Stage 4 Mesothelioma

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This page was medically reviewed by 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.

James Stevenson, M.D. Thoracic Medical Oncologist

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Stage 4 mesothelioma involves cancer spreading (metastasizing) to distant tissues, organs and lymph nodes. This is the most advanced stage. Treatments aim to improve survival and quality of life. Stage 4 pleural mesothelioma patients typically have a life expectancy of about one year.

01. Overview

What Is Stage 4 Mesothelioma?

Stage 4 malignant mesothelioma is the most advanced stage of the asbestos-related cancer.

Stage 4 Mesothelioma Characteristics

  • Cancerous tumors develop in the lining of the organs (most often, the lining of the lungs)
  • Cancer spreads (metastasizes) to distant tissues, organs and lymph nodes

When cancer has spread distantly, treatment options are typically limited. Due to the widespread tumors, surgical resection is typically no longer an option.

However, patients diagnosed with end-stage mesothelioma may seek treatment for supportive care, which is often referred to as palliative care. Palliative treatments may provide symptom management and increase survival times and comfort levels.

Clinical trials may also be available to late-stage patients and should be discussed with their doctors. Trials offer emerging therapies to patients in various stages. Doctors may suggest these treatments for stage 4 mesothelioma patients, depending on each case.

Staging of Mesothelioma
  • Mesothelioma is categorized into four stages.
  • Stage 1 and stage 2 are considered early stages.
  • Stage 3 and stage 4 are considered late stages.
  • Patients with late-stage diagnoses typically have shorter life expectancies than those diagnosed earlier.
02. Stage 4 Symptoms

What Are the Symptoms of Stage 4 Mesothelioma?

Stage 4 mesothelioma symptoms may be severe. These symptoms may stem from the cancer spreading to other parts of the body.

Stage 4 Mesothelioma Symptoms*

  • Abdominal pain
  • Chest pain
  • Difficulty breathing (dyspnea)
  • Difficulty swallowing (dysphagia)
  • Fatigue
  • Fever
  • Night sweats
  • Peritoneal effusion
    (fluid build-up)
  • Pleural effusion
    (fluid build-up)
  • Unexplained weight loss

*List is a combination of common pleural, peritoneal, pericardial and testicular symptoms

Patients may undergo palliative treatments to reduce discomfort caused by symptoms. Common palliative options include removing fluid buildup through surgical procedures. Fluid accumulation is often the cause of breathing difficulty.

03. Stage 4 Types

Stage 4 Mesothelioma by Type

Mesothelioma cancer staging protocols are different based on the type of mesothelioma a patient has. Cancer location and metastasis (spreading) also vary by mesothelioma type. Doctors will use staging and type to better understand a patient’s prognosis.

Stage 4 Pleural Mesothelioma

Pleural mesothelioma is the most common form of the cancer and has the most documented cases. The number of cases enabled doctors to establish three types of staging systems.

Pleural Mesothelioma Staging Systems

Doctors use the TNM staging system more commonly than the Butchart or Brigham staging systems. According to the TNM system, stage 4 malignant pleural mesothelioma involves cancer cells spreading beyond the pleura (lung lining).

The defining characteristic of stage 4 pleural mesothelioma is distant metastasis. Spreading may occur in the:

  • Bones
  • Lining of the abdomen (peritoneum)
  • Liver
  • Lung on the other side of the body
  • Nearby lymph nodes

The 2-year survival rate for stage 4 pleural mesothelioma is about 24%. The 5-year survival rate for stage 4 pleural mesothelioma is about 4%.

Stage 4 Peritoneal Mesothelioma

There is no staging system for peritoneal mesothelioma. However, many mesothelioma specialists use the Peritoneal Cancer Index (PCI) to stage this type. Other forms of abdominal cancer also use this staging system.

This system divides the abdomen into nine distinct areas. Each area is scored based on the size of tumor(s) in that area. Scores are added to determine the stage. Stage 4 peritoneal mesothelioma has a PCI score of 31 – 39.

