Stage 4 malignant mesothelioma indicates that the cancer has spread to distant areas of the body. Treatment options are limited and usually palliative to improve patient comfort. Stage 4 mesothelioma patients typically face a life expectancy of around one year.
Based on the four-tier staging system used to classify mesothelioma, this is the final stage and usually considered terminal. The cancer has spread beyond the point of origin to distant tissues, organs and lymph nodes, resulting in severe symptoms.
Stage 4 Mesothelioma by Type
Determining the stage of mesothelioma cancer that a patient has helps provide physicians with an understanding of progression and the treatment options available. Pleural mesothelioma has the most diagnosed cases, allowing specialists to establish three types of staging systems, including the Butchart system, Brigham system and TNM system, which is the most common. The other three types of mesothelioma are less common and do not have their own staging systems, so specialists rely on general stage 4 mesothelioma characteristics to classify the disease.
Stage 4 Pleural Mesothelioma
According to the TNM system, stage 4 malignant pleural mesothelioma indicates that cancer cells have spread to both nearby and distant organs, tissues and lymph nodes. The defining characteristic of stage 4 mesothelioma cancer is distant metastasis. The Butchart system notes that pleural mesothelioma has spread through the bloodstream to the other organs, and the Brigham system stresses the likelihood of recurrence if tumors are surgically removed.
According to the American Cancer Society, the 2-year survival rate for stage 4 pleural mesothelioma is around 17%, and the 5-year survival rate is less than 1%.
Stage 4 Peritoneal Mesothelioma
Many mesothelioma specialists use the Peritoneal Cancer Index (PCI), a staging system for all abdominal cancers, to stage mesothelioma in the peritoneum. This system looks at distinct areas of the abdomen and grades tumors numerically based on their size and extent. Scores are then added up to determine stage. A score of 31 – 39 indicates stage 4 peritoneal mesothelioma.
At this stage, tumors have spread outside the immediate area of the peritoneum, likely to nearby and distant lymph nodes, throughout the abdominal cavity and into the chest wall and other distant tissues and organs.
Resources for Stage 4 Mesothelioma Patients
- Request a Free Stage 4 Mesothelioma Treatment Guide
- Connect with Top Mesothelioma Doctors
- Locate the Nearest Comprehensive Cancer Center
Stage 4 Pericardial Mesothelioma
Like peritoneal mesothelioma, there is no formal staging system for pericardial mesothelioma, and doctors use general staging guidelines to determine the stage at diagnosis. Because it is so rare, the disease is almost never caught before it enters mesothelioma final stages, and this particular form of the cancer is often diagnosed posthumously during an autopsy.
Stage 4 pericardial mesothelioma typically consists of the spreading of tumors outside the pericardium and throughout the chest cavity, possibly into other parts of the body, such as the abdomen or esophagus.
Stage 4 Testicular Mesothelioma
Testicular mesothelioma is diagnosed in less than 1% of all cases, leaving specialists with little information on staging the disease. Specialists rely on other tools to stage mesothelioma of the tunica vaginalis and look for spreading to distant organs and tissues, as well as distant lymph node involvement.
Symptoms of Stage 4 Mesothelioma
Mesothelioma symptoms get worse as the disease progresses, and symptoms at stage 4 are typically severe. New symptoms may also emerge as the cancer affects other areas of the body. To address these symptoms, patients often undergo palliative care.
- General feeling of unwellness or fatigue
- Difficulty breathing and shortness of breath (dyspnea)
- Dysphagia (difficulty swallowing)
- Chest pain and tightness
- Night sweats
- Abdominal pain and discomfort
- Accumulation of fluid in the chest or abdomen
- Hemoptysis (coughing up blood)
- Unexplained weight loss
Prognosis of Stage 4 Mesothelioma
Stage 4 mesothelioma has the least favorable prognosis due to spreading and a decline in patient health. Stage 4 mesothelioma life expectancy is typically around one year. In addition to mesothelioma staging, a patient’s prognosis also depends on age, gender, overall health and cell type. Statistics can help patients understand the typical progression of the disease, but each diagnosis is different.
For malignant pleural mesothelioma, the most common form, the 2-year survival rate is around 17% and the 5-year survival rate is less than 1%. Though prognosis is poor, new diagnostic tools help with early detection of the disease and new treatment options may be able to extend life expectancies for patients even with advanced stage mesothelioma.
Stage 4 Mesothelioma Treatment
Treatment for stage 4 mesothelioma patients is limited, as they may not be able to withstand the risks and side effects of aggressive surgeries, chemotherapy and radiation. Depending on the individual case, patients may still be able to undergo these procedures, but typically as palliative treatments to alleviate symptoms and discomfort.
- Surgery: Surgery can remove one or more tumors to help relieve symptoms. Palliative surgeries like thoracentesis, pleurodesis and paracentesis can drain fluid buildup and help with breathing and pain.
- Chemotherapy: Chemotherapy may alleviate pain for patients or may be used to slow growth after tumors have been removed. However, the risks are often too severe for stage 4 patients to undergo this treatment option.
- Radiation: Radiation is rarely recommended for stage 4 mesothelioma, though it has been used in some cases to reduce tumor size and relieve pressure on the chest or abdomen.
Mesothelioma patients may decide to pursue experimental treatments and clinical trials after a stage 4 diagnosis. New treatments have shown success in extending life expectancies in some cases, though patients must meet certain criteria to be considered for a clinical trial. Patients and their loved ones should discuss all options when working with their doctor to determine the best treatment plan for them.
Author: Linda Molinari
Editor in Chief, Mesothelioma Cancer AllianceRead about Linda
Reviewer: Annette Charlevois
Patient Support CoordinatorRead about Annette
American Cancer Society. Malignant Mesothelioma Stages. Updated December 2017.
American Cancer Society. Survival Statistics for Mesothelioma. Updated December 2017.
Kircheva DY, Husain AN, Watson S, et al. Specimen weight and volume: important predictors of survival in malignant pleural mesothelioma. European Journal of Cardio-Thoracic Surgery. January 2016; 49(6):1642-1647. doi: 10.1093/ejcts/ezv422
Valente K, Blackham A, Levine E, et al. A Histomorphologic Grading System That Predicts Overall Survival in Diffuse Malignant Peritoneal Mesothelioma With Epithelioid Subtype. American Journal of Surgical Pathology. September 2016; 40(9):1243-1248. doi: 10.1097/PAS.0000000000000696