caused a total loss of more than 200,000 years of life expectancy.

Survival Rates by Age

Because of mesothelioma's decades-long latency period, individuals often don't feel symptoms until they are older, which increases the average age of patients. Individuals exposed to asbestos decades earlier usually don't develop symptoms of mesothelioma until they are at least in their 50s. Because of this, mesothelioma patients die at a median age of 74 years old, and more than three-fourths are 65 years or older.
Older patients have a much lower survival rate than younger ones. More than half of patients diagnosed before the age of 50 live one year, but less than one-third of patients 75 or older live the same amount of time. Rates are similar for long-term survival. Younger patients have a 20 percent chance of living a decade; older individuals only have a 1 percent chance.
This difference is largely because younger patients are eligible for more intensive treatments like surgery. Older individuals may not be candidates for these procedures because of overall poor health or a high risk of complications.

Survival Rates by Gender

Most asbestos exposure occursin the workplace and in industrial jobs typically held by men. That helps explain whyabout 81 percent of mesothelioma patients are men. The few women who do develop mesothelioma usually were exposed to asbestos by living near asbestos mines or factories or by living with someone who was directly exposed to asbestos.
Studies show women usually respond better to mesothelioma treatments, which may explain their higher survival rates. Women have better rates than men for both short-term survival and long-term survival. About 46 percent of women live one year, compared to only 37 percent of men. And 11 percent of women live a decade, while only 2 percent of men live as long.

Survival Rates by Race

Click to view image

Mesothelioma is almost exclusive to white individuals, who make up 95 percent of patients. This vast difference may be in large part because black and Hispanic individuals are less likely to be diagnosed with any type of cancer, mesothelioma included. Data from Surveillance, Epidemiology, and End Results (SEER) state that African Americans and Hispanics account for only 8 percent of all cancer diagnoses.
Race, however, does not affect initial survival times. About 40 percent of patients live one year, regardless of race. As time goes on, race becomes a more telling factor and white patients have slightly worse long-term survival rates. For white patients, 8 percent live five years, and half of those patients live another five years. Comparatively, 12 percent of black and Hispanic patients live five years, and 9 percent live 10 years.
Like the incidence rates for race, the survival rates are not fully understood. One 2010 report that studied mesothelioma rates from 1990 to 2004 concluded that although black and Hispanic patients have better long-term survivals, they are less likely to receive surgery. Whereas a quarter of white patients received surgery during this time, only 14 percent of black patients underwent a surgical procedure.

Survival Rate by State and Region

Mesothelioma predominantly affects groups living in more industrial states or those with naturally occurring asbestos deposits. While survival rates by state are not significant, death rates can be used to describe the total number of deaths in each state. This figure is usually expressed in deaths per million, meaning the number of deaths is for every million residents of the state. The basic formula is this:
Death Rate (in deaths per million) = (Mesothelioma Deaths / Total Population) × 1,000,000
For example, if the total number of residents in a state is 2 million and a total of 10 people died of mesothelioma, the death rate is 5 deaths per million. This formula provides a way of accounting for vast population differences. A state may have a high number of deaths but a low death rate. This can happen in more populous states.
Based on data from 1999 to 2005, Maine has the highest death rate of 27.5 deaths per million people. Only five other states have a comparable death rate of more than 20 deaths per million people. These states and their death rates are:

• Wyoming (22.2 deaths per million).
• West Virginia (21.0 deaths per million).
• Pennsylvania (20.8 deaths per million).
• New Jersey (20.2 deaths per million).
• and Washington (20.1 deaths per million).

Survival Rates by Site of Mesothelioma

Data from the National Cancer Institute (NCI) show that peritoneal mesothelioma patients have overall higher short- and long-term survival rates than pleural mesothelioma patients. Collected between 1988 and 2001, they show one-year survival rates as comparable: peritoneal mesothelioma at 42 percent, pleural mesothelioma at 38 percent. The survival gap becomes larger over the next few years. While more than 25 percent of peritoneal mesothelioma patients are alive at three years, only 11 percent of pleural mesothelioma patients live this long.
The data from NCI do not include other types of mesothelioma because they are so rare, but these rare types have been studied separately. A 2009 study plotted the survival rates for pericardial mesothelioma. The study found similarly low survival rates, with about 40 percent of patients surviving one year. Testicular mesothelioma has the best survival rates. Nearly half of all testicular mesothelioma patients live two years or longer.

The four types of mesothelioma:

Pleural mesothelioma

- is the most common type of mesothelioma. It develops in the lining of the lungs and makes up about 75 percent of mesothelioma diagnoses. It is also has lower survival rates than peritoneal mesothelioma.

Peritoneal mesothelioma

- develops in the lining of the abdomen, makes up nearly 25 percent of the remaining mesothelioma diagnoses.

Pericardial mesothelioma

- develops in the lining of the heart sac, accounts for less than 2 percent of cases.

Testicular mesothelioma

- grows in the lining of a testicle, accounts for less than 2 percent of cases.

Survival Rates by Stage of Mesothelioma

The stage at which mesothelioma is diagnosed can be a good predictor of overall survival rates. This is only for patients with pleural mesothelioma, which is the only form of the cancer that has a staging system. If patients have earlier stages of mesothelioma, the cancer has not substantially spread beyond the lining of the lungs. This means patients have more treatment options such as surgery which can improve survival rates. Normally, mesothelioma is not diagnosed until it reaches Stage III or Stage IV, the last stages of development. This can include a larger tumor or cancer growth throughout the body. Later stages of mesothelioma are more difficult to treat effectively, so these patients have worse survival rates.
A 1996 study observed survival rates for 131 pleural mesothelioma patients. It found that at one year, more than 90 percent of patients with Stage I cancer were alive, but only about one-third of patients with Stage 4 mesothelioma survived as long. This trend continued into longer-term survival. At three years, more than 40 percent of Stage I patients were still alive, compared to less than 5 percent of Stage IV patients.

Survival Rates by Tumor Histology

The histology, or cellular makeup, of a mesothelioma tumor also provides an accurate predictor for survival rate. Epithelial tumors are made up of more consistent and uniform cell patterns, whereas non-epithelial tumors have messy and random cellular patterns. This is an important distinction because the straightforward patterns of epithelioid mesothelioma respond better to treatment. For that reason, patients with epithelioid mesothelioma live longer.
The 1996 study of 131 pleural mesothelioma patients also grouped individuals by epithelial or non-epithelial tumors. About a quarter of patients with non-epithelial tumors lived for one year, compared to more than 60 percent of those with epithelial tumors. Every patient in the study with non-epithelioid mesothelioma died within three years of diagnosis. Comparatively, a small amount of patients with epithelioid mesothelioma reached four or five years.

Extending Survival Time

Learn more about your expected life span and what you can do to live longer. Visit a mesothelioma specialist for a health evaluation and a second opinion about your treatment options. To find the specialist nearest you, use the Mesothelioma Center’s free Doctor Match Program.

