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Vanessa Blanco, patient advocate for the Mesothelioma Prognosis Network
Written By Vanessa Blanco
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What Factors Affect Mesothelioma's Life Expectancy?

Life expectancy is the estimated number of years a person is expected to live. The average life expectancy for people in the U.S. is around 78 years, but asbestos-caused cancers, such as mesothelioma and lung cancer, often cut lives short.

Doctors estimate life expectancy by looking at statistics on how long people with mesothelioma tend to survive. According to an international 2013 study, mesothelioma shortens life expectancy by about 17 years.

Most people are older than 65 when diagnosed with mesothelioma, but some are diagnosed in their 50s or earlier. People diagnosed at a younger age stand to lose more years of their life expectancy.

A number of things — including lifestyle and environmental factors — can influence how long someone with mesothelioma may live. Decades of research have revealed three factors that significantly influence mesothelioma life expectancy: Your overall health, the cell type of your cancer and its stage at diagnosis. Your age and gender can also play a role.

How do Mesothelioma Cell Types Affect Life Expectancy?

The type of cells that make up mesothelioma tumors, called histology, has the greatest impact on how long someone may live with the cancer.

Mesothelioma tumors are made up of epithelial or sarcomatoid cells, or a mix of the two, which is called biphasic. People with epithelial tumors tend to live longer than people with sarcomatoid tumors — upwards of seven months longer.

A 1996 study published in the esteemed journal Chest evaluated the impact cell type has on life expectancy. Participants with epithelial cells lived nearly seven months longer than those with sarcomatoid cells. There was no significant survival difference among biphasic patients with high or low ratios of epithelial to sarcomatoid cells.

The longest survival was among patients with a subtype of epithelial cells called tubulopapillary. These participants lived 6.5 months longer than those with other epithelial subtypes.

How Does the Mesothelioma Stage Affect Life Expectancy?

One of the first things doctors do after diagnosing mesothelioma is assign a stage of development to the cancer. They want to know if the disease has progressed in the body and, if so, how far. They consider staging important because it sets the foundation for what comes next — the treatment plan.

Mesothelioma treatments like aggressive surgery and chemotherapy are more effective against early stages and only offer some survival benefits to late-stage cancers. Doctors carefully assess the stage to ensure the most effective next steps.

Calculating a cancer stage can be complex, and that is especially true with asbestos-related cancers because surgery is required for truly accurate staging. Most people don’t develop symptoms of mesothelioma until the cancer has progressed. That tendency explains why so many diagnoses are in stage 3 or 4 and why few patients qualify for surgery.

Oncologists manage late-stage patients with treatments that ease symptoms and hopefully extend survival. Specialists can treat early stage patients more aggressively and with more therapies, leading to longer life expectancies.

Defining Your Mesothelioma Stage

Pleural Staging

Pleural mesothelioma, the predominant form of asbestos-related cancer that accounts for roughly 80 percent of cases, has four stages of development. Specialists determine development with imaging scans, biopsies and other tests. X-rays, MRI, PET and CT scans assess the extent of tumor growth and spread.

Stage 1

Stage 1 is split into two classifications, Ia and Ib. In stage 1a, only the outer layer of the lung lining contains tumors. A diagnosis of Ib is given when tumors have spread from the outer layer to the inner layer of the lung lining or into the underlying muscle, fat, or lung tissue.

Stage 2

When tumors can be classified as Stage 2b, but cancer cells have also spread to the lymph nodes on the same side of the chest, the diagnosis is considered Stage 2.

Stage 3

Stage 3 is divided into 3a and 3b. In 3a, the tumor is locally advanced, including spread to the chest wall or the covering of the heart (pericardium). Stage 3b tumors are so advanced that they cannot be removed surgically. If cancer has spread to the lymph nodes on the opposite side of the chest from the tumors, the diagnosis is Stage 3b.

Stage 4

In stage 4, tumors have spread from the original affected lung to distant parts of the body such as the spine or other organs.

Peritoneal Staging

No officially accepted staging system exists for peritoneal mesothelioma. Because the disease rarely spreads outside the abdomen, a staging system for distant spread is not necessary.

Localized tumors that have not spread outside the peritoneal lining of the abdomen are considered early-stage cancer and may be assigned stage 1 or 2 by certain specialists. Tumors that migrated to nearby lymph nodes can result in a stage 3 diagnosis. Tumors that traveled to nearby or distant organs can lead to a stage 4 diagnosis.

