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People with mesothelioma may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor’s best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic factors for mesothelioma.
Epithelioid mesothelioma is the most common subtype of mesothelioma and has a better prognosis than sarcomatoid or mixed (biphasic) types. Sarcomatoid subtype has the least favourable prognosis no matter what treatment is given.
Pericardial mesothelioma is usually associated with a poorer prognosis than the other types of mesothelioma.
Mesothelioma that can be completely removed by surgery (resectable) has a more favourable prognosis than mesothelioma that has spread too far and cannot be removed by surgery (unresectable).
Clear (or negative) surgical margins (no cancer cells in the healthy tissue around the tumour) improve prognosis. Mesothelioma is often a diffuse disease, which means it usually spreads over a large area and doesn’t stay localized in one spot for long. This makes it difficult to get clear surgical margins.
Stage plays a role in prognosis for people who have surgery. The stage of mesothelioma does not impact survival for people who do not have surgery. Generally, early stage mesothelioma has a better prognosis than more advanced stages. If mesothelioma has spread to the lymph nodes, it is usually associated with a less favourable prognosis.
The presence of chest pain with pleural mesothelioma or excessive weight loss is associated with a poorer prognosis. Chest pain can mean there is advanced disease that surgeons may not be able to remove with surgery.
People with mesothelioma can have problems with platelets levels. Thrombocytosis (an increase in the number of platelets) is associated with a poorer prognosis.
People with mesothelioma can have problems with white blood cell levels. Leukocytosis (an increase in the number of white blood cells) is associated with a poorer prognosis.
Performance status is the measure of how well a person is able to perform ordinary tasks and carry out daily activities. It is ranked on a scale, and there are different performance status scales. Generally, the more active the person is and the more able they are to continue their normal activities of daily living, the better the performance status. People with a good performance status (those able to function fairly normally) have a better prognosis than those with a poor performance status (those who need help with daily living activities or need to spend a lot of time in bed).
Younger people have a better prognosis than older people.
Women seem to have a better prognosis than men.
People with increased LDHLDHAn enzyme that is involved in energy production in cells. blood levels tend to have a less favourable prognosis than those with normal LDH levels. LDH is an enzyme in the blood that can be increased when there is damage to certain tissue or cancer.