Understanding the Stages of Mesothelioma

For decades, doctors have known that asbestos exposure causes cancers like mesothelioma. Now they’re learning how.

The unfortunate truth is that the asbestos industry had scientific research since the 1930s that showed asbestos causes cancer and other diseases, but they buried the results. Companies like Johns Manville continued to deny and downplay doctors and health studies around the world that connected exposure to asbestos with cancerous tumors and other diseases.

Recent medical research has resulted in significant discoveries explaining the mechanisms of how asbestos exposure greatly increases a person’s likelihood of developing cancer. 

The research has also offered a deeper understanding of mesothelioma, an aggressive cancer of the respiratory system caused almost exclusively by asbestos. 

Understanding the connection between asbestos fibers leads and mesothelioma (cancer of the mesothelium).

Asbestos fibers cause lung scarring and disrupt the body’s natural defense mechanisms. In their weakened states, these victims are more susceptible to cell DNA alteration and tumor development.

Like all illnesses, early diagnosis of early-stage mesothelioma gives doctors more treatment options. Unfortunately for victims, treatment options are limited, even in the early stages of mesothelioma. However, a Stage I diagnosis at least gives victims a fighting chance. At Stage III or Stage IV, doctors can usually make these victims more comfortable, at best.

Mesothelioma treatments at any stage are very expensive. Only an asbestos exposure lawyer can obtain the compensation these victims need to fight their illnesses and move on with their lives. Several legal options are available, mostly depending on the nature of the exposure. A non-legal option, a bankruptcy victim compensation fund claim, may be available as well.

Sometimes, pleural mesothelioma progresses from Stage I to Stage IV in a matter of months. Other times,the progression is slower, largely depending on the success of any medical interventions. Other factors include the victim’s age, gender (mesothelioma is more aggressive in men), LDH levels in the blood (i.e. are any other bodily tissues damaged), and red blood cells, white blood cells, and platelet levels (body’s ability to fight infection).

The American Cancer Society classifies pleural mesothelioma stages according to the size of the tumor (T), the spread of cancer cells to nearby lymph nodes (L), and the metastasization to other bodily organs (M).

Stage IA (T1 or 2, L0, M0)

A mesothelioma tumor is in the meso lining that separates the heart from the lungs. The cancer is localized to one side of one lung. Stage IA mesothelioma has few symptoms, since it hasn’t spread at all. Some victims don’t have any visible symptoms at all, such as trouble breathing. Stage 1A mesothelioma often doesn’t affect the the diaphragm (thin breathing muscle below the lungs), mediastinum (space between the lungs), or pleura covering the lung.

Misdiagnosis is very common at this stage. Doctors usually have no reason to suspect that the victim has cancer. Usually, these victims have no lifestyle or genetic red flags.

Or, we should say they have no obvious lifestyle red flags. Mesothelioma has a very long latency period. Even Stage I mesothelioma usually doesn’t appear for at least fifty years after exposure. After so much time passes, most victims have forgotten about their possible exposure, and most doctors don’t think to ask.

Stage IB (T3, N0, M0)

The cancer has spread in the pleural lining, but it’s still localized in the heart-lung area. Cancer hasn’t yet spread to the lymph nodes and it certainly hasn’t metastasized. 

Usually, the tumor is in the pleura lining the chest wall on one side of the chest, as well as the pleura coating the lung, the diaphragm, and the mediastinum on the same side. The cancer has generally spread to one or more of the following locations:

• The first layer of the chest wall (endothoracic fascia),
• The fatty tissue in the mediastinum,
• A single place in the deeper layers of the chest wall, or
• The surface of the pericardium (outer covering layer of the heart).

Although the tumor is much larger, since it’s still localized within the lung, it’s resecable (surgically removable).

Mesothelioma has a very narrow treatment window that’s usually limited to Stage IB. Once cancer spreads to the lymph nodes, it’s very difficult to treat. Once it metastasizes, it’s nearly impossible to treat.

The good news for victims is that Stage IB mesothelioma is often detectable. The tumor is large enough to show up on diagnostic tests and small enough to be treatable. That’s especially true if something in the victim’s background, like service on a naval vessel prior to 1980, suggests possible asbestos exposure.

Females, which account for about one in five mesothelioma victims, are at a distinct disadvantage. Occupational exposure is much less likely among women. Many females were exposed to asbestos at home. Others were victims of indirect exposure, like asbestos-laced talcum powder. These kinds of exposure are much harder to trace.

Stage II (T2, N1, M0)

T2 usually means the tumor has grown to the lung or diaphragm. This growth seriously impairs breathing. Furthermore, once cancer spreads to a lymph node, general symptoms, such as pain, fatigue, and weight loss, often appear. 

STage II mesothelioma is usually treatable. Unfortunately, doctors often misdiagnose mesothelioma as NSCLC (non-small cell lung cancer), a far more common kind of lung cancer. Based on a biopsy, cancer is usually cancer. This test doesn’t distinguish between NSCLC and mesothelioma, at least in most cases. Only a B-radiation test makes that distinction. 

NSCLC is also a much less aggressive form of lung cancer. Radiation and/or chemotherapy treatments usually contain the cancer while doctors and patients mull surgical options. But these treatments hardly slow down mesothelioma. Stage II quickly becomes Stage III.

Stage IIIA (T3, N1, M0)

This stage isn’t much more advanced than Stage II. The major difference is that the tumor has spread to the lymph nodes on that side of the body. 

T3 tumors are still resecable, although tumors this large are very difficult to surgically remove. As mentioned, radiation and chemotherapy, treatments that usually shrink tumors, aren’t an option in pleural mesothelioma cases. These treatments cause too much collateral damage to nearby vital organs, such as the heart, lungs, and kidney. 

Stage IIIB (T4, N2, M0)

Even the best doctors cannot surgically remove very large T4 mesothelioma tumors that extend from the pleural lining to:

• Deeper layers of the chest wall, including the muscle or ribs,
• Through the diaphragm and into the peritoneum (the lining around the abdomen),
• One or more mediastinum organs (esophagus, trachea, thymus, or blood vessels),
• The spine,
• To the pleura on the other side of the chest,
• Through the heart lining (pericardium), or
• Into the heart itself.

The good news is that since the cancer hasn’t metastasized, it’s still somewhat manageable. Stage IIIB mesothelioma is always fatal, but the life expectancy period is measured in years instead of months.

Speaking of doctors, an asbestos exposure lawyer usually connects victims with top doctors who charge nothing upfront for their services. This connection gives some hope to Stage II victims, who otherwise would have none. 

And, since these doctors agree to defer billing or at least collection until settlement, the enormous cost of cancer treatments doesn’t burden a family, a private health insurance company, or a public health insurance company.

If a private health insurance company or a government-sponsored program, like Medicare, pays for treatment, we all pay, in the form of higher insurance premiums and taxes. An asbestos exposure lawyer helps ensure that the responsible company pays these costs.

Stage IV (T4, N2, M1)

This final section will be very brief. Once any kind of cancer, especially pleural mesothelioma, spreads across the body, there’s not much doctors can do, other than make the patient as comfortable as possible.

Legally, in addition to asbestos exposure actions, many victims prepare wills, trusts, and other documents that help secure the future of their survivors. For example, many of our Stage II and Stage IV clients establish trust funds to manage their settlement money, which is usually considerable in these cases.