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Different Stages of Mesothelioma: Stage 1, Stage 2, Stage 3 And Stage 4

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Different Stages of Mesothelioma: Stage 1, Stage 2, Stage 3 And Stage 4

Stages of Mesothelioma

Staging tracks malignant mesothelioma tumor growth and helps doctors make a treatment plan and predict patient prognosis. The stages of mesothelioma range from 1 to 4 and are based on tumor size and location.

Four stages of mesothelioma are used by doctors to determine the progression of cancer and the best course of treatment. Stage 1 mesothelioma has the best prognosis, while stage 4, also known as end-stage mesothelioma, has the shortest average life expectancy. Symptoms are less noticeable in the early stages and begin to worsen in stage 3.

Early-stage mesothelioma is more confined to one site, while late-stage mesothelioma shows tumors spreading beyond the chest or abdominal cavity. Staging is an important part of determining treatment.

What Are the Stages of Mesothelioma?

The stages of mesothelioma describe the size of tumors and how far they have spread. The location and size of tumors have a direct impact on a patient’s symptoms.

Pleural mesothelioma is the only type that has an officially adopted cancer staging system.

The stages of pleural mesothelioma are:

  • Stage 1: Early tumor growth occurs along the mesothelial lining of one lung.
  • Stage 2: Cancer has spread to nearby lymph nodes.
  • Stage 3: Tumors have invaded deeper tissues in nearby organs and distant lymph nodes.
  • Stage 4: Metastasis is present, and tumors have formed at distant sites in the body.

People often wonder if they can determine their stage based on their symptoms. Unfortunately, the symptoms of mesothelioma are not strongly correlated with individual cancer stages.

Mesothelioma diagnoses often don’t occur until the later stages of the disease because the early stages typically cause no symptoms. The cancer is small in the early stages and does not affect the body the way larger, late-stage tumors do.

Cancer staging is a crucial part of malignant mesothelioma diagnosis and treatment. Pathologists use biopsy samples to complete tumor grading and differentiation. Oncologists use these results with imaging scans to determine the cancer stage and whether a patient will benefit from mesothelioma treatments such as surgery.

  • Stage 1

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    The cancer is localized. Surgery is most effective at this stage. Survival rate is higher. A patient’s median life expectancy at stage 1 is 22.2 months.

    Early-stage malignant pleural mesothelioma means cancer has not spread beyond the outer lung lining, and major surgery to remove the tumor is usually the first line of treatment. Stage 1 mesothelioma prognosis and life expectancy are significantly better than in later stages. The median life expectancy at stage 1 is 22.2 months with surgery.

    Stage 1 mesothelioma has a better prognosis than when the cancer is diagnosed in its later stages. Early-stage mesothelioma has no major symptoms and is often detected by accident when a doctor is looking for another illness. While there is no cure for any stage of mesothelioma, stage 1 offers the most aggressive surgical treatment options.

    Stage 1 mesothelioma includes two substages: 1A and 1B. Stage 1A tumors develop on one side of the chest within the pleural layers. The more advanced stage 1B tumors extend further into the lungs, chest wall, the mediastinum between the lungs or the diaphragm muscle under the lungs.

    It is challenging to catch cancer this early because at this stage, tumors are too small to cause pain or breathing difficulties. Patients with a known history of asbestos exposure undergo screening before experiencing symptoms. After diagnosis, stage 1 mesothelioma multimodal treatment includes a combination of surgery, chemotherapy or radiation therapy.

    Development of Stage 1 Mesothelioma

    In stage 1 mesothelioma, cancer cells have not yet spread through the lymph nodes or far beyond the pleural lining.

    Early-stage mesothelioma has a better prognosis than cancer diagnosed in later stages. Surgery, radiation and chemotherapy are more effective at controlling stage 1 disease.

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    • Two-year survival rate is between 41% and 46%
    • Often causes no major symptoms
    • Cancer can be removed if the patient is eligible for surgery
    • Combination of surgery, chemotherapy and radiation recommended

    Definition Of Stage 1 Mesothelioma

    There are three staging systems for evaluating how far pleural mesothelioma has spread. They use somewhat different definitions for stage 1. The TNM staging system is the most commonly used.

    The first stage of pleural mesothelioma is divided into two parts: 1A and 1B.

    Stage 1A

    In stage 1A, tiny tumors develop in one or both layers of the pleural lining on one side of the chest.

    Until recently, stage 1A tumors were separated into T1a and T1b classifications (T stands for tumor). This division indicated whether tumors had developed on one or both layers of the pleural lining.

    A 2016 study by the International Association for the Study of Lung Cancer found no survival difference between stage T1a and T1b and this led them to recommend a consolidation. In 2018, the American Joint Committee on Cancer adopted the recommendation.

    Stage 1A still includes tumors on one or both layers of the pleura, but does not separate them anymore into T1a and T1b.

    Stage 1B

    In stage 1B, the tumors start spreading into other tissues next to the pleural lining. This may include the lung tissue under the lining or the chest wall outside it. Cancer could also spread into the muscle under the lungs (the diaphragm) or the area between the lungs (the mediastinum).

    Even if mesothelioma has spread to nearby tissues, a stage 1 diagnosis means the cancer has not spread to any lymph nodes or metastasized to distant sites throughout the body.

    Peritoneal mesothelioma does not have an official staging system. However, doctors typically think of it as early-stage cancer if it has not spread beyond the lining of the abdomen.

