Resources for Patients and their Families

Mesothelioma Stages

The four stages of mesothelioma allow doctors to identify and classify the severity and progression of the cancer at diagnosis. Early stages offer the most hopeful prognosis, while the last stages of mesothelioma often limit the patient to managing pain and improving quality of life.

Mesothelioma staging refers to the process of categorizing malignant mesothelioma according to the extent of the disease in a patient’s body. Staging is a process common to all types of cancer, although specific staging systems are often developed based on characteristics of specific cancers, like mesothelioma.

The Four Stages of Mesothelioma
Mesothelioma Stages Stage 1 Mesothelioma Stage 2 Mesothelioma Stage 3 Mesothelioma Stage 4 Mesothelioma

How Many Stages of Mesothelioma Are There?

Mesothelioma has four stages that doctors can use to determine the extent of the cancer within the body. Upon being diagnosed, the doctor will identify the stage with a number between 1 and 4, with stage 4 being the most severe and deadliest form.

The four stages of mesothelioma are:

Mesothelioma Staging at Diagnosis

Mesothelioma staging only occurs at diagnosis. While the cancer may progress or recede, the stage of mesothelioma at diagnosis will not change. For example, if a stage 1 mesothelioma tumor spreads to other parts of the body, it is called stage 1 with metastasis. Likewise, if a stage 4 mesothelioma tumor reduces in size or goes into remission, the stage will not change.

While the initial treatment program may depend on the mesothelioma stage, actual treatment may vary depending on how the disease progresses. Generally, staging requires a number of diagnostic tests to determine the tumor location, size, and whether it has spread beyond the initial site.

Mesothelioma Staging by Type

Given the rarity of mesothelioma, a formal staging classification exists only for pleural mesothelioma, the most common variety. No formal pericardial or peritoneal mesothelioma staging systems have been defined.

Although there are no mesothelioma staging systems for less common forms of the disease, the American Joint Committee on Cancer (AJCC) has published general guidelines for staging cancer in its AJCC Cancer Staging Manual. When doctors do not have guidelines for a specific form of cancer, they can refer to the general guidelines to help determine the stages of extremely rare cancers like peritoneal, pericardial, or testicular mesothelioma.

Treatment by Mesothelioma Stages

Early mesothelioma stages often allow more aggressive curative treatment options, such as surgery and systemic chemotherapy. However, patients who are diagnosed closer to end-stage mesothelioma will often be given palliative treatments to help them remain comfortable and improve quality of life.

Stage 1 Mesothelioma Treatment

Surgery is the most commonly recommended course of treatment for pleural mesothelioma patients with a stage 1 diagnosis. The most common surgical procedures are pleurectomy/decortication or extrapleural pneumonectomy. After surgery, doctors may also recommend chemotherapy or radiation treatment as necessary, though such adjunct therapies are not always required with stage 1 mesothelioma.

Resources for Mesothelioma Patients

Stage 2 Mesothelioma Treatment

Patients with stage 2 mesothelioma typically have a wide range of treatment options available to them. Chemotherapy and radiation therapy are the most common treatments, while surgery may or may not be a viable treatment option at this stage. Experimental treatments may also be available to slow disease progression or manage pain.

Stage 3 Mesothelioma Treatment

Treatment options for stage 3 mesothelioma patients are primarily focused on providing patient comfort and improving quality of life. Systemic chemotherapy may be used to kill cancer cells, while radiation might be used to shrink tumors to relieve pressure on internal organs. Surgical procedures such as pleurocentesis or pleurodesis may be used to drain fluid and make patients more comfortable.

Stage 4 Mesothelioma Treatment

Therapies such as chemotherapy and radiation are typically not offered at this stage unless they are needed to support pain management objectives. Many families seek support through a local hospice program, which focuses on providing patient care, managing pain, and providing support for both the patient and family members at this difficult time. Patients with stage 4 mesothelioma may also be interested in participating in specialized clinical trials offered at leading cancer hospitals and centers.

Pleural Mesothelioma Stages

Over the years, several different pleural mesothelioma staging systems have been developed. The three most commonly used systems are the Butchart System, the Brigham System, and the TNM System. While similar, they vary slightly in the definitions of each of the stages of mesothelioma.

Butchart Staging System

Proposed in 1976, the Butchart System is the oldest formal mesothelioma staging system. It relies on determining the location of the primary tumor mass in the body for each stage. It does not take into account the size of the tumor, the number of cancer cells present, or the overall level of cancer in the body.