Stage 1 and Stage 2 Mesothelioma Life Expectancy

Median Survival
Pleural: 20 Months
Peritoneal: 67 Months

Without electing any treatment, stage 1 pleural mesothelioma patients can expect to live about two years. Stage 1 patients who undergo an extrapleural pneumonectomy surgery have a median life expectancy of 40 months, just over three years. Nearly 30 percent of stage 2 pleural patients live that long following surgery.

The five-year survival rate for stage 1 peritoneal mesothelioma patients who have surgery and heated chemotherapy is 87 percent. About 53 percent of stage 2 patients who undergo such aggressive treatment have a mesothelioma life expectancy of at least five years.

I was able to chat and speak over the phone with the Patient Advocates who were very helpful, professional and great to work with. Some gave me their direct lines and made it easy to access them at any time, especially when I wanted to ask questions after hours.
Charlotte C.
Median Survival
Pleural: 16 Months
Peritoneal: 56 Months

Stage 3 Mesothelioma Life Expectancy

Pleural patients can expect lung-related symptoms to progress in stage 3. Those who undergo intensive surgery often live longer than 16 months.

The five-year mesothelioma life expectancy for stage 3 peritoneal patients who have surgery and heated chemotherapy is 29 percent, meaning that about one-third of patients can expect to live longer than five years. Half of stage 3 patients live at least 26 months.

Median Survival
Pleural: 12 months
Peritoneal: 26 Months

Stage 4 Mesothelioma Life Expectancy

During stage 4 pleural mesothelioma, patients can expect symptoms to affect the lungs and other parts of the body because the cancer may be spreading to distant locations.

Median survival for people with stage 4 pleural mesothelioma is 12 months. However, people who are younger, in good health, with epithelial cell type and no indication of blood disorders often live longer than one year.

Stage 4 peritoneal cases don’t usually qualify for aggressive surgery. Patients who don’t have surgery live about one year. Chemotherapy may be able to extend mesothelioma life expectancy beyond one year in some patients.

How Is Life Expectancy Affected by Your Overall Health?

Asbestos exposure can cause cancer to develop in anyone, regardless of their overall health. Although mesothelioma strikes healthy and unhealthy people alike, healthy people tend to live longer with the disease.

Certain factors can shorten life expectancy, including a sedentary lifestyle, poor diet, mental health conditions and weak social connections. Exposure to toxins like cigarette smoke, radon and asbestos can also affect a person’s life expectancy.

Oncologists determine a person’s overall health using a scoring system called performance status. It basically assesses the ability to perform physical activities and basic self-care. Doctors use various scoring systems to grade performance status.

The Eastern Cooperative Oncology Group (ECOG) developed one popular grading system called the ECOG Scale of Performance Status. The scale ranges from zero to five, with zero representing a fully active person. Ascending numbers represent increasing disability.

People with low ECOG performance scores, indicating better overall health, tend to live longer with mesothelioma than people with high scores. A comprehensive study conducted in the late 1980s and ’90s reported overall survival of 11 months for people with a performance score of zero, 7.6 months for a score of 1 and 3.3 months for a score of 3.

Taking good care of your health by eating well and staying active when possible can help people recover quicker from cancer treatments like surgery and chemotherapy.

Mesothelioma Survival Rates

The American Cancer Society reports five-year relative survival rates for pleural mesothelioma based on National Cancer Institute data. These percentages show how likely someone diagnosed with pleural mesothelioma will live for at least five years, compared to the overall population.

How Far Pleural Mesothelioma Tumors Have SpreadFive-Year Relative Survival Rate
Still localized in the pleura18%
Spread regionally or to nearby lymph nodes11%
Metastasized to other parts of the body7%
Average for all pleural mesothelioma cases9%
Source: The American Cancer Society, 2019.

These estimates are based on pleural mesothelioma cases diagnosed between 2008 and 2014. Survival rates are expected to increase as medical technology improves.

Beating the Odds

Some people with asbestos-related cancer far surpass the average survival rate. Certain patients respond particularly well to treatment, or their immune system may be surprisingly adept at controlling the cancer from spreading extensively. Those who are younger in age, with epithelial cell type and in otherwise good health, often live longer than the one-year average.

Catching the cancer in early development and treating it aggressively can help some people live for three, five or more years. But even people diagnosed in stage 3 or 4 can live for years with mesothelioma. For example, pleural mesothelioma survivor Andy A. was diagnosed at stage 4 and has lived longer than three years thanks to an immunotherapy drug (Amatuximab) he tried through a clinical trial.