    Primary Signs of Mesothelioma

    At stage 1, most patients do not have symptoms, or symptoms are so mild that patients do not feel they need medical attention. Mesothelioma is rarely diagnosed at stage 1 for this reason.

    When stage 1 cases are discovered, it is often by accident when a doctor performs an X-ray or CT scan while looking for something else. Other stage 1 cases are caught because a patient with a known history of asbestos exposure received cancer screening.

    Patients and doctors often mistake mesothelioma symptoms for more common illnesses such as the flu or pneumonia.

    Symptoms are caused by tumors that begin to wrap around the affected lung and constrict it. The patient may experience pain, difficulty breathing or a chronic cough as tumors grow. These symptoms typically begin to appear in stage 3 of mesothelioma, but may appear as early as stage 2 for some patients.

    These symptoms can also be caused by fluid building between the two layers of the pleural lining, which puts pressure on the lung. This condition is called pleural effusion, and it is a common sign of cancer forming in the lining of the lungs.

    In 2020, Case Reports described a pleural mesothelioma patient whose first and only sign of the disease was gastric and colonic polyps discovered on an imaging scan. Testing of the polyps revealed they were metastases of pleural mesothelioma.

    Treatment for Stage 1 Mesothelioma

    There is no perfect healing for mesothelioma, at any stage. While mesothelioma is incurable, early-stage mesothelioma does have more treatment options, and palliative treatments can ease symptoms. The prognosis for stage 1 mesothelioma is favorable compared to mesothelioma diagnosed in later stages.

    In the past, most patients have not survived longer than two years after diagnosis. However, some early-stage patients have gone into remission for years after treatment. Remission means the cancer has stopped growing and spreading.

    Patients testing for mesothelioma early enough to qualify for surgery have the best chance of achieving remission.

    Every day, doctors and researchers work to develop treatment strategies in hope of finding a cure. At the same time, many mesothelioma specialists are optimistic they may soon be able to manage this form of cancer as a chronic disease, rather than a terminal illness.

    A number of notable mesothelioma survivors, particularly among those with peritoneal mesothelioma, have outlived their prognosis by years thanks to new treatment techniques.

    Survival Rate for Stage 1 Mesothelioma

    Stage 1 patients have a better prognosis compared to patients diagnosed at other stages of mesothelioma. Approximately 41%-46% of stage 1 mesothelioma patients survive two years, and 18% survive five years.

    For comparison, stage 4 patients usually live around one year, and 7% survive five years.

    Survival rates are calculated from the statistics for thousands of patients. The rate shows the percentage of patients who were still alive a certain amount of time after they were diagnosed.

    This rate explains what happened to a large group of patients in the past. It can only give you a general idea about what to expect from an individual diagnosis in the present.

    Life expectancy with stage 1 mesothelioma depends on a number of factors, especially the cancer cell type and the patient’s age and physical fitness level.

    Mesothelioma is a rare, complex disease, and every case is different.

    How Age Influences Prognosis for Stage 1 Mesothelioma

    Younger patients diagnosed with early-stage mesothelioma often have a better prognosis and more treatment options than patients over 55 years of age.

    In general, younger patients have a higher five-year survival rate due to their overall health and greater chance of being surgical candidates. However, research is showing that patients over 70 years of age receive similar benefits if they are candidates for surgeries such as pleurectomy with decortication.

    The average age of a mesothelioma patient is 69, and about 8% of male patients ages 65 to 74 live for five years or more. Meanwhile, women in the same age group have a 14.1% five-year survival rate.

    Stage 1 Mesothelioma Treatment Options

    Surgery is the mainstay of treatment for stage 1 patients. But often, radiation, chemotherapy or a combination of both will be performed around the time of surgery to help improve long-term remission rates. Talk to your doctor to learn how they prefer to sequence therapy because it can vary from center to center.

    Patients with localized cancer have the most treatment options available to them. But it also depends on the patient’s overall health. Patients must be in strong health to handle an aggressive treatment plan.

    Patients who undergo multimodal therapy may live years beyond the average mesothelioma prognosis.

    A 2022 study published in Multidisciplinary Digital Publishing Institute that included stage 1 and 2 pleural mesothelioma patients found multimodal therapy safe and effective at improving survival.

    Patients underwent induction chemotherapy, surgery, and postoperative radiation therapy and chemotherapy. The median overall survival was 32.1 months, which is a significant improvement from the average 12-month survival.

    Surgery: There are two major surgery options for stage 1 pleural mesothelioma. One removes the diseased tissue around the lung, while the other removes the lung as well.

    Which option is best depends on how far the cancer has spread and how much surgery the patient’s body can handle.

    Chemotherapy: Pemetrexed (Alimta) and cisplatin are the most common chemotherapy drugs for mesothelioma.

    Doctors may use chemotherapy on its own or in combination with surgery for stage 1 patients. After a patient recovers from surgery, they usually receive chemotherapy. The goal is to kill any remaining cancer cells in their body.

    Radiation Therapy: Doctors traditionally use radiation therapy after surgery to prevent local recurrence. Applying radiation therapy after surgery might improve survival rates for certain stage 1 patients.

    Clinical Trials and Emerging Therapies: Many early-stage patients in otherwise good health qualify for mesothelioma clinical trials.