Mesothelioma Life Expectancy

Mesothelioma life expectancy is the projected number of months or years a mesothelioma patient will live following a diagnosis. The average life expectancy is about one year for mesothelioma, but each patient has a unique set of life expectancy factors that could help them surpass this average. Factors like overall health, age, stage at diagnosis and the unique type of mesothelioma a patient has will play a role in their expected life span.
Thankfully, research scientists and doctors have been working to improve the life expectancy for mesothelioma patients for decades. And they've done just that: survival rates for mesothelioma have steadily increased over the past several decades. These numbers are expected to climb in the coming years with recent advancements in mesothelioma treatment. While there is no definitive cure for mesothelioma, patients can elect to undergo specialized treatment or participate in clinical trials that often help prolong their life expectancy and improve their overall quality of life.
In an effort to help patients understand and improve their life expectancy, the Mesothelioma Center offers a complimentary packet that contains treatment information tailored to your specific diagnosis. The packet also covers the nation's top mesothelioma doctors and cancer centers, as well as financial assistance options to help cover medical costs. To receive your packet in the mail, please enter your information below.

Life Expectancy Factors

The life expectancy of a mesothelioma patient can be influenced by a number of factors, including stage of the cancer, type of mesothelioma, age at diagnosis, latency period of symptoms and other prognostic indicators. Mesothelioma is identified by where it attacks the body, and the location plays a role in survival.
Pleural mesothelioma attacks the lining of the lungs and makes up about 75 percent of mesothelioma cases. Its commonness makes for a longer life expectancy. Peritoneal mesothelioma occurs in the lining of the abdomen and is responsible for 20 to 25 percent of mesothelioma cases. On average, peritoneal mesothelioma patients live around six months after diagnosis, but women tend to live longer than men with this type.
Pericardial mesothelioma occurs in the lining of the heart. It accounts for only about 5 percent of the cases and is extremely difficult for doctors to treat and for patients to survive long.
Doctors have had some success treating mesothelioma, and there are actions someone can take to increase life expectancy. The earlier the disease is spotted, the better the chance of a successful treatment. A few (mostly younger) patients have survived five years or longer because of their treatment and exercise regimens.
Mesothelioma is also classified by cell type, and that type impacts average survival periods. Patients with an epithelioid type mesothelioma generally have a better life expectancy than those with a sarcomatoid or biphasic (mixed) subtype.

Staging

The exact stage of the cancer upon diagnosis has a direct impact on life expectancy. The primary factors that help define the stage of mesothelioma include symptoms and metastasis (spreading of the cancer).

• Stage l

  Cancer is localized. Surgery may be able to remove tumors and prognosis is highest.

• Stage ll

  Cancer has spread beyond point of origin. Surgery may still be an option, but life expectancy is decreased.

• Stage lll

  Cancer has progressed to advanced stage of development. Palliative treatments to ease symptoms may be considered.

• Stage lV

  Cancer has spread to distant locations. Palliative treatments can improve comfort, but life expectancy is severely decreased.

Mesothelioma Diagnosis

Doctors use a handful of common techniques to render a diagnosis: physical examinations, biopsies, blood tests, X-rays and imaging scans. They also take a medical history, including any history of smoking. In the case of mesothelioma, they will want to know about any history of asbestos exposure. A person should get a diagnosis from a specialist within three to six months of first seeing the doctor.

Histology

The histological subtype is one of the most important prognosis factors for malignant mesothelioma. Patients with epithelioid mesothelioma have a much better life expectancy than those with a sarcomatoid or biphasic (mixed) subtype.

Epithelial Sarcomatoid Biphasic

Latency Period

The severe latency period associated with the onset of symptoms may result in a late diagnosis. When referencing mesothelioma, latency period is defined as the period of time between exposure to asbestos and the moment the cancer become noticeable. Mesothelioma patients diagnosed in the later stages of development will often receive treatment to ease pain and discomfort rather than try to cure the disease.

Other Factors

A mesothelioma patient's life expectancy may also be affected by demographic and lifestyle factors, such as:

Gender

Males are predominantly affected by mesothelioma cancer.

Age

75 percent of mesothelioma cases in the United States occur in men age 55 or older.

Smoking

Smokers are 90% more likely to develop lung cancer after asbestos exposure.

Prolonging Life Expectancy

The efficacy of treatment should not be ignored when considering impacts on life expectancy. Treatment is improving with research and new medical advancements, and this is having a positive influence on the five-year survival rate. Additionally, mesothelioma survivors seem to have a unifying link: they integrated holistic and natural medicine into their treatment plan. Nutritional regimens, the addition of supplements and alternative therapies like acupuncture are among the holistic approaches tha survivors are using for their lives.

5-Year Relative Survival (Percent) 1999-2006

Age at Diagnosis

Patients Reaching 5-Year Survival (%)

< 45

39.7%

45-54

15.7%

55-64

7.5%

65-74

6.0%

75+

2.7%

Source: SEER Cancer Incidence Report

Treatment Factors

There are a number of options for patients to relieve symptoms and prolong their asbestos cancer life expectancy. Patients can elect to undergo treatment to remove the cancer, kill cancerous cells, reduce pain or manage metastasis. Some treatments that may improve life expectancy include:

Traditional Treatment:

Surgery, chemotherapy and radiation therapy are the three forms of traditional treatment currently available to extend life expectancy. Tests to diagnose mesothelioma in its earliest stage of development are also being explored to enhance the effectiveness of current traditional treatments.

Surgery Chemotherapy Radiation Therapy

Non-Traditional Treatment:

Therapies such as immunotherapy, gene therapy, photodynamic therapy and hormonal therapy are a class of experimental treatments. These therapies have improved life expectancy in some patients, but are only available through clinical trials since they are still in an experimental stage of medical testing.

Alternative Treatment:

A selection of mesothelioma patients have benefitted from alternative or complimentary therapies such as acupuncture, meditation, massage and yoga. These alternative therapies may reduce stress, pain and improve quality of life.

Clinical Trials

Mesothelioma researchers are testing new medications and treatment approaches through clinical trials with the hope of improving life expectancy. Clinical trials allow patients to take advantage of new treatments that may extend survival, but may also come with an element of risk.

Completed Get Help Enrolling Non-recruiting

Nutrition

A number of dietary changes can affect an asbestos cancer patient’s life expectancy. Considering nutrition in the treatment plan could have positive impacts on pain, stress levels and response to treatment. The Mesothelioma Center offers a complimentary nutrition book to mesothelioma patients looking to learn more about diet and cancer.

Patients who are searching for a second opinion or an experienced mesothelioma doctor can contact the Doctor Match department at the Mesothelioma Center to learn more about their options depending upon their unique diagnosis and location. To take advantage of this complimentary service, please call the Doctor Match department at (800) 549-0544.

Mesothelioma Prognosis

Approximately 2,000 to 3,000 new cases of mesothelioma are diagnosed in the United States each year. Once a patient is diagnosed, a doctor will likely discuss their prognosis, or probable course of the cancer's influence on the body and recommend various treatment options. .The prognosis of a patient diagnosed with mesothelioma and the recommended treatments can vary greatly depending on the patient's age, sex, asbestos exposure history and the specific cells involved.
The best way to avoid a poor prognosis is through early detection of the cancer. When mesothelioma is detected early, the prognosis is generally more favorable, as the cancer may not have spread to other parts of the body and may be more receptive to various treatments and surgery. Following detection, the best way to improve a patient's prognosis is educating oneself about the latest mesothelioma treatments.
Those who have been exposed to asbestos may wish to alert their doctor, as this may aid in the early detection of mesothelioma or another asbestos-related disease.

