Mesothelioma Metastasis
Mesothelioma metastasis is when cancer cells spread from the first tumor to another area, often through the lymph system. It may happen in up to 50% of mesothelioma cases. In later stages, tumor cells may reach distant areas like the liver, bones or brain. Treatment may help slow cancer growth, manage symptoms and extend survival, even when significant metastasis is present.
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What Is Mesothelioma Metastasis?
Metastasis happens when cells break away from a tumor, travel to a new area and form another tumor. This may occur if tumor cells travel through blood vessels or the lymph system, which includes lymph nodes. These steps may happen over a long or short period of time.
Experts say metastasis occurs in mesothelioma in steps, including:
- Mesothelioma cancer cells form in areas of normal tissue.
- Cancer cells travel into lymph nodes or blood vessels.
- Blood or lymph vessels carry the cancer cells away from their source.
- Cancer cells get stuck in small blood or lymph vessels.
- Cancer cells move into the tissue near their stopping point.
- Cancer cells grow in their new location until a secondary tumor forms.
- The secondary tumor sends signals to grow new blood vessels.
- The new blood vessels form and help the tumor keep growing.
Metastasis is the medical term for cancer that spreads from where it started to another part of the body. Not every cancer spreads in the same way or at the same rate. Systemic treatments, such as chemotherapy and immunotherapy, travel throughout the body and may treat both the original tumor and cancer cells that have spread.
Understanding Mesothelioma Metastasis and Disease Progression
Some patients may think that metastatic mesothelioma has limited treatment options. This may be because they think cancer only progresses in late stages. But metastasis can occur even in early stages of mesothelioma. That means patients who have metastatic mesothelioma have almost as many treatment options as those who do not.
Mesothelioma metastasis is different from metastatic mesothelioma.
- Mesothelioma metastasis refers to mesothelioma cells spreading from the primary tumor to another location. The spread may be regional or distant.
- Metastatic mesothelioma generally describes mesothelioma that has spread beyond its original location, especially to distant organs or tissues. Distant metastasis is associated with advanced disease.
When Does Mesothelioma Metastasize?
Metastasis may occur at nearly any stage of mesothelioma. Metastasis that occurs far from the origin (distant metastasis) generally happens in stage 3 or stage 4 mesothelioma.
Patients may think metastatic mesothelioma has few treatment options and a poor prognosis, but this is not the case. Mesothelioma research has led to multiple effective treatment options for patients in later stages.
What Is the Prognosis for Metastatic Mesothelioma?
With treatment, the prognosis for metastatic mesothelioma ranges from about 12 to 26 months. This life expectancy range corresponds to stages 3 and 4, which may be called metastatic mesothelioma. Prognosis for later stages depends on treatment approach and mesothelioma type.
What Are the Symptoms of Mesothelioma Metastasis?
Metastasis does not always cause symptoms. When symptoms do arise, they can depend on the site and extent of metastasis.
- Bone metastasis: If cancer spreads to the bones, it may cause bones to break during normal activity.
- Brain metastasis: If cancer spreads to the brain, patients may experience headaches or dizziness. They may also have speech difficulty, nausea, confusion or problems with walking.
- Liver metastasis: If cancer spreads to the liver, patients may experience pain, abdominal swelling or jaundice (yellowing of the skin and eyes). Other signs of liver metastasis include nausea, loss of appetite and weight loss.
- Lung metastasis: If cancer spreads to the lungs, the patient may have a cough (with or without blood), chest pain or difficulty breathing.
Where Does Mesothelioma Metastasize?
Doctors may describe mesothelioma as being locally advanced or having distant metastasis.
- Locally advanced mesothelioma: The cancer has spread to areas near the primary tumor.
- Distant metastasis: The cancer has spread to areas far from the primary tumor.
Mesothelioma tumors often progress in areas near the primary tumor. Common sites of mesothelioma metastasis include lymph nodes and the linings of nearby organs.
For example, pleural mesothelioma’s primary tumor develops in the lung lining. If the cancer is locally advanced, tumors may surround the affected lung. But the cancer may be confined to just the area near the original tumor.
If the original tumor spreads to the bones or liver, that is distant metastasis. According to research, distant metastasis of malignant mesothelioma is rare. But it may happen even before the cancer is locally advanced.
A mesothelioma specialist can explain how far the cancer has spread and how it may affect a patient’s treatment options and outlook. Where mesothelioma spreads can vary by type. The table below shows reported sites of metastasis for each mesothelioma type.
| Known Metastasis Sites | Pleural Mesothelioma | Peritoneal Mesothelioma | Pericardial Mesothelioma | Testicular Mesothelioma |
|---|---|---|---|---|
| Adrenal glands | ✓ | ✓ | ||
| Bone | ✓ | ✓ | ||
| Brain | ✓ | ✓ | ✓ | ✓ |
| Chest wall | ✓ | |||
| Heart | ✓ | |||
| Kidney | ✓ | ✓ | ||
| Liver | ✓ | ✓ | ✓ | |
| Lung | ✓ | ✓ | ||
| Lymph nodes | ✓ | ✓ | ✓ | |
| Pancreas | ✓ | |||
| Pericardium (lining around the heart) | ✓ | |||
| Peritoneum (abdominal lining) | ✓ | |||
| Pleura on either side | ✓ | |||
| Pleura on the opposite side | ✓ | |||
| Skin | ✓ | ✓ | ||
| Spinal cord | ✓ | |||
| Spleen | ✓ | |||
| Thyroid gland | ✓ | |||
| Tongue | ✓ |
Metastatic Pleural Mesothelioma
Pleural mesothelioma commonly metastasizes to sites near the original tumor, including the lymph nodes and chest wall. It can also spread to more distant sites, like the brain or liver.