At this stage, tumors have spread outside the immediate area of the peritoneum. Spreading may occur in the:

  • Chest wall
  • Lymph nodes throughout the abdominal cavity
  • Other distant tissues and organs

The 2-year survival rate for stage 4 peritoneal mesothelioma is about 51%. The 5-year survival rate for stage 4 peritoneal mesothelioma is about 30%.

Stage 4 Pericardial Mesothelioma

Like peritoneal mesothelioma, there is no formal staging system for pericardial mesothelioma. Doctors use general cancer staging guidelines to determine the stage at diagnosis.

Due to its rarity, the disease is almost never detected before it enters the late stages. This particular form of the cancer is often diagnosed posthumously.

Stage 4 pericardial mesothelioma may spread to the:

  • Abdomen
  • Chest cavity
  • Esophagus
  • Other organs and tissues outside of the pericardium (heart lining)

Stage 4 Testicular Mesothelioma

Testicular mesothelioma accounts for less than 1% of all mesothelioma cases. The limited information complicates a mesothelioma doctor’s ability to stage the disease. Doctors stage testicular mesothelioma by assessing the extent of cancer spreading to distant:

  • Lymph nodes
  • Organs
  • Tissues
04. Stage 4 Prognosis

Stage 4 Mesothelioma Prognosis

Compared to other stages of disease, stage 4 mesothelioma has the least favorable mesothelioma prognosis and shortest average life expectancy. The extent of disease spreading and a decline in patient health limit treatment options, which may impact prognosis. In addition to mesothelioma staging, other factors can impact patient outcomes.

Factors Influencing Stage 4 Mesothelioma Prognosis

  • Tumor location: Patients with stage 4 pleural or peritoneal mesothelioma often have longer life expectancies than those with other forms of the disease.
  • Cell type: Stage 4 epithelioid mesothelioma typically has a more favorable life expectancy than sarcomatoid or biphasic mesothelioma.
  • Patient age: Young patients with stage 4 mesothelioma typically have better outcomes than older patients diagnosed at this stage.
  • Overall health: Poor overall health and pre-existing conditions like diabetes and chronic obstructive pulmonary disease (COPD) may decrease life expectancy.

Statistics can help patients understand the typical progression of the disease. However, each patient’s diagnosis is unique.

Stage 4 Mesothelioma Life Expectancy

Stage 4 mesothelioma life expectancy is around one year. Though prognosis is poor, new treatment options may extend life expectancies for some advanced-stage mesothelioma patients.

Stage 4 Mesothelioma Survival Rate

On average, survival rates for stage 4 mesothelioma are lower than the earlier stages. Survival rate is the percentage of patients with the same type and stage of disease who survive for a given period of time.

Although survival rates are typically low for stage 4 mesothelioma, each case is different. Patients should discuss their chance of survival with their doctors.

Stage 4 Pleural Mesothelioma Survival Statistics

  • The 2-year survival rate for stage 4 pleural mesothelioma is 24%.
  • The 5-year survival rate for stage 4 pleural mesothelioma is 4%.
  • The median survival for stage 4 pleural mesothelioma is 12 months.

Stage 4 Peritoneal Mesothelioma Survival Statistics

  • The 2-year survival rate for stage 4 peritoneal mesothelioma is about 51%.
  • The 5-year survival rate for stage 4 peritoneal mesothelioma is 30%.
  • The median survival for stage 4 peritoneal mesothelioma is 26 months.

Stage 4 Testicular and Pericardial Mesothelioma Survival

Given the rarity of testicular and pericardial mesothelioma, data on the associated stage 4 survival rates is unavailable. A mesothelioma specialist can advise pericardial and testicular mesothelioma patients on their individual prognosis.

05. Can It Be Cured?

Can Stage 4 Mesothelioma Be Cured?

There is no cure for mesothelioma. Late-stage mesothelioma patients typically have a lower chance of long-term survival than those diagnosed earlier. However, patients may extend life expectancy by receiving treatment.