Pleural Mesothelioma 5-Year Survival Rate

Type of Mesothelioma: A patient's prognosis can be affected depending upon whether they are diagnosed with pleural, peritoneal, pericardial or testicular mesothelioma. Statistics show that approximately 10 percent of patients with pleural mesothelioma will survive for five years following diagnosis. Statistically speaking, pleural mesothelioma patients have the most optimistic prognosis.
Learn More About The Types of Mesothelioma
Overall Health: Patients diagnosed with mesothelioma who are otherwise healthy may have an easier time undergoing intensive treatment, such as chemotherapy, than someone with pre-existing health issues. Additionally,non-smokers often have a better prognosis than patients who smoke.
Stage of Mesothelioma: Doctors typically discuss the severity of a patient's cancer in terms of stages, ranging from Stage 1 to Stage 4. Patients with Stage 3 or Stage 4 mesothelioma will typically have a poorer prognosis than patients with Stage 1 or Stage 2 mesothelioma.
For example, in a study published in the European Respiratory Journal involving 167 patients with pleural mesothelioma, participants with Stage 1 pleural mesothelioma survived for 359 days, while those with Stage 3 or Stage 4 (combined) mesothelioma survived approximately 112 days. In general, treatment options are typically more limited and surgery may not be an option once the cancer has progressed beyond Stage 2.

Stage I Mesothelioma Patients Averaged a 359-day Life Span Following Diagnosis

Stage III and IV Patients Averaged a 112-day Combined Life Span Following Diagnosis

Cell Type: Mesothelioma histology impacts a patient's prognosis, as those with epithelial mesothelioma have a greater life expectancy than those with sarcomatoid or biphasic mesothelioma.
Size and Location of the Tumor: The size and location of a patient's tumor can impact their prognosis. Patients with tumors that have progressed or spread to other parts of the body generally have a poorer prognosis. Patients with tumors that may be surgically removed often have a better prognosis.
Progression of Symptoms: Patients who are experiencing serious symptoms of mesothelioma, such as chest pain or shortness of breath, may have a weakened prognosis, because the prevalence of mesothelioma symptoms often indicates the cancer has progressed to a later stage of development.
Learn More About The Progression of Symptoms
Additional factors, such as age and a patient's response to surgery may also affect a patient's prognosis.

Favorable Prognostic Factors	Poor Prognostic Factors
Stage I or Stage II Mesothelioma	Stage III or Stage IV Mesothelioma
Tumor Located in One Area of the Body	Tumor Progressed to Other Parts of the Body
Good Overall Health	Preexisting Health Conditions, Poor Overall Health
Epithelial Mesothelioma	Sarcomatoid, Biphasic Mesothelioma
Age 55 or Below	Over Age 55
Non-Smoker	Smoker
Female	Male

Current Prognosis Studies

The ability to provide patients with a more accurate mesothelioma prognosis increases as results from ongoing studies continue to surface. According to a January 2011 study conducted by the University of South Wales, females with mesothelioma may have a more positive prognosis, as the expression of the estrogen gene may lead to tumor suppression.
Additionally, a February 2011 study involving 636 patients with pleural mesothelioma conducted by the Division of Thoracic Surgery and Department of Pathology of Brigham and Women's Hospital in Massachusetts notes that patients with pleural mesothelioma who underwent an aggressive surgery known as an extrapleural pneumonectomy experienced extended survival.

Typical Mesothelioma Prognosis

Patients Surviving 5 or More Years Following a Mesothelioma Diagnosis (%)

Patients < 45 Years of Age

Patients 45- 54 Years of Age

Though a patient's prognosis varies greatly depending on the factors mentioned above, patients under the age of 45 appear to have a more optimistic prognosis. A study conducted by the American Cancer Society (ACS) involving 2,959 patients noted that nearly 37 percent of mesothelioma patients who were less than 45 years old survived for more than five years after diagnosis. Approximately 20 percent of patients aged 45 to 54 survived for longer than five years.
According to a study published by the Journal of Thoracic Oncology, the survival rate for mesothelioma patients is generally considered to be one year.
Learn More About Survival Rates

Improving Prognosis

Following a mesothelioma diagnosis, patients may wish to learn more about how they can improve their prognosis. Many patients will elect to undergo treatment to fight the cancer.

Common treatment options include:

• Surgery
• Chemotherapy
• Radiation Therapy

Mesothelioma patients may also wish to enroll in a clinical trial, as the clinical trial process tests up-and-coming medications and may provide access to new treatments that could extend life expectancy.

Desmoplastic Mesothelioma

Desmoplastic mesothelioma is a cell subtype of mesothelioma that occurs in the pleura and occasionally in the peritoneum. It is classified as a fairly common variant of sarcomatoid mesothelioma – an aggressive cell type – but cases of desmoplastic mesothelioma with biphasic and epithelial cells are diagnosed on rare occasions.
This rare subtype was initially described in 1980 and represents 5 to 10 percent of all mesothelioma cases. Its cells are often described as bland or “patternless” in appearance and are usually found once they have invaded the chest wall adipose tissue.

Diagnosing Desmoplastic Mesothelioma

To accurately diagnose any case of mesothelioma, a sample of tumor tissue (called a biopsy) is essential. Doctors are recommended to take a large tissue biopsy so that enough cells are reviewed. A large biopsy is particularly important to diagnosing the desmoplastic subtype because fibrous regions of this tumor can hide cell variations that are important to a desmoplastic diagnosis.
The presence of this dense fibrous tissue in addition to minimal cellularity (patterns formed by cells) makes it challenging for doctors to diagnose desmoplastic malignant mesothelioma (DMM). It’s sometimes misdiagnosed as fibrous pleurisy, pleural fibrosis, rheumatoid disease and spindle cell sarcoma.
Doctors and pathologists have specific criteria to look for when a patient is suspected of having desmoplastic mesothelioma. This criterion includes:

• At least 50 percent of the tumor must be made up of dense fibrous tissue that frequently forms nodules
• Areas of increased cellularity that have sarcomatoid mesothelioma characteristics
• Specific areas of cell death, known as necrosis, are seen in 70 percent of cases
• Spread of neoplastic spindle cells to the lung or chest wall
• Metastasis to nearby fat tissue, skeletal muscle or the lung
• Presence of the p53 tumor suppressor gene protein

Doctors warn that when desmoplastic mesothelioma metastasizes, it can look bland and may be confused as benign fibrous tissue. Imaging scans like a CT or MRI may help a pathologist identify spread to the lung or chest wall to diagnose DMM in difficult cases.
Fast Fact: In a study that analyzed 709 cases of mesothelioma from 1998 to 2002, the desmoplastic subtype was diagnosed in 2 percent of cases – less than the average 5 to 10 percent typically diagnosed.