    These voluntary research studies test experimental drugs and therapies not yet approved by the U.S. Food and Drug Administration for mainstream use. Emerging therapies for mesothelioma include immunotherapy, gene therapy and photodynamic therapy.

  • Stage 2

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    Tumors have spread from the original location into adjacent structures. Surgery is still an option. Median life expectancy at stage 2 is 20 months.

    Stage 2 mesothelioma means cancer cells may not have spread far, but they are entering nearby lymph nodes. Stage 2 prognosis may still be favorable, and there are plenty of treatments available to extend life expectancy. The 2-year survival rate for patients at this stage is around 38%.

    Prognosis is generally favorable in stage 2 mesothelioma, and most treatment options are still available. Symptoms in stage 2 are uncommon, but if present, may be more noticeable than in stage 1. Stage 2 tumors have spread beyond the mesothelial lining and into nearby lymph nodes. Tumors remain small enough for surgical removal, which positively impacts life expectancy for mesothelioma patients.

    It is generally rare for symptoms to appear in stage 2, and most symptoms usually arise in stage 3. Stage 2 pleural mesothelioma symptoms may resemble the common cold, such as difficulty breathing during exercise or mild cough. Peritoneal patients may lose weight or feel bloated. Doctors treat stage 2 mesothelioma with surgery, chemotherapy and radiation therapy. The same multimodal approach to treatment used at stage 1 is also an option in stage 2. The median life expectancy at stage 2 is 20 months with surgery. However, those who respond well to aggressive treatment may live three years or longer.

    Features of Stage 2 Mesothelioma

    Once mesothelioma cells have spread to hilar lymph nodes, the case is considered stage 2 or higher, even if the main tumor growths are still very small.

    Hilar lymph nodes, also known as N1 lymph nodes, are located at the root of the lung.

    There are two important features of Stage 2 Pleural Mesothelioma which are as follows:

    • Tumors have developed in the membrane lining the chest cavity and surrounding the lungs
    • Cancer cells have spread into nearby lymph nodes

    Tumor cells in the hilar lymph nodes is the main difference between stage 2 and stage 1 disease. In stage 1, cancer cells have not yet reached lymph nodes. In stage 2, tumors may or may not have grown into the breathing muscle under the lungs (the diaphragm) or into the lung tissue.

    Peritoneal mesothelioma has no formal staging system. Doctors often define it as stage 2 if there is local tumor growth and some lymph node involvement.

    Stage 2 pleural and peritoneal mesothelioma patients can benefit from multimodal therapy that combines surgery, chemotherapy and radiation therapy. They must be healthy enough to endure an aggressive treatment plan.

    Multimodal therapy currently is the gold standard for mesothelioma treatment. It has helped some patients live years beyond the average prognosis.

    Early-stage patients with stage 1 or stage 2 mesothelioma often have a number of promising experimental therapies available to them as well.

    Facts About Stage 2 Mesothelioma

    • Two-year survival rate is about 38%
    • Tumor-removing surgery recommended for eligible patients
    • Surgery is usually supported by chemotherapy and radiation therapy

    Signs And Symptoms Of Stage 2 Mesothelioma

    In most cases, mesothelioma symptoms do not directly present themselves in stage 2. When people do notice symptoms they are typically minor and may include:

    • Chronic coughing
    • Slight breathing issues
    • Minor chest pain

    Less commonly, some people with stage 2 disease may experience a fever.

    If symptoms do arise, they are easily mistaken as signs of a less serious condition, such as flu, pneumonia or bronchitis.

    Symptoms can be caused by tumor growth or a buildup of fluid in the pleura (known as pleural effusion), which constricts the lung or causes pain. This is more common with stage 3 or 4 disease than with stage 2 mesothelioma.

    Difficulty Diagnosis Of Stage 2 Mesothelioma Difficult

    Mesothelioma has a long latency period. Decades pass between initial asbestos exposure and cancer development. Once it begins to develop, it can grow quickly without causing symptoms until stage 3 or 4.

    Most mesothelioma cases are diagnosed after the cancer has already advanced beyond stage 2, though sometimes this is not the case.

    Some stage 2 cases are discovered through cancer screening. More often they are found by chance when a doctor checks a patient’s chest for an unrelated reason.

    Life Expectancy for Stage 2 Mesothelioma

    Each patient’s life expectancy depends on many factors. Their overall health and the specific cell type of their cancer play important roles.

    Pleural Mesothelioma Stage 2 Survival Rates

    Stage 2 38% 11%

    Researchers calculate what percentage of stage 2 patients survived at least two years and at least five years. This is based on the statistics from thousands of patients diagnosed in recent years.

    These survival rates reveal the seriousness of this diagnosis. However, because every patient is different and treatment technology has changed since these statistics were collected, these survival rates cannot predict the outcome for an individual patient.

    “People now being diagnosed with MPM may have a better outlook than these numbers show,” the American Cancer Society shows. “Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.”

    Patients with stage 2 peritoneal mesothelioma tend to have better survival rates than patients with pleural disease.

    Your lymph nodes are a series of filters that keep germs out of your bloodstream. Once cancer cells reach the lymphatic system, they can spread into the bloodstream and throughout the body.

    Stage 2 Mesothelioma Total Treatment

    Unfortunately, no stage of mesothelioma is considered totally healable. But therapies can control the cancer to help people live longer with mesothelioma.

