Resources for Patients and their Families

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.

Stage 4 Mesothelioma

Stage 4 Mesothelioma Prognosis

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.

What are the Common Treatments for Stage 4 Mesothelioma?

Surgery / Radiation / Chemotherapy

Conventional multimodal treatment plans that combine surgery, radiation and chemotherapy are not typically used for Stage 4 Mesothelioma patients. They are, however, sometimes used for pain management reasons.

Surgery may remove the primary tumor, but it does not guarantee relief from further metastasizing or reoccurrence.

With pleural mesothelioma, surgery may remove the primary tumor to ease pressure on the lungs and improve breathing. Similarly, surgery for pericardial and peritoneal mesothelioma may reduce pressure on the heart and abdomen and provide pain relief.

Chemotherapy may lessen pain for some patients, but at this advanced stage of mesothelioma, there are considerable risks. In some cases, after removing the primary tumor, chemotherapy may help slow metastasizing.

A Stage IV prognosis is terminal and the treatment plan is palliative rather than curative.

Thoracentesis / Paracentesis / Pericardiocentesis

Draining excess fluid from the affected areas may provide symptomatic relief but is not a curative option for Stage 4 Mesothelioma.

Thoracentesis drains excess fluid in the lungs; paracentesis drains excess fluid in the abdomen; and pericardiocentesis drains fluid from the heart.

These procedures, however, may only provide temporary relief because there is a significant risk for fluid buildup to reoccur.

Palliative Care

With advanced stages of mesothelioma, treatment turns to palliative care, ensuring that the patient is pain free and comfortable.

Hospice care provides a dignified option for some Stage 4 Mesothelioma patients. Quality of life is a primary goal of hospice care along with providing necessary emotional support not only for the patient but for loved ones as well.

Integrating alternative options with palliative care may provide additional physical, emotional and spiritual support. For those with Stage IV Mesothelioma, meditation or art therapy may provide a necessary emotional outlet and help cope with the terminal nature of the disease. Other alternative mesothelioma treatments may not be appropriate for Stage 4 Mesothelioma patients because many of them require movement.

Financial Assistance for Stage 4 Mesothelioma

Medical treatment costs can be significant as one progresses through the various stages of a mesothelioma diagnosis. Sometimes insurance companies may not cover the cost of diagnostic tests, clinical trials or other alternative treatments. If you or a loved one is diagnosed, you should strongly consider taking steps to help offset this potential financial burden. Learn more about the financial assistance that is available to you if you or a loved one has been diagnosed with mesothelioma and exposed to asbestos.

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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