Symptoms, Treatment and Prognosis

Although symptoms of mesothelioma are not profoundly affected by the cell type of the tumor, the primary symptom of desmoplastic mesothelioma is chest pain , often caused by a buildup of fluid in the lungs. Treatment for this particular type of mesothelioma is typically palliative, which aims to reduce symptoms, prolong survival and improve quality of life without taking aggressive action.
Common treatments include the use of chemotherapy and radiation to shrink tumors and kill cancerous cells. A pleurodesis or paracentesis may be recommended to extract excess fluid from the lungs or abdomen.
Desmoplastic mesothelioma is categorized as a sarcomatoid cancer, which is typified by a poor prognosis. In this case, the life expectancy following diagnosis is usually less than one year. In one seven-year study (1982-1989) that evaluated 255 cases of mesothelioma, researchers identified 17 cases of desmoplastic mesothelioma. Of those, 11 were sarcomatoid and six were biphasic. The mean survival from the onset of symptoms to death was 5.8 months for the sarcomatoid variant and 6.8 months for the biphasic variant.
Additional research on this rare mesothelioma subtype is needed so that doctors can make a more accurate diagnosis and patients can extend their survival. Desmoplastic patients who are looking for new or unique ways of treating cancer can consider clinical trials and alternative therapies.

Adenomatoid Mesothelioma

Adenomatoid mesothelioma is a specific subset of epithelioid mesothelioma. It is sometimes known as glandular or microglandular mesothelioma. This subtype is one of the more common secondary patterns of epithelial malignant mesothelioma.
Any type of mesothelioma can have an adenomatoid growth pattern. Pleural, peritoneal or pericardial mesotheliomas may all feature an adenomatoid differentiation.
Adenomatoid mesothelioma can mimic several other types of tumors, including benign adenomatoid tumors and pleural metastases of adenocarcinoma. To correctly diagnose a patient with adenomatoid mesothelioma, doctors will need to evaluate the patient’s clinical presentation as well as the unique histological features of the tumor.

Adenomatoid Mesothelioma Cells and Growth Patterns

Adenomatoid Mesothelial Lesions vs. Adenomatoid Mesothelioma

The adenomatoid subtype of epithelial mesothelioma is not the same thing as an adenomatoid mesothelial lesion. Adenomatoid lesions can grow in mesothelial cells, but these tumors have a different cellular makeup than malignant mesothelioma tumors. Adenomatoid lesions typically develop in genital organs, but they can also arise in the pleura, mesentery or omentum. These benign tumors are very small and lack significant cellular abnormalities.

Adenomatoid mesothelioma cells can be either flat or cube-shaped. In adenomatoid mesothelioma, the cells line small, gland-like structures.
As with other types of epithelioid mesothelioma, adenomatoid mesothelioma grows in a uniform pattern. Some adenomatoid tumors grow into microcystic structures. These patterns can have a lace-like appearance.
Adenomatoid growth patterns may coexist with other growth patterns in epithelial mesothelioma tumors. However, the adenomatoid pattern is often the predominant pattern.

Diagnosing and Treating Adenomatoid Mesothelioma

Malignant adenomatoid mesotheliomas are often diagnosed differently than benign adenomatoid lesions. The benign growths often develop in the genital tract (in both males and females), and they are often diagnosed incidentally during a pelvic surgery. A handful of these tumors have also been detected in the pleura during a debulking surgery for other lung masses.
However, when doctors diagnose a patient with malignant mesothelioma of the adenomatoid variety, the diagnostic process is the same as it is for any other type of malignant mesothelioma. Patients typically present with chest pain, shortness of breath and coughing. The oncologist then runs several imaging scans and biopsies that lead to diagnosis.

In rare cases, benign adenomatoid tumors have also appeared in the following locations:

• Omentum
• Mesentery
• Pancreas
• Liver
• Bladder
• Mediastinal Lymph Nodes
• Adrenal glands

Because adenomatoid mesotheliomas look very similar to other adenomatoid lesions, doctors need to look for specific markers to differentiate between the two conditions. When diagnosing adenomatoid mesothelioma, doctors primarily look for pleural thickening and pleural nodules. These two characteristics are typically absent in cases of benign adenomatoid tumors. To diagnose adenomatoid lesions, doctors look for fibrous stroma (soft tissues) and bland, will well-defined cell borders.
While benign adenomatoid tumors are typically easy to remove through surgery, malignant adenomatoid mesothelioma is more difficult to treat. The therapeutic options include surgery, chemotherapy and radiation therapy. However, one study showed that the mean survival of seven patients who received treatment for adenomatoid mesothelioma was 10 months from the time of diagnosis.

Deciduoid Mesothelioma

One defining characteristic of mesothelioma is the vast number of unique variations documented in medical literature. While doctors mainly classify the four primary types of mesothelioma based on their location in the body, a mesothelioma tumor can also be described by its histology, or the appearance and growth patterns of its composite cells. These mesothelioma cell types can be divided even further into specific subtypes, such as deciduoid mesothelioma.
Deciduoid mesothelioma is an unusual form of epithelial mesothelioma, the most common of all mesothelioma cell types. The term deciduoid reflects this subtype’s histological resemblance to a cellular transformation that takes place during the early stages of pregnancy. After conception, a hormone causes the lining of the uterus to take on new and distinct cellular characteristics. The new lining, which helps form the placenta, then becomes known as the decidua. Although the features of deciduoid mesothelioma and various other diseases appear remarkably similar to the decidua on a cellular level, they result from entirely different biological processes.

An Atypical Mesothelioma Subtype

A rarely documented cancer, deciduoid mesothelioma is substantially different from the more common variations of the disease. While most mesothelioma cancers strike older men, early studies only found the deciduoid subtype in the abdomens of young women. And although nearly all mesotheliomas are caused by overabundant exposure to asbestos, many experts initially believed there was no link between deciduoid mesothelioma and asbestos whatsoever.
First described in 1985, deciduoid mesothelioma has been diagnosed in about 45 cases. As more cases emerged, doctors learned the disease was in fact not exclusive to the peritoneums of young women. Several cases involved men and older women. Deciduoid elements were also observed in pleural and pericardial mesotheliomas, and some patients disclosed a history of asbestos exposure.
Slightly less than half of all deciduoid mesotheliomas are pleural, meaning they form in the lining of the lungs. A roughly equal number of deciduoid cases occur in the peritoneum, which lines the abdomen. This distribution is atypical considering that about 75 percent of all mesotheliomas develop in the pleura.

Risk Factors and Causes

Medical experts do not know the exact cause of deciduoid mesothelioma, but some consider asbestos or hormonal changes to be potential factors. Unlike most types of mesothelioma, deciduoid mesothelioma has not been conclusively linked to asbestos exposure. Some doctors speculate that asbestos is a contributing cause, yet only one third of all known deciduoid mesothelioma patients disclosed a history of asbestos exposure. Overall, about 80 percent of all mesothelioma cases are linked to asbestos.
Doctors who doubt the connection to asbestos speculate that a hormonal imbalance may help trigger the onset of deciduoid mesothelioma. More than half of all cases have occurred in women, and two of the patients were diagnosed during pregnancy. In one of these cases, a woman's tumor was discovered during a Cesarean section. These findings seem to support the hormonal hypothesis. However, researchers opted to rule out this possibility, citing negative test results for certain hormones that should have been present in patients.