    Pleural mesothelioma is an aggressive disease. Most patients do not survive longer than two years after diagnosis. Stage 2 mesothelioma carries a better prognosis than more advanced stages of the cancer.

    Patients with stage 2 peritoneal mesothelioma may be eligible for surgery and heated intraperitoneal chemotherapy, which is also known as HIPEC. About 50% of peritoneal patients who receive HIPEC will be alive five years after diagnosis.

    Doctors and researchers are testing new drugs and treatment approaches in hopes of finding a way to control and ultimately defeat mesothelioma. The goal is to help patients manage the cancer as a chronic disease rather than a terminal illness.

    Their efforts have allowed some mesothelioma survivors to outlive the average life expectancy for mesothelioma by years.

    Stage 2 Mesothelioma Treatments

    Stage 2 mesothelioma is treated with surgery, chemotherapy and radiation therapy. A combination of treatments is called multimodal therapy.

    Even with lymph node involvement, there are effective treatment options available to early-stage mesothelioma patients. Clinical trials offer experimental treatments such as immunotherapy.

    In 2022, a study on stage 1 and 2 pleural mesothelioma patients found multimodal therapy safe and effective at improving survival.

    Participants underwent induction chemotherapy, surgery, and postoperative radiation therapy and chemotherapy. Researchers reported a median overall survival of 32.1 months, which significantly surpassed the average 12-month survival.

    Surgery: There are two main surgical options for removing pleural mesothelioma tumors. The difference comes down to whether or not surgeons have to remove one of the patient’s lungs to eliminate all detectable the cancer.

    Each patient’s medical team must create a treatment plan based on the patient’s overall health and how far the cancer has spread.

    Chemotherapy: The chemotherapy combination of Alimta and cisplatin or carboplatin is the most common treatment for pleural mesothelioma.

    Doctors may use drugs to shrink tumors before surgery or kill remaining cancer cells after surgery. Patients not eligible for surgery may benefit from chemotherapy as a stand-alone treatment.

    For patients with stage 2 peritoneal mesothelioma, chemotherapy can be circulated throughout the abdominal cavity during surgery to remove visible tumors.

    While experimental, chemotherapy has been used to shrink tumors down to an earlier stage of development in order to operate on a patient.

    In a 2020 report published in General Thoracic and Cardiovascular Surgery, a stage 3 patient who responded well to chemotherapy was downstage to stage 2 and subsequently qualified for aggressive surgery. The patient was alive at 30-month follow-up and undergoing another round of chemotherapy to combat a recurrence.

    Radiation Therapy: Radiation can be used to shrink tumors before surgery or prevent local recurrence after surgery. Radiation therapy also can be used palliatively, to alleviate symptoms and improve quality of life.

    Clinical Trials: Patients can access cutting-edge treatments through clinical trials. These trials test immunotherapy, gene therapy and novel combinations of chemotherapy drugs.

    Patients often have to be relatively healthy to volunteer for these research studies. Many people diagnosed with stage 2 mesothelioma qualify for clinical trials.

  • Stage 3

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    Cancer has spread into regional lymph nodes. Surgery is an option in select cases. The patient’s median life expectancy at stage 3 is 17.9 months.
    Stage 3 mesothelioma is the most common stage of diagnosis. In stage 3, tumors have spread into tissues, organs or lymph nodes around the cancer’s original site. The prognosis for stage 3 mesothelioma is poor. About 26% to 38% of stage 3 mesothelioma patients live at least two years after diagnosis.

Stage 3 mesothelioma includes two substages: 3A and 3B. Stage 3A tumors have grown and spread deeper to nearby tissues, organs and lymph nodes. However, some patients may still qualify for surgery. Stage 3B tumors have more extensive lymph node involvement, making surgical benefits less likely. The median life expectancy at stage 3 is 17.9 months with surgery.

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Symptoms worsen in stage 3 mesothelioma and include difficulty breathing, dry cough, wheezing and chest pain. Peritoneal mesothelioma patients develop constipation or diarrhea, abdominal pain and bloating. Weight loss, fever and night sweats are common to both mesothelioma types.

Doctors typically treat stage 3 mesothelioma with chemotherapy because most stage 3 patients are ineligible for surgery. At this stage, doctors offer palliative options to control pain, improve quality of life and extend survival. Stage 3 patients can also join clinical trials for a chance to receive experimental chemotherapy drugs and immunotherapies.

Stage 3 is an advanced stage of pleural mesothelioma cancer. Multiple types of mesothelioma exist, but only the pleural variant has an official staging system. In this stage, tumors have spread throughout the pleural lining of the lungs on one side of the chest, including the centralized immune glands known as mediastinal lymph nodes.

The primary tumor in stage 3 can affect nearby structures such as the diaphragm, heart sac, chest wall layers and central chest region between the lungs, known as the mediastinum. The most significant difference between stage 3 and stage 4 mesothelioma is that tumors have not yet spread to distant organs.

Facts About Stage 3 Mesothelioma

  • The two-year survival rate is between 26% and 30%.
  • Tumor-removing surgery is still a possibility.
  • Symptoms include frequent chest pain and difficulty breathing.
  • Emerging treatments through clinical trials may extend survival.

When doctors diagnose mesothelioma stage 3, the treatment options are more limited than in earlier mesothelioma stages. Surgery is still possible but less likely to be successful, and the disease progression negatively impacts prognosis and survival.

