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Stage 4 Mesothelioma

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This page was medically reviewed by Dr. James Stevenson, M.D. on February 6, 2019. For information on our content creation and review process read our editorial guidelines. If you notice an error or have comments or questions on our content please contact us.

Dr. James Stevenson, M.D. Thoracic Medical Oncologist

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Dr. James Stevenson, M.D.

Stage 4 malignant mesothelioma indicates that the cancer has spread to distant areas of the body. Treatment options are aimed at improving survival and quality of life. 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 most advanced stage. 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 that a patient has helps provide physicians with an understanding of the extent of the disease 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 beyond the pleura to distant organs, tissues and lymph nodes. The defining characteristic of stage 4 mesothelioma cancer is distant metastasis.

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.

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 may worsen as the disease progresses, and symptoms at stage 4 can be severe. New symptoms may also emerge as the cancer affects other areas of the body. To address these symptoms, it is important that patients receive palliative care in addition to any treatments they are undergoing.

Common Symptoms of Stage 4 Mesothelioma
  • General feeling of unwellness or fatigue
  • Difficulty breathing and shortness of breath (dyspnea)
  • Dysphagia (difficulty swallowing)
  • Chest pain and tightness
  • Night sweats
  • Fever
  • Abdominal pain and discomfort
  • Accumulation of fluid in the chest or abdomen
  • Unexplained weight loss

Prognosis of Stage 4 Mesothelioma

Stage 4 mesothelioma has the least favorable prognosis due to the extent of disease spread 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 have been shown to extend life expectancies for patients even with advanced stage mesothelioma.

Stage 4 Mesothelioma Treatment

Treatment for stage 4 mesothelioma patients is limited, as there is no role for aggressive surgery. Depending on the individual case, patients may still be able to undergo minor surgical procedures as palliative treatments to alleviate symptoms and discomfort.

  • Surgery: Palliative minimally invasive surgeries like thoracentesis, pleurodesis and paracentesis can drain fluid buildup and help with breathing and pain.
  • Chemotherapy: Intravenous chemotherapy options such as pemetrexed,  cisplatin and bevacizumab are used to prolong life and improve quality of life.  Immunotherapy treatments have also become standard options after chemotherapy.
  • Radiation: Radiation therapy is less common for advanced stages of cancer, but may be used palliatively to shrink tumors and reduce symptoms like chest pain and difficulty breathing.

Mesothelioma patients may decide to pursue experimental treatments and clinical trials after a stage 4 diagnosis. Patients and their loved ones should discuss all options when working with their doctor to determine the best treatment plan for them.

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