Diagnosis and Related Challenges

Deciduoid mesothelioma is difficult to diagnose not only because of its rarity, but also because it resembles other diseases. A deciduoid mesothelioma tumor is made up of firm, whitish gray nodules. Just as in the decidua, individual tumor cells are tightly packed and appear large and polygonal or oval-shaped. The extent of deciduoid features in mesothelioma tumors can vary significantly, ranging from small isolated areas to the entire bulk of the tumor. The most common symptom patients experience is abdominal or chest pain, depending on the tumor’s location.
In the abdomens of young women, deciduoid mesothelioma resembles another type of tumor called pseudotumoral deciduosis. The two types of tumors have the same physical features and presenting symptoms. Additionally, both illnesses show a history of being diagnosed in pregnant women and during Cesarean section. These similarities led some deciduoid mesothelioma patients to be misdiagnosed with pseudotumoral deciduosis, a dangerous mistake considering that pseudotumoral deciduosis is generally non-cancerous. Mesothelioma patients mistakenly diagnosed with pseudotumoral deciduosis generally do not receive the immediate care they need.

Prognosis and Treatment Options

For all forms of deciduoid mesothelioma, curative treatment options remain elusive. In patients treated with radical surgery followed by aggressive chemotherapy, the disease typically continues to progress despite the elimination of all signs of cancer. This treatment plan is therefore palliative, meaning it aims to control symptoms and prolong survival rather than cure the cancer.

While the most effective course of treatment for mesothelioma is an ongoing topic of debate, most experts agree that multimodal therapies represent the gold standard of care. These therapies include various combinations of standard cancer treatments like surgery, chemotherapy and radiation therapy. One example boasting noteworthy success rates is extrapleural pneumonectomy surgery combined with pre- or post-operative chemotherapy. However, some experts claim that the risks of this aggressive surgical technique commonly outweigh its potential benefits.
The only treatment found to increase survival in randomized trials was systemic chemotherapy, which can kill cancer cells that have spread to the lymph nodes and distant organs. One 2001 case study reported on a deciduoid peritoneal mesothelioma patient who received cytoreductive surgery and systemic chemotherapy. While the cancer did not return to his peritoneum after treatment, he showed no response to the chemotherapy and died of distant metastases five months after his initial diagnosis.
A short survival time is common among people diagnosed with deciduoid mesothelioma. The medial survival rate is five or six months after diagnosis, as compared to eight to 12 months for nondeciduoid peritoneal mesothelioma. About 32 percent of deciduoid mesothelioma patients will survive for one year after beginning treatment. Still, just as in other types of mesothelioma, some patients may live with the cancer for years. One deciduoid mesothelioma patient, for example, survived 60 months after diagnosis.

Benign Mesothelioma

In most cases, forms of asbestos cancers, such as mesothelioma, do not surface for 20 to 50 years after exposure. However, a rare disease known as benign (non-malignant) mesothelioma can occur much sooner. Since it is not a form of cancer, benign mesothelioma is typically addressed easily and immediately once detected. It can also act as a sort of "wake-up call," prompting the patient's doctor to search for other asbestos-related diseases, or at least signal the need for consistent monitoring.
In contrast to malignant mesothelioma, which has an extremely high mortality rate, effective treatment and full recovery is possible for most people who are diagnosed with benign mesothelioma.
To learn more about benign mesothelioma and other asbestos related diseases, fill out the form on the right side of the page and receive the Mesothelioma Center's free informational packet.

Malignant Versus Benign Mesothelioma

Tumors form when previously healthy cells begin rapid division. This rapid pace of cellular growth leads to the formation of tumors as cells mass on top of one another, forming a solid lump of cells. Tumor cells are not all the same, which may be classified as benign or malignant. It is important to note that benign tumors are not cancerous. The term cancer only refers to malignant tumors.
There are two important differences between malignant and benign tumor cells. First, malignant tumors can invade nearby tissues and cause damage to healthy tissues and organs, whereas benign cannot. Second, malignant tumor cells can 'relocate' to other parts of the body by traveling through the blood or lymphatic system. When this occurs, these cells can begin forming new cancerous tumors in other locations.
The key difference, therefore, is that benign tumors do not invade nearby tissues, and do not spread to other parts of the body. For this reason, benign mesothelioma is much less serious than malignant mesothelioma (though it can certainly be life-threatening if not addressed).
While benign mesothelioma tumors will not invade or spread within the body, they can grow to large sizes, and larger tumors can have a negative impact on the tissues and organs around them. When these particular tumors grow large enough, they may cause fluid to build up in mesothelial membranes, and very large tumors can cause serious side effects, such as comas and seizures.
Symptoms of benign mesothelioma are quite similar to those of malignant mesothelioma. Most people with benign mesothelioma of the pleura (lung membranes) experience shortness of breath, chest pain, and a chronic, dry cough. People with malignant mesothelioma also experience these symptoms, but may additionally experience fever, night sweats, weight loss, and other symptoms.
Benign mesothelioma diagnosis is also similar to the diagnosis of malignant mesothelioma. Patients will provide a complete medical history and undergo a physical examination. If a problem is suspected, the doctor will recommend one or more imaging tests or biopsy procedures.
Imaging tests include chest X-rays, CT scans, and MRI scans. Each of these allows your doctor to determine where tumors are located. A chest x-ray is usually the first test ordered by the physician, followed by CT or MRI scans, which are used to obtain more detailed images of the exact location of tumors.
Other diagnostic tests involve taking samples of tumor tissue or samples of the fluid in or around the tumor. A tissue biopsy, for example, involves removing a sample of tumor cells from the affected area, whereas a fluid biopsy (also called needle aspiration) involves the insertion of a long needle into the tumor to remove fluid.

Benign Mesothelioma Treatments

In most cases of benign mesothelioma, the only treatment that is needed is a surgical procedure to remove the tumor. In contrast to malignant mesothelioma, there is no need for follow-up treatment such as mesothelioma chemotherapy because in these cases the tumor is not cancerous and has not spread.
Because approximately 75 percent of individuals with benign mesothelioma develop tumors in the lung, a surgical procedure called a thoracotomy is commonly performed. The exact nature of the procedure depends on the size and location of the tumor. Thoracotomy may involve removal of one segment of the lung, a lobe, or even the entire lung (removal of the entire lung is very rare in cases of benign mesothelioma).
Although benign mesothelioma itself is a relatively harmless disease, complications may develop following surgery. The most common side effect of surgery is pleural effusion, a fluid build-up in the pleural spaces, which puts pressure on the lungs and heart. Patients are usually fitted with a chest drain for the first few days after surgery to remove excess fluid and prevent effusion.
Following surgical treatment, most people experience complete recovery. Studies show that 90 percent of those who develop a benign mesothelioma tumor will never experience a repeat occurrence of tumor development following successful surgery.