However, doctors specializing in stage 3 pleural mesothelioma can help patients find clinical trials and experimental treatments that may improve survival rates and quality of life. Presently there is no cure for this rare cancer, but researchers are continually discovering new therapies that may extend mesothelioma patients’ lives.

Signs And Symptoms Of Stage 3 Mesothelioma

In stage 3, symptoms are much more noticeable and intense compared to stage 2 mesothelioma. Unfortunately, because of the long latency period of mesothelioma, many patients do not notice symptoms until stage 3 of the disease.

These symptoms are primarily associated with pleural mesothelioma but may also appear in other variants such as peritoneal or pericardial mesothelioma.

The most common symptoms of stage 3 mesothelioma include:

  • Shortness of breath
  • Pain in the chest or abdomen
  • Recurring dry cough
  • Fatigue
  • Fever
  • Fluid buildup
  • Weight loss

As the tumors continue to grow and spread throughout the chest, symptoms will become more problematic. Stage 3 symptoms vary from patient to patient depending on where the cancer is spreading and if the tumor mass damages vital organs. Some patients may experience referred pain felt in the neck, back or shoulders.

A tumor invading the chest wall may cause increased chest pain, while tumors forming around the lung may lead to increased breathing difficulties. Pleural mesothelioma tumors also cause increased pleural fluid, which puts pressure on the lungs. Symptoms and characteristics of stage 3 mesothelioma vary based primarily on cancer type.

Characteristics of Stage 3 Mesothelioma by Type

The characteristics of stage 3 mesothelioma include: tumor size, location and cell type. They present in different ways depending on the cancer origin and the staging system used to measure disease. These characteristics and differences help doctors determine the best course of treatment for each patient.

In most cases, symptoms are more severe than in stage 2, treatment options are more limited and cancer has invaded nearby tissues and organs. However, compared to stage 4, tumors have not yet metastasized to distant areas of the body. Also, many therapy options, such as chemotherapy and radiation, can help prevent metastasis and extend survival.

Stage 3 Pleural Mesothelioma

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Doctors use mesothelioma staging to determine the extent of cancer, but the pleural variant is the only one with an official staging system. The American Joint Committee on Cancer developed this measurement tool, called TNM, which was last updated for pleural mesothelioma in 2018.

The TNM staging system measures the tumor spread, lymph node involvement and level of metastasis. Characteristics of stage 3 include cancer progression further from its origin into

  • Stage 3A: Tumors have grown into nearby structures, including the diaphragm and mediastinum on one side of the chest. Cancer has spread to nearby lymph nodes and possibly layers of the chest wall and the heart sac (pericardium). Surgery to remove all visible tumor growth may still be an option.
  • Stage 3B: This category is split into two variations depending on the size of the primary tumor and spread to the lymph nodes. Surgery is not usually an option. Chemotherapy often is the best treatment.

Stage 3 Peritoneal Mesothelioma

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Peritoneal mesothelioma is the second-most common form of the disease. Instead of a formal staging system to measure progression, physicians typically use the existing Peritoneal Cancer Index to grade tumors in the abdomen. In addition, the PCI helps doctors determine the stage in many other abdominal cancers.

The PCI ranges from 0 to 39, measuring the spread of tumors across 13 different abdominal sectors. A score between 21 and 30 indicates stage 3 peritoneal mesothelioma. The characteristics of this stage are tumors localized within the abdomen, with some spread to nearby lymph nodes.

Stage 3 Pericardial and Testicular Mesothelioma

Doctors and researchers do not clearly define stage 3 pericardial or testicular mesothelioma due to their rare nature.

Only 1% to 2% of mesothelioma cases are pericardial, which means cancer forms within the sac that protects the heart. Therefore, a diagnosis for this disease is unlikely until the late stages, after metastasis to the lungs or chest cavity.

Doctors evaluate testicular mesothelioma tumor characteristics by using staging guidelines for general testicular cancer. For example, doctors more commonly refer to stage 3 testicular mesothelioma as late-stage cancer. This description indicates that cancer has spread beyond the lining of the testicles to other tissues such as lymph nodes or bone.

Stage 3 Mesothelioma Life Expectancy and Prognosis

About 26% to 38% of stage 3 mesothelioma patients live at least two years after diagnosis, and some patients live for many years with successful treatment. However, every patient responds differently to treatment, and survival rates are not the only indicators of a mesothelioma patient’s prognosis.

A prognosis is an estimate of how successfully a patient’s treatment plan will control their disease. Doctors evaluate every aspect of a patient’s medical history, overall health and response to treatment before determining a prognosis. For some patients, a mesothelioma prognosis can improve unexpectedly after trying a new therapy.

Life expectancy is a measure of how long someone will live after their diagnosis. For stage 3 mesothelioma patients, life expectancy depends on how well they respond to treatment and the extent of lymph node involvement. When malignant tumors spread to lymph nodes, cancer cells can enter the lymphatic system and create new tumors in distant parts of the body.

Survival statistics do not apply to each patient and can’t predict a person’s prognosis. In addition, successful responses to surgery and post-surgery therapies help patients live past their life expectancy. Factors that can affect survival are different for each patient and include age, gender, cancer cell type, response to treatment and overall health.

