Stage 4 Mesothelioma

In order to evaluate the extent and nature of any kind of cancer, including mesothelioma cancer, oncologists use a rubric or “staging” system. This is only one of the benchmarks used to classify malignancies. Additional criteria include the location of the tumor and identification of mesothelioma cell types.

Staging assists mesothelioma doctors in determining how far the asbestos cancer has advanced and what mesothelioma treatment would be appropriate for the patient’s malignancy.

Although there are three distinct staging systems currently in use, all three are based on four primary stages relative to the assessment of the tumor:

  • The tumor in stage 1 mesothelioma is confined to one organ or region and is relatively small.

  • The tumor in stage 2 mesothelioma has grown in size, and has spread to one other tissue.

  • The tumor in stage 3 mesothelioma has spread to adjacent areas.

  • The tumor in stage 4 mesothelioma has spread to distant areas of the body, or “metastasized.”

In Stage 4, the cancer has spread throughout the body and the anticipated mesothelioma life expectancy is not long.

Butchart System

This is the oldest system used by oncologists, and is used only for patients diagnosed with the pleural variety of mesothelioma. In Stage 4 under the Butchart System, the cancer has spread via the blood stream and can be found throughout parts of the body remote from the tumor's point of origin.

TMN System

TNM stands for Tumor, Lymph Nodes, and Metastasis. This is a newer method which is usually employed for staging malignant pleural mesothelioma, although it is also used for peritoneal mesothelioma as well.

Under this system, the cancer has spread well beyond the original site and into the neck as well as the lymphatic system.

Brigham System

This is the newest staging system, which was developed especially for use in cases of mesothelioma.

In Stage 4 of the Brigham System, the cancer is inoperable. Tumors are either be too large to remove surgically or have penetrated deep into vital organs. The cancer has metastasized to that point that malignant cells can be found throughout the patient's body, so that even if some of it can be removed, the cancer will almost certainly recur elsewhere.


By Stage 4, the mesothelioma prognosis is identified as terminal, and the patient has less than a year to live in most cases. At this point, doctors focus on quality of life issues, offering palliative treatments that can at the very least reduce patient discomfort and pain.

View Sources


Cancer Guide. "Understanding Cancer Types and Staging.", March 2009,

Dodson, R. and Hammar, S. Asbestos: Risk Assessment, Epidemiology, and Health Effects. (Boca Raton:Taylor & Francis, 2006.)

Galateau-Salle, Francoise. Pathology of Malignant Mesothelioma. (London: Springer-Verlag London Limited, 2006.)

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