Metastatic Peritoneal Mesothelioma
Peritoneal mesothelioma commonly metastasizes to lymph nodes near the original tumor. It may also spread to nearby organs like the liver or kidneys.
Metastatic Pericardial Mesothelioma
Pericardial mesothelioma arises in the lining around the heart. It accounts for less than 1% of mesothelioma cases, so information about how this rare type of mesothelioma spreads is limited. However, local metastasis has been reported in 81% of pericardial mesothelioma cases.
Metastatic Testicular Mesothelioma
Testicular mesothelioma develops in the lining around the testis, the tunica vaginalis. It accounts for less than 1% of all mesothelioma cases. As such, little is known about testicular mesothelioma metastasis. Case reports indicate it may spread to the brain or spinal cord.
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How Is Mesothelioma Metastasis Treated?
Treatment for metastatic mesothelioma depends on where and how far the cancer has spread. It also depends on the mesothelioma type, the patient’s overall health and treatment goals. Cancer spread may rule out major surgery. However, patients may still receive chemotherapy, immunotherapy, radiation or palliative care. They may also take part in a clinical trial.
Depending on the degree of metastasis, patients may qualify for radiation or some forms of surgery. Stage 3 or 4 mesothelioma patients may not be eligible for aggressive surgery. But they commonly qualify for systemic treatments like chemotherapy and immunotherapy.
Treatment options for patients with metastatic mesothelioma may include:
Some patients with metastasis may benefit from heated local chemotherapy, such as HIPEC or HITHOC. HIPEC stands for hyperthermic intraperitoneal chemotherapy. It may be used to treat peritoneal mesothelioma. HITHOC stands for hyperthermic intrathoracic chemotherapy. It may be used to treat pleural mesothelioma. These treatments may target metastatic cancer cells more effectively than other approaches.
Mesothelioma patients with metastasis have effective treatment options. Patients should discuss new or worsening symptoms with a doctor. Catching metastasis early may allow for more aggressive treatment and a better prognosis.
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Factors That Influence Mesothelioma Metastasis
Experts have suggested two main factors that may influence mesothelioma spread: cell type and treatment response. But research has not fully determined what causes or encourages mesothelioma metastasis. The evidence scientists currently have is outlined below.
Cell Type
Mesothelioma occurs in three main cell types: epithelioid, sarcomatoid and biphasic. It has been suggested that certain cell types spread faster than others. But medical literature is inconclusive about these claims.
There is no proof that certain cell types spread more quickly. But some studies suggest certain cell types may be more likely to spread than others. The studies do not agree on which cell type is more likely to spread, though.
- March 2025 report: This study looked at brain metastasis in pleural mesothelioma patients. It found all three cell types were equally likely to spread to the brain.
- October 2025 report: This study analyzed metastasis in about 2,000 pleural mesothelioma patients. It found epithelioid tumors were significantly more prone to distant spread than biphasic.
Additional mesothelioma research may help scientists learn more about cell types and metastasis.
Response to Treatment
Treatment success may influence metastasis. For instance, if a treatment kills every mesothelioma cell, there would be no cancer left to spread. A highly effective treatment could therefore prevent the original cancer from metastasizing later.
On the other hand, if a treatment leaves behind many mesothelioma cells, later metastasis may still occur. This concept may help explain why some treatments extend survival more effectively than others.
It may also help explain why earlier stages tend to have better survival. In earlier stages of mesothelioma, there may be less cancer to fight. This might allow a treatment to kill a larger percentage of cancer cells. Fewer remaining cells could reduce the risk of later metastasis. The following studies demonstrate some of these concepts.
Early-Stage Pleural Mesothelioma Study
Pleural mesothelioma patients with little to no metastasis received chemotherapy followed by extrapleural pneumonectomy surgery. The study patients had a median progression-free survival of 16.5 months. Two patients lived at least three years without any evidence of metastasis or recurrence.
What does it mean? In this case, the patients started with a smaller amount of mesothelioma tumors. They also received aggressive, combination treatment. This approach may have killed most of the existing cancer cells, helping keep tumors at bay for nearly 1.5 years.
Late-Stage Pleural Mesothelioma Study
Researchers treated pleural mesothelioma patients with multimodal therapy. Nearly 90% of the study patients had stage 3 or 4 mesothelioma. They underwent surgery, photodynamic therapy and chemotherapy. This treatment kept mesothelioma from spreading or returning for about one year.
What does it mean? These study patients had a significant amount of cancer and metastasis. Doctors addressed this with aggressive, trimodal therapy. This approach killed enough cancer cells to delay further progression for about one year.
Sources
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Dr. Francis Perry Wilson is the Director of the Clinical and Translational Research Accelerator at the Yale University School of Medicine. He specializes in nephrology and clinical research.
Liza Adelberg has more than 20 years of experience in marketing and communications. At Mesothelioma.com, she creates clear, compassionate resources for patients and families affected by asbestos-related diseases.