Mesothelioma Stage 3 Survival Rates

Patients with late-stage testicular mesothelioma have a median survival time of about two years. Pericardial mesothelioma patients with a late-stage diagnosis have an average survival of about 10 months, but some live much longer after surgery or chemotherapy.

The American Cancer Society uses information from the National Cancer Institute to provide updated survival statistics for mesothelioma. The data tracks patients for a certain number of years and classifies them by their mesothelioma type and stage.

Pleural Mesothelioma 23% 12% 16 months
Peritoneal Mesothelioma 74% 52% 56 months
Source:American Society of Clinical Oncology, 2021

How Lymph Nodes Affect Cancer

Lymph nodes play a vital role in the spread of cancer. Lymph nodes help filter the blood, blocking bacteria and viruses from spreading through the body. When cancer cells invade lymph nodes, they can enter the bloodstream and spread into distant organs. Once cancer spreads to other organs, doctors characterize it as metastasis and surgery is no longer helpful.

Beginning treatment soon after diagnosis is essential to preventing metastasis and extending life expectancy. Early treatment is critical for removing cancerous growths before they spread to other areas of the body.

Patients with stage 3 mesothelioma may have varying degrees of lymph node involvement. Those with minor lymph node involvement often live more than two years, while patients with more cancerous lymph nodes have an average life expectancy of around 13 months.

Even if cancer has not spread to the lymph nodes, surgery may not be an option for some stage 3B patients. Patients with stage 3B mesothelioma may have cancer in vital structures such as the diaphragm or pericardium, where surgery is not a viable option.

Steps to Take After a Stage 3 Mesothelioma Diagnosis

After receiving a mesothelioma diagnosis, the most crucial step is finding a team of well-equipped specialists to treat this rare cancer. It is essential to seek treatment as soon as possible following a stage 3 mesothelioma diagnosis.

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Working with doctors who have successfully treated patients through surgery and the latest therapies gives you the best chance of improving your mesothelioma prognosis. Additionally, improving overall health through proper nutrition and exercise can help extend your mesothelioma life expectancy.

Joining a mesothelioma support group is a great way to connect with resources such as clinical trials and physicians who specialize in this rare cancer. These specialists know the intricacies of mesothelioma, and they understand the challenges patients face. Not all hospitals or major metropolitan cancer centers have doctors who focus on mesothelioma.

Support groups, such as the one The Mesothelioma Center at offers, help patients and their families come to terms with their mesothelioma diagnosis and provide resources for improving quality of life and mental health awareness.

Stage 3 Mesothelioma Treatment Options

A multimodal treatment plan using tumor-removing surgery, chemotherapy and radiation therapy has produced the best survival rates for people with stage 3 pleural mesothelioma.

These tumors are locally advanced, but removal may be possible with extensive surgery and aggressive cancer treatment in specific circumstances.

Stage 3 mesothelioma patients may also benefit from emerging treatments such as immunotherapy, which they can access through experimental clinical trials.

Surgery: At stage 3, tumors have likely spread to surrounding tissues and lymph nodes. However, tumor-removing surgery may still be a possibility. Pleural mesothelioma patients may be eligible for extrapleural pneumonectomy surgery. This extensive procedure removes the entire affected lung, its pleural lining, the diaphragm and the heart lining, known as the pericardium.

Some stage 3 mesothelioma patients may qualify for the less drastic but more meticulous pleurectomy and decortication procedure, depending on the spread of tumors. It removes the lining of the lung, pericardium, diaphragm and any tumor masses growing inside the chest cavity, leaving the lung intact.

Chemotherapy: In general, mesothelioma surgeries have better survival rates when combined with chemotherapy. Most patients receive chemotherapy drugs in combination through an intravenous line, or IV. Chemotherapy can begin as soon as a patient recovers from surgery. Doctors may also administer mesothelioma chemotherapy before or during surgery.

One chemotherapy technique attempts to shrink tumors before a patient’s operation. In a 2020 report published in General Thoracic and Cardiovascular Surgery, a stage 3 mesothelioma patient responded well to chemotherapy and improved to stage 2. After aggressive surgery, the patient was alive and undergoing another round of chemotherapy to fight off a recurrence.

Radiation Therapy: Radiation therapy may also be administered after surgery to prevent local recurrence, a term used to describe cancer regrowth. Not every stage 3 mesothelioma patient is eligible for radiation, but it has helped avoid tumor growth in many cases. Some research has reported improved survival when radiation therapy is applied before surgery to shrink tumors.

Palliative Care: Stage 3 mesothelioma patients who are not in good enough health to undergo aggressive treatments have other options that can improve symptoms. Because symptoms are more intense in stage 3, palliative care options are essential for mesothelioma patients. They can improve their quality of life with palliative therapies.

While these treatments will not cure mesothelioma cancer, they usually help patients feel better and live longer. Doctors use palliative chemotherapy and radiation to lessen cancer-related pain and extend survival. Palliative surgery drains fluid buildup around the tumor, which helps with difficulty breathing.

Immunotherapy & Clinical Trials

Voluntary research studies may provide the best hope for stage 3 mesothelioma patients. Immunotherapy and gene therapy are two constantly evolving areas in cancer treatment. In 2020, the U.S. Food and Drug Administration approved multiple immunotherapies for mesothelioma.

Specialists at specific treatment centers offer mesothelioma clinical trials and experimental treatments to improve prognosis and extend life expectancy. Patients should ask their mesothelioma specialists about appropriate clinical trials in their area and the requirements for enrolling in a research trial.