Other systems based on the Butchart system have been proposed over the last 30 years. For example, in 1982, Karin Mattson proposed a variation on the Butchart System that offered more concise and precise descriptions of each stage.

Brigham Staging System

In 1993, while working at the Brigham & Women’s Hospital, Dr. David Sugarbaker and several colleagues developed the Brigham/Dana-Farber Cancer Institute Staging System (often shortened to the Brigham Staging System). The system was initially based on clinical experience with 52 patients and updated in 1998 based on subsequent experience.

The Brigham Staging System places an emphasis on surgery as a mesothelioma treatment option. Generally, stage 1 and stage 2 mesothelioma tumors are viable candidates for removal; however, by the time the mesothelioma cancer reaches the lymph nodes (stage 3) or metastasizes into other areas of the body (stage 4), surgery is no longer a valid option.

TNM Staging System

The Tumor, Nodes and Metastasis (TNM) Staging System was developed by French physician Pierre Denoix in the 1940s. Since then it has evolved into a basis for staging many cancers. The first mesothelioma-specific TNM staging system was developed by A. P. Chahinian in the early 1980s.

The International Union Against Cancer (UICC) and International Mesothelioma Interest Group (IMIG) developed an internationally used mesothelioma staging system in 1995. The most current version was published in the American Joint Committee on Cancer’s AJCC Cancer Staging Manual (8th ed., 2017).

Mesothelioma Stages Are Not a Sentence

Although mesothelioma staging can provide guidance about a patient’s prognosis, it is important to remember that the staging systems are only guides. Mesothelioma can be deadly at any stage – but there is hope. People have found long-term survival at all stages, though it becomes less likely in the final stages of mesothelioma.

Each individual’s treatment options will depend on the stage of the disease, the cell type and location of the mesothelioma they have, as well as the patient’s age, gender, and overall health.


Von St. James Family

Coordinate a time to speak with Heather Von St. James.

Learn Firsthand About:

  • Heather’s Amazing Story
  • Dr. David Sugarbaker’s Successful Treatment Approach
  • Life After Surviving a Mesothelioma Diagnosis
  • Coping Strategies for Patients & Family Members

If you or a loved one was recently diagnosed with mesothelioma, you may want to talk with someone who can provide explanation and context around your diagnosis. Contact us to connect with an expert who can help you understand what your stage means.

Financial Assistance at Any Mesothelioma Stage

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 available to you if you or a loved one has been diagnosed with mesothelioma, no matter what stage.

Author: Linda Molinari

Editor in Chief, Mesothelioma Cancer Alliance

Linda Molinari

Butchart EG, Ashcroft T, Barnsley WC, Holden MP. Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura: experience with 29 patients. Thorax. February 1976;31(1):15-24.

Edge, S., Byrd, D.R., Compton, C.C., Fritz, A.G., Greene, F.L., Trotti, A.AJCC Cancer Staging Manual. 8th ed. 2017.

Flores, Raja M, Rush Valerie W. “Staging of Mesothelioma.” Malignant Mesothelioma: Pathogenesis, Diagnosis, and Translational Therapies, ed. Harvey I. Pass, Nicholas Vogelzang, Michele Carbone. New York, NY: Springer;2005:402-415.

Heelan RT, Rusch VW, Begg CB, et al. Staging of malignant pleural mesothelioma: comparison of CT and MR imaging. American Journal of Roentgenology. 1999;172: 1039-1047. doi: 10.2214/ajr.172.4.10587144

International Mesothelioma Interest Group. A Proposed New International TNM Staging System for Malignant Pleural Mesothelioma. Chest. 1995;108(4):1122-1128. doi: 10.1378/chest.108.4.1122 Accessed September 7, 2016.

Jett JR. Malignant Pleural Mesothelioma: A Proposed New Staging System. Chest. 1995;108(4):895-897. doi: 10.1378/chest.108.4.895

Richards WG. Recent Advances in Mesothelioma Staging. Seminars in Thoracic and Cardiovascular Surgery. 2009;21(2):105-110. doi: 10.1053/j.semtcvs.2009.07.002

Van Schil P. Malignant pleural mesothelioma: Staging systems. Lung Cancer. 2005;49(Supplement 1):S45-S48. doi: 10.1016/j.lungcan.2005.03.008

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