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Cystic Mesothelioma

Cystic mesothelioma is a very rare histological subtype, or cell type, of mesothelioma that almost exclusively develops in the peritoneum, or lining of the abdominal cavity. It is usually a benign condition, meaning non-cancerous or non-malignant. Another factor that differentiates cystic mesothelioma from other malignant mesothelioma types is that it's much more common in women than in men.
The condition is marked by cysts and lesions that form within the peritoneum and it can be a recurring condition even after successful treatment. Although cystic mesothelioma is rarely cancerous, the symptom of abdominal pain is experienced by most patients just as in cancerous peritoneal mesothelioma. Ascites, or fluid buildup between the peritoneum and abdominal organs, is common in malignant peritoneal mesothelioma, but is rarely present in cystic mesothelioma.
This particular type of mesothelioma is part of the epithelial cell variety and is difficult to diagnose. Cystic mesothelioma also has a variety of subcategories, including multicystic mesothelioma, microcystic mesothelioma and macrocystic mesothelioma. Information on all of these types is limited because of the low number of cases reported and the lack of a uniform approach to treatment.

Cystic Mesothelioma Types

In addition to receiving the general diagnosis of cystic mesothelioma, patients can be diagnosed with:
The medical community is unsure why some patients develop one type versus another, but all are usually benign and present the same symptoms since they almost always develop in the peritoneum. Treatment options are also the same for all cystic mesothelioma types.

multicystic
microcystic

macrocystic mesothelioma

Benign Cystic Mesothelioma

The most common location for benign cystic mesothelioma is the pelvic peritoneum of younger women. Many patients do not present symptoms and detection often occurs during unrelated testing or surgery. If symptoms are present, abdominal pain and lumps in the pelvic region are most common. Although diagnosing benign cystic mesothelioma is difficult, there are procedures that can help with detection.
One procedure that is used to diagnose cystic mesothelioma is a laparotomy. When used to diagnose an unknown condition, this surgical procedure is often called an exploratory laparotomy. It requires a large incision through the abdominal wall so that doctors can see into the abdominal cavity. A laparotomy can help doctors detect cysts and lesions that are commonly associated with cystic mesothelioma.
Another surgical procedure that can be used to diagnose cystic mesothelioma is a laparoscopy. Similar to a laparotomy, this procedure inserts cameras and other instruments through small incisions in the abdomen to provide a visual of suspicious areas. Other diagnostic tools used to detect cystic mesothelioma include ultrasound scans and CT scans.
Treatment for cystic mesothelioma is currently experimental. The most common treatment approach is surgery, which aims to remove all peritoneal cysts and lesions. Common procedures include cytoreductive surgery and a peritonectomy. Even when surgery is successful, recurrence of cysts and lesions is common in about 50 percent of patients. Follow-up treatment for cystic mesothelioma patients is usually expected and malignant development is possible (some rare cases have turned malignant), so monitoring the condition is standard following treatment.
For example, in one case report involving a 36-year-old woman diagnosed with benign cystic mesothelioma, doctors evaluated a series of surgeries spanning a 10-year period. After six surgical procedures designed to reduce the volume of intraperitoneal fluid and cysts, the disease developed into a malignant subtype known as diffuse malignant mesothelioma.
Unlike other types of mesothelioma where asbestos is the primary cause, doctors are unsure of the underlying causes of cystic mesothelioma. In many cases, patients have a history of previous pelvic operations or pelvic inflammatory disease.

Benign Multicystic Mesothelioma

Benign multicystic mesothelioma arises almost exclusively from the peritoneum, which is why this condition is also known as multicystic peritoneal mesothelioma. First described in 1979 by Mennemeyer and Smith, about 150 cases of multicystic mesothelioma have been reported. In extremely rare cases, the disease has been reported in the pleura and testis. Multicystic mesothelioma presents similar symptoms as other cystic mesothelioma types and is treated with the same surgeries.
This cystic mesothelioma subtype is very rare, often occurring in women in the reproductive age group. It is sometimes confused with multilocular cystic lymphangioma, but this condition is typically seen in males under the age of five. Surgery and follow-up treatment is important to managing the disease, but a standard treatment protocol is not available because of its rarity.
The factor uniting these theories is that asbestos leads to cellular damage that disrupts the natural cell cycle. Once normal function of the cell cycle is lost, cells begin to divide and grow uncontrollably. These cells then accumulate into tumors that trigger mesothelioma symptoms.
In a 2010 study conducted by the National Cancer Institute and the Mesothelioma Applied Research Foundation, researchers may have confirmed a primary way that asbestos causes mesothelioma. The study reported that asbestos damages cells through a process researchers dubbed "programmed cell necrosis." This process involves the release of a molecule known as "high-mobility group box 1 protein" (HMGB1), which triggers a chronic inflammatory reaction that causes tumor growth.

Microcystic and Macrocystic Mesothelioma

There is very little medical literature published on these rare subtypes of cystic mesothelioma. Microcystic mesothelioma is generally characterized by its cell shape, which is marked by lace-like spaces and lined with flattened cells. It can be observed with an Alcian blue stain (a popular staining method in pathology).
Macrocystic mesothelioma usually consists of one or several cysts with thin walls. These cysts often contain fluid and can be seen as a pale yellow color. The individual cells are flattened and may have the appearance of malignant mesothelioma.

Further Research on Cystic Mesothelioma

Cystic mesothelioma and its subtypes are in need of additional research to create a more standardized treatment plan for patients. Unfortunately, since the condition is so rare, it is unlikely to receive extensive funding for researchers to further evaluate treatment strategies. Prognosis remains positive, but common recurrence even after successful surgery suggests caution should be used when treating cystic mesothelioma.

Malignant Mesothelioma

Malignant mesothelioma is a rare type of cancer that forms on the mesothelium, a protective tissue that lines several of the body’s internal organs. Exposure to asbestos is almost exclusively responsible for the development of malignant mesothelioma.
The prevalence of lung cancer among asbestos-exposed workers has been documented since the 1920s. The first case report of malignant mesothelioma, derived from records at Massachusetts General Hospital, was published in 1947. It was not until 1999, however, that the U.S. government began tracking malignant mesothelioma as a recognized cause of death.

Malignant mesothelioma can develop in four parts of the body:

Pleural Mesothelioma

The most frequently affected site is the pleura, or the mesothelial lining that surrounds the lungs. Cancer that originates here is classified as pleural mesothelioma.

Pericardial Mesothelioma

Another variation of the disease, pericardial mesothelioma, develops in the protective sac surrounding the heart.

Peritoneal Mesothelioma

The second most common location for the tumors to originate is the abdomen. Asbestos cancer that develops here is known as peritoneal mesothelioma.

Testicular Mesothelioma

The rarest location for mesothelioma to be found is in the lining of the testicles, known as the tunica vaginalis. iThis form of the cancer is medically classified as testicular mesothelioma.

While most diagnosed cases of mesothelioma are malignant, doctors sometimes find mesothelioma tumors that are non-cancerous.