Integrative Therapies for Mesothelioma

Complementary therapies, such as acupuncture, yoga and nutritional counseling, are often integrated with conventional stage 3 mesothelioma treatments. They may improve overall health, decrease symptoms or boost the immune system.

Some late-stage patients choose to forego conventional treatments for alternative therapies. However, a 2017 study published in the Journal of the National Cancer Institute shows cancer patients who rely on alternative medicine alone have a significantly lower survival rate.

Help Covering Treatment Expenses

Treatment for mesothelioma is costly. The average price of tumor-removing surgery is estimated at around $120,000, while chemotherapy sessions can cost up to $12,000 a month. Private insurance or Medicare won’t always cover all the costs, so financial assistance is essential for many mesothelioma patients.

Grants are available to help cover travel expenses to the top mesothelioma cancer centers. Additional financial aid may be available through asbestos trust funds and legal claims. A qualified mesothelioma attorney can help answer any questions you may have and explain your options for compensation.

Frequently Asked Questions About Stage 3 Mesothelioma

Question: Is stage 3 pleural mesothelioma curable?

Answer: There is no mesothelioma cure for any stage of the disease. A small number of stage 3 patients are eligible for surgery, which can extend survival. However, in this stage, care is palliative and focuses on reducing symptoms and improving quality of life.

Question: What are the signs of stage 3 mesothelioma?
  • Shortness of breath
  • Coughing or wheezing
  • Chest pain or discomfort
  • Fever of night sweats
  • Unexplained weight loss

Question: How can stage 3 life expectancy be improved?

Answer: Factors affecting mesothelioma life expectancy in stage 3 include:

  • Cancer stage and cell type
  • Age, gender and overall health
  • Mesothelioma treatment response

Lifestyle changes, such as diet and exercise, can improve overall health and extend survival for patients undergoing chemotherapy and radiation in stage 3 mesothelioma.

Question: Are stage 3 mesothelioma patients eligible for clinical trials?

Answer: Mesothelioma clinical trials for patients in stage 3 are available in many treatment centers across the United States. Patients in this stage typically have more options than patients in stage 4 who have metastatic cancer.

  • Stage 4

    Tumors have spread into distant organs. Chemotherapy and immunotherapy ease symptoms. Median life expectancy at stage 4 is 14.9 months.
    Stage 4 mesothelioma is a rare, malignant cancer in an advanced stage. Stage 4 cancer cells have metastasized, spreading to distant areas in the body. Stage 4 is the final stage of mesothelioma and considered terminal. The average life expectancy for stage 4 mesothelioma is less than 12 months.

Stage 4 mesothelioma is also known as end-stage mesothelioma or late-stage mesothelioma. This is the most advanced and difficult stage to treat because therapy options cannot remove all tumors. Some patients with stage 4 disease are too weak for aggressive surgeries and other therapies, too.

By stage 4, cancer has spread beyond its origin to distant body parts such as the liver, brain, bones or elsewhere. Treatments are limited to palliative care options, including chemotherapy, surgery or radiation therapies that can reduce symptoms and improve quality of life.

Pleural symptoms in stage 4 mesothelioma include difficulty breathing, trouble swallowing and severe chest pain. Abdominal issues, such as digestive problems, abdominal swelling and bowel obstruction, are more common in peritoneal patients. Patients may also experience loss of appetite, weight loss, muscle weakness, nerve pain, night sweats, fever and fatigue.

Treatments and clinical trial options such as immunotherapy and chemotherapy for mesothelioma patients help people live up to one year or longer. Aggressive surgery for tumor removal is not beneficial in this stage. The median life expectancy for stage 4 mesothelioma is 14.9 months.

Is Mesothelioma Terminal?

Mesothelioma is a terminal cancer. While many patients go into remission, especially with treatment, there is no cure for mesothelioma. Life expectancy with advance stage mesothelioma cancer depends largely on the extent of tumor growth and how well you respond to treatments.

Although stage 4 mesothelioma is considered terminal, continued advancements in palliative care can help you live longer and have a better quality of life. Some stage 4 patients continue to defy the odds, living years after their initial mesothelioma prognosis.

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Signs And Symptoms of Stage 4 Mesothelioma

At stage 4, common symptoms of mesothelioma cancer such as breathlessness and coughing are more severe. Because tumors have spread beyond the lungs, symptoms are not isolated to the chest cavity.

Common Symptoms of Late-Stage Mesothelioma Include the Following:

  • Shortness of breath (dyspnea)
  • Pain and tightness in the chest
  • Night sweats and fever
  • Difficulty swallowing (dysphagia)
  • Coughing up blood (hemoptysis)
  • Fluid buildup in the chest or abdomen
  • Abdominal pain
  • Fatigue
  • Severe weight loss or anorexia (lack of appetite)
  • General feeling of discomfort (malaise)

Some patients also suffer from cachexia. This is a metabolic syndrome involving weight loss, muscle atrophy (breakdown), weakness and appetite loss. Stage 4 cancer sometimes causes blood problems such as high platelet counts (thrombocytosis) and low red blood cell counts (anemia).

Unfortunately, a number of stage 4 mesothelioma cases do not produce symptoms that clearly indicate a diagnosis of mesothelioma. The symptoms of mesothelioma lead most general practitioners to a diagnosis of pneumonia or another pulmonary condition. In most cases, mesothelioma is diagnosed in stage 4 at a hospital or cancer center by an oncologist and not by general practitioner.