Studies and clinical trials are continually testing emerging treatment options for late-stage mesothelioma patients. One study from 2017, achieved a median survival of three years for late-stage pleural mesothelioma patients.

  • The study analyzed 73 patients with stage 3 or stage 4 epithelial pleural mesothelioma.
  • In the study, patients had a median overall survival of three years.
  • Patients without lymph node metastasis (spreading) had a median overall survival of 7.3 years.
  • Patients were treated with lung-sparing surgeries (surgery to remove cancer that does not remove the lung) and photodynamic therapy (light-activated medication to kill cancer cells). Some also received chemotherapy.

Mesothelioma research continues to test emerging treatments for all stages of mesothelioma patients.

Stage 4 Mesothelioma Survivors

Although rare, it is possible for stage 4 mesothelioma patients to live beyond their initial prognosis.

Quincy Jones, a well-known comedian, was diagnosed with stage 4 peritoneal mesothelioma in 2016. At diagnosis, he was given one year to live. Quincy has now been living with mesothelioma for four years.

06. Stage 4 Treatment

Stage 4 Mesothelioma Treatment

Treatment for stage 4 mesothelioma patients is limited. Aggressive mesothelioma treatments are often no longer viable at this point in the cancer’s progression. However, patients may undergo standard mesothelioma therapies such as palliative treatments. These treatments reduce symptoms and discomfort.

Stage 4 Mesothelioma Treatment Options

  • Surgery
  • Chemotherapy
  • Radiation therapy
  • Clinical trials
  • Alternative therapies
  • Surgery


Depending on the individual case, palliative care may consist of minimally invasive surgeries. These surgeries may include thoracentesis, pleurodesis and paracentesis. These treatments drain fluid buildup to ease pain and breathing difficulties.

  • A thoracentesis procedure removes fluid buildup from the pleural space with a needle.
  • A pleurodesis procedure closes the pleural space to prevent fluid buildup. This surgery can be performed mechanically or chemically.
  • Paracentesis removes fluid from the abdominal cavity. For some patients, a catheter may be used long term for symptom relief.


Intravenous chemotherapy may be used to prolong survival and improve quality of life. Pemetrexed, cisplatin and bevacizumab are some of the most common chemotherapy drugs for stage 4 patients. Immunotherapy treatments are often administered after chemotherapy.

Radiation Therapy

Radiation therapy is less common for advanced stages of cancer. In some cases, radiation therapy may be used palliatively to shrink tumors. The treatment also may reduce symptoms, such as chest pain and difficulty breathing.

Clinical Trials

Stage 4 mesothelioma patients may be eligible for clinical trials. These studies test promising emerging treatments such as photodynamic therapy. Patients and their loved ones should discuss all options with their doctor to determine the best treatment plan.

Alternative Therapies

Stage 4 mesothelioma patients may choose to supplement more standard therapies with alternative options. Although not curative, these therapies aim to increase a patient’s comfort level. Common alternative treatments include massage, acupuncture and herbal remedies.

07. Survival Without Treatment

Can You Survive Stage 4 Mesothelioma Without Treatment?

Mesothelioma life expectancy without treatment is shorter than average life expectancy with treatment. Treatment can affect how long a mesothelioma patient lives after their diagnosis.

  • Regardless of stage, patients who do not undergo mesothelioma treatment have a life expectancy of around six months.
  • Stage 4 pleural mesothelioma patients who undergo treatment have a median survival of 12 months.

Patients should discuss their treatment options with their doctors and families.

08. Coping With Diagnosis

Coping With a Stage 4 Mesothelioma Diagnosis

Diagnosis during the final stages of mesothelioma can be difficult for the patient and their loved ones. Coping with a cancer diagnosis is a personal journey, but there are resources that may make difficult decisions easier.

Our Resources for Stage 4 Mesothelioma Patients

A stage 4 diagnosis is daunting, but there are options available to patients. Connect with the team and learn more about how we help mesothelioma patients.

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