Benign vs. Malignant Mesothelioma

As with most forms of cancer, mesothelioma can be classified as either malignant or benign. Benign tumors can be surgically removed because they are non-cancerous and incapable of spreading throughout the body. Malignant mesothelioma, on the other hand, is cancerous, highly aggressive and more challenging to treat. While asbestos has been definitively linked to causing malignant mesothelioma, benign mesotheliomas often result from other disorders such as infectious pleuritis, hepatic cirrhosis or systemic lupus erythematosus.
Because a mesothelioma patient may present with benign and malignant tumors simultaneously, a doctor must be able to differentiate between the two before recommending a course of treatment. Benign tumors do not metastasize, so if a tumor spreads to local glands, cells and connective tissue it is considered malignant.
A doctor can also determine a tumor’s potential malignancy based on how deeply it penetrates into the pleura. Benign tumor cells typically conglomerate at a relatively shallow depth, while malignant cells can reach the fat or muscle areas of the chest wall or well into the patient’s lung tissue.
Total cell enlargement, as opposed to just the enlargement of the cell’s nucleus, is another indicator of malignancy. Large aggregations of cells with irregular nuclei and hyperchromasia (an elevated level of the DNA protein chromatin) almost always imply a malignant diagnosis. Benign lesions feature linear cells that typically lack papillae, which are dome-shaped structures found on the cell surface.

Malignant Mesothelioma Cell Types

A malignant mesothelioma tumor may be made up of three different cell types:

Epithelial cells appear the most frequently in malignant mesothelioma tumors, and this subtype accounts for between 50 and 70 percent of all cases. These cells, which are uniform and sharply defined, feature prominent nuclei and often form complex branching patterns.

These spindle-shaped Sarcomatoid cells typically lack strong characteristics, occurring in approximately 10 to 20 percent of reported malignant mesothelioma cases.

Malignant mesothelioma is considered biphasic when both epithelial and sarcomatoid cells are present and each type accounts for at least 10 percent of the tumor’s mass. Biphasic (mixed) cells are present in 20 to 35 percent of all malignant mesotheliomas.

Doctors use these histological classifications to develop a prognosis and treatment plan for malignant mesothelioma patients. Although the life span associated with malignant mesothelioma can be short, your cell type can account for differences in life expectancy ranging up to 200 days.
Of all subtypes, mesotheliomas involving epithelial cells are typically most responsive to treatment, which often leads to a better prognosis. Because sarcomatoid cells are the most resistant to treatment, some surgeons do not consider sarcomatoid tumors eligible for resection. Biphasic cells are also considered less responsive to treatment than epithelial.
Diagnosing a patient’s specific type of malignant mesothelioma can be challenging for doctors. One common obstacle is differentiating mesothelioma from adenocarcinoma, the most common form of lung cancer among non-smokers.

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BAP1 Gene Mutation

BAP1 is a tumor suppressor gene that doctors use as a biomarker to aid in the detection of various cancers. A 2011 study funded by the National Cancer Institute (NCI) discovered that a mutation in the BAP1 gene significantly increases a person’s risk for developing mesothelioma following an exposure to asbestos.
After observing numerous cases where malignant mesothelioma was diagnosed in multiple members of a single family, researchers began to investigate hereditary predispositions for the disease. Within these families, some studies found evidence of BAP1 mutations in every family member diagnosed with mesothelioma. This finding suggests that as a direct result of a BAP1 mutation, a strong family history of mesothelioma may increase a person’s susceptibility for the disease and the overall risk of developing it.
Testing for inherited gene mutations such as a defective BAP1 gene can be a valuable, minimally-invasive screening tool for mesothelioma oncologists. If a mutation is not found, for example, it can alleviate a high-risk individual’s fear of increased susceptibility for mesothelioma and other cancers. And if doctors do in fact locate a BAP1 mutation, they can immediately provide a patient with steps to minimize the risk of developing mesothelioma, such as avoiding workplace exposures to asbestos.
In addition, finding a BAP1 mutation before cancer has the chance to develop allows doctors to initiate a screening process and create a schedule for routine exams. In the future, early detection of a BAP1 mutation could identify patients who would benefit from novel therapeutic interventions currently being tested in mesothelioma clinical trials, such as the use of gene therapy to restore the gene’s tumor suppressing function.

Genetics, the BAP1 Gene and Their Links to Cancer

As researchers discover more about the cellular processes that trigger the onset of mesothelioma and other cancers, they continue to unveil the increasingly important role that genetics plays as a risk factor for these diseases. Genetics is a branch of science that explores the structure and function of our genes, the sections of our DNA that tell our cells how and when to perform crucial activities that keep our bodies healthily functioning.
Changes in our genetic material commonly occur when our cells make copies of themselves, and environmental factors such as exposure to the sun and airborne asbestos can also damage our DNA. Because our cells have mechanisms to repair such damage, the majority of the genetic errors we accumulate are not passed on to our children.
But DNA damage to some types of cells can be passed along to the next generation, which can cause hereditary diseases ranging from colorblindness and diabetes to Down syndrome and cancer. When damaged DNA has adverse consequences, this is known as a genetic mutation. And while some genetic changes are harmless, certain mutations can inhibit the proper functioning of important genes, allowing uncontrolled cancer cells to grow and spread.
We have determined that mutations in the BAP1 gene disable it from performing its role as a tumor suppressor and preventer of metastasis. Researchers have identified more than 30 tumor suppressor genes that are responsible for stopping cell division, repairing damaged DNA and killing cells that cannot be repaired. When tumor suppressor genes like BAP1 mutate, these mechanisms are inactivated and a person becomes genetically predisposed to cancer.

Cancers Associated with a BAP1 Mutation

Research indicates that a mutation in the BAP1 gene may increase a person’s susceptibility to various cancers, including:

• Mesothelioma
• Breast cancer
• Pancreatic cancer
• Ovarian cancer
• Kidney cancer
• Skin cancer
• Uveal melanoma

Researchers have found that a high percentage of people carrying a BAP1 gene mutation are more prone to developing various benign and malignant tumors, including skin cancer, malignant mesothelioma and uveal melanoma (a rare cancer of the eye).
In one study conducted at the University of Hawaii, BAP1 gene mutations were associated with breast cancer, ovarian cancer, pancreatic cancer, renal cancer and mesothelioma. This finding prompted a follow-up study, in which researchers examined 26 patients diagnosed with mesothelioma.
Of this group, 25 percent carried BAP1 mutations. Two patients had germline mutations — a BAP1 defect they inherited from their parents. These individuals were also diagnosed with melanoma of the eye, which indicated a genetic predisposition to cancer. Donald Blair, a doctor at the National Cancer Institute, commented that “this provides yet another example of the critical importance of the detailed genetic analysis of human tumors."

Visible Signs of a BAP1 Mutation

Many patients with BAP1 mutations develop a specific type of skin tumor known as MBAITs. Short for melanocytic BAP1-mutated atypical intradermal tumors, these noncancerous growths can serve as a visual marker for patients with a BAP1 mutation and, consequently, a heightened risk of developing mesothelioma.
MBAITs are pink and tan in color and range from 0.2 to 1.0 cm in diameter. Mole-like in appearance, the tumors are often flat or slightly elevated. Because of their unique shape, doctors can distinguish MBAITs from other skin tumors such as Spitz nevus and AST lesions.
A 2012 study by Dr. Michele Carbone and colleagues focused on two families with BAP1 mutations. Results indicated that in one family, four out of five members carried a germline BAP1 mutation and had one or more MBAITs. In the second family, all seven members had the BAP1 mutation and four had MBAITs.
In a second study conducted by the same researchers, 118 individuals were divided into two groups based on the presence or absence of the BAP1 gene mutation. A significantly higher incidence of malignant mesothelioma, uveal melanoma, cutaneous melanoma and MBAITs was observed in the group with the BAP1 mutation.