Type Of Late-Stage Mesothelioma

Each type of mesothelioma has unique characteristics at the final stages of the cancer.

Stage 4 Pleural Mesothelioma

Stage 4 typically refers to mesothelioma in the lungs, the most common type of the asbestos-related cancer.

Pleural disease can take the form of epithelial or sarcomatoid cell tumors. Cell type does not affect how stage 4 disease is diagnosed, but it does affect how it can be treated at this stage.

During the final stages of pleural mesothelioma, the cancer has spread to distant organs. Symptoms at this stage may include shortness of breath (dyspnea), painful coughing, pain and tightness in the chest and severe weight loss.

Stage 4 Peritoneal Mesothelioma

There is no official stage 4 for peritoneal mesothelioma. This type of the cancer accounts for roughly 20% of all mesothelioma cases. It is generally accepted that peritoneal patients with extensive tumor spreading are classified as stage 4.

By this point, the cancerous tissue is more extensive and tumors have moved outside of the peritoneum. Surgery usually is not an option for end-stage peritoneal mesothelioma.

For people who can try surgery, heated intraperitoneal chemotherapy (HIPEC) is the most promising option. It combines surgery and heated chemotherapy circulated throughout the abdomen.

Stage 4 Pericardial Mesothelioma

Pericardial mesothelioma is a rare form of the cancer which develops on the lining of the heart. It is typically diagnosed in the later stages, although it may not be defined as stage 4.

Stage 4 Testicular Mesothelioma

Testicular mesothelioma is the rarest type of this cancer, with around 100 cases documented in medical literature. As with the pericardial type, testicular mesothelioma may not be defined as stage 4, but it is recognized as advanced disease in most cases.

Three systems are commonly used to define stages of pleural mesothelioma (Brigham, TNM and Butchart). They categorize stage 4 on similar cancer characteristics and tumor behaviors. The Butchart and TNM staging systems note whether the cancer has metastasized to distant organs. Brigham designates when surgery is not a viable option.

Treatment Options for Mesothelioma at Stage 4

For many patients with stage 4 mesothelioma, chemotherapy is the best option. Even though it won’t cure the disease, this treatment can shrink tumors to improve quality and length of life.

Mesothelioma treatment options to extend survival are most limited at stage 4. Aggressive surgeries to remove tumors are not an option because the tumor has spread too far.

Targeted radiation therapy also can be used in a palliative treatment plan. Radiation treatments may alleviate pain and pressure and ease breathing.

Stage 4 Chemotherapy: Chemotherapy is one of the most common treatment options for stage 4 mesothelioma. These drugs slow tumor growth and may shrink tumors in some cases. This helps alleviate symptoms and extend survival.

A 2016 Wayne State University study out found chemotherapy more than doubles life expectancy for malignant mesothelioma patients, including those with stage 4 disease. Combining chemotherapy with surgery extended survival even longer.

Some patients’ tumors respond so well to chemotherapy that they qualify for surgery. A 2020 case report published in General Thoracic and Cardiovascular Surgery described a woman in her 60s with stage 4 pleural mesothelioma who qualified for surgery after responding well to chemotherapy. She was alive and undergoing another round of chemotherapy 30 months after surgery.

The most commonly prescribed chemotherapy regimen for pleural mesothelioma is cisplatin or carboplatin combined with pemetrexed (Alimta).

Stage 4 Surgery: Extensive tumor-removing surgeries, such as a pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP) are not offered to patients with stage 4 disease.

Due to the extensive spread of tumors at stage 4 disease, doctors cannot remove all growths with EPP or P/D.

Still, some peritoneal mesothelioma patients can benefit from less extensive surgical procedures. Surgeons will attempt to remove as much tumor mass as possible in a procedure called debulking.

They can target tumors causing symptoms, so patients breathe more comfortably and experience less pain.

Less Invasive Surgeries Include:

  • Thoracentesis: Drains fluid from the chest
  • Paracentesis: Drains fluid from the abdomen
  • Pericardiocentesis: Drains fluid from around the heart
  • Pleurodesis: Potential long-term solution to fluid buildup in the chest

Stage 4 Radiation Therapy: Doctors don’t always treat stage 4 mesothelioma with radiation therapy. They may recommend the procedure depending on your tumor growth and overall health.

Radiation therapy at this stage is used to reduce the size of tumors. This can lessen chest pressure, decrease pain and improve breathing.

Immunotherapy and Clinical Trials: Some stage 4 mesothelioma patients may qualify for clinical trials. Clinical trials investigate the value of various treatment combinations for late-stage mesothelioma or may test newer options such as immunotherapy.

In some cases, experimental treatments can help stage 4 patients survive far past their prognosis. These include immunotherapy, gene therapy and other emerging therapies.

A 2016 study published in The Annals of Thoracic Surgery showed photodynamic therapy may improve late-stage mesothelioma survival.

A subset of pleura mesothelioma patients with no cancer cells in their lymph nodes lived an average of 7.3 years compared with the typical one-year prognosis.

Improve Quality of Life with Palliative Care

Palliative or supportive care can relieve symptoms and improve quality of life. At stage 4, doctors may recommend pain medication, oxygen therapy and respiratory therapies. These treatments control pain and improve