BAP1 Mutation Studies

In addition to Carbone's findings, other researchers have identified noteworthy trends in individuals with BAP1 mutations. A study by Bott et al. located BAP1 mutations in 23 percent of the 53 pleural mesothelioma patients studied. Half of the patients reported a past exposure to asbestos. In another group of mesothelioma patients without a history of asbestos exposure, Bott identified BAP1 mutations in 18 percent of the 68 patients studied.
In 2010, Harbour et al. completed a study indicating that the loss of BAP1 encouraged the spread of uveal melanoma. With a loss of BAP1 found in 84 percent of metastasizing tumors, these findings suggest that the BAP1 pathway may be a prime target for intervention with gene therapy.
Information gleaned from these and other studies affirms a definitive link between BAP1 mutation, mesothelioma, uveal melanoma, MBAITs and several other cancers. The studies also stress the need to further examine why these mechanisms are connected and whether or not BAP1 mutations can be prevented.

The Future of BAP1 Research

Researchers are hopeful that research on the BAP1 gene will lead to new targeted therapies for mesothelioma patients.

Identifying BAP1 gene mutations can help doctors with detecting mesothelioma in its early stages. In a 2012 study published in the Journal of Translational Medicine, researchers diagnosed four early-stage mesothelioma patients based on suspicion of a BAP1 mutation. This early diagnosis improved prognosis, as the patients experienced survivals of five to ten years.
As ongoing studies explore the link between gene mutations and cancer, researchers hope to discover more about what causes tumors to grow, ways to prevent BAP1 mutations and what drugs and treatments can prevent the spread of cancer.
Dr. Yang of the University of Hawaii Cancer Center is one of many doctors who celebrated this progressive moment in mesothelioma's history. "We are very excited about this discovery,” said Yang. “The next step is to translate this discovery into actual treatments for mesothelioma patients."

Mesothelioma Biomarkers

Mesothelioma is a rare cancer that is difficult to diagnose and treat, and research is still ongoing to find new treatment options for patients. One of these new areas of study involves biomarkers. Biomarkers are proteins found in or on the body’s cells. Researchers have found that certain biomarkers are present in the blood when a disease is present in the body.
While biomarkers cannot yet be used to accurately diagnose mesothelioma, they may be used to tell doctors and researchers if the disease is responding to treatment. Researchers are hopeful that less invasive and more effective methods of diagnosing and treating mesothelioma can be based on biomarker research.
Different biomarkers are present in the body depending on the stage of the disease. Doctors hypothesize that mesothelioma can be tracked from its beginnings (exposure to asbestos) to the final stages of the tumor. Groups of biomarkers at various stages are used by scientists for different applications.

Biomarkers of Exposure

When a person is exposed to asbestos and the fibers enter the body, damage already begins to occur. The byproducts of this process can be used to detect the beginning changes of cancer cells. Biomarkers of exposure are present in the body after asbestos is inhaled. Doctors can monitor these biomarkers to potentially track the progression of disease.

8OHdG

8OHdG is a biomarker for oxidation (cellular damage) and is often found in the body during the early stages of cancerous cell development. Elevated levels of 8OHdG have been found in people occupationally exposed to asbestos. It has also been linked to asbestosis.

• This is a clear marker of asbestos exposure.
• It cannot distinguish between an individual exposed to asbestos with mesothelioma or without mesothelioma.

Biomarkers of Diagnosis

Biomarkers that may help diagnose mesothelioma earlier are the most crucial for mesothelioma patients since an earlier diagnosis means more treatment options and possibly a greater chance of survival. Unfortunately, current studies have yet to find a biomarker that has the right sensitivity and accuracy to replace a biopsy as the preferred method of diagnosis.
Doctors find that these biomarkers are also useful for measuring a patient’s response to treatment.

Osteopontin (OPN)

Elevated levels of OPN have been found in patients with mesothelioma, but they have also been found in a number of other cancers.

• It shows potential for use as a way of assessing a patient’s response to treatment.
• This biomarker is not specific or sensitive enough to detect mesothelioma.

Soluble Mesothelin-Related Peptides (SMRPs)

SMRPs are currently the most reliable biomarkers for mesothelioma. It has been found that patients with mesothelioma have elevated levels of SMRP in the blood. However, it is also present in patients with other cancers.

• Reliable for detecting epithelioid mesothelioma.
• It lacks specificity to detect mesothelioma. Also, it lacks sensitivity for detecting non-epithelial mesothelioma.

Prognostic Biomarkers

Prognostic biomarkers may be used to determine the aggressiveness of a particular mesothelioma and to track its development. This may help doctors more accurately predict someone's mesothelioma prognosis.

Platelet Derivative Growth Factor (PDGF)

In some studies, the levels of PDGF in a patient’s blood correlated to a higher or lower survival. Patients with a lower level survived on average six months longer than patients with high levels, but these results were not as accurate when adjusted for age, gender and platelet count.

Estrogen Receptor-β (ER-β)

Studies revealed that patients with higher levels of ER-β in pleural tissues survived longer than patients with low levels. ER- β is normally found in healthy pleural (lining of the lungs and chest cavity) tissue.

Epidermal Growth Factor Receptor (EGFR)

Like ER- β, the presence of EGFR in patients was related to longer survival. The absence of this receptor was also linked to other predictors of poor prognosis, such as chest pain and weight loss.

Applications of Biomarkers

Studies on biomarkers have led to potential applications in the treatment of mesothelioma. One example of this is the development of the Mesomark blood test. The test, which is available commercially, was approved by the FDA in 2007 to monitor the progression of mesothelioma that has already been diagnosed.
Mesomark detects the levels of the SMRP biomarker in the blood, and doctors can use this information to see if the disease is responding to treatment. When SMRP levels are low, this usually correlates to a shrinking tumor.
Another clinical study of mesothelin revealed that the binding of this protein with CA-125, another biomarker, may be a component in the metastasis of mesothelioma. Scientists created an antibody called MORAb-009 to stop the binding process. They also found that MORAb-009 can kill mesothelin-expressing cells. This discovery can lead to new treatments that may help stop tumor growth and metastasis.

Tumor Markers vs. Biomarkers

While the term tumor marker is often used interchangeably with biomarker, the definitions of these two terms are slightly different. Tumor markers are substances found in or expressed by the actual tumor. Biomarkers can be other physiological markers or substances expressed by the body that can indicate the presence of a tumor though not necessarily expressed by tumor cells. Another distinction between these two terms is that biomarkers can also apply to non-solid tumor cancers such as those found in blood cancer.
For example, scientists recently discovered a tumor marker expressed by pleural mesothelioma tumor cells called intelectin-1. This tumor marker is specifically expressed by epithelioid-type mesothelioma tumor cells. It has a specificity of 88 percent, which makes this marker a good candidate for detecting epithelioid mesothelioma.
Many researchers believe tumor markers aren't sensitive enough to be used for screening, yet one tumor marker, the prostate-specific antigen (PSA), has been used in the screening of prostate cancer among men for several years and has shown much success. However, an elevated PSA level does not necessarily indicate cancer, but does indicate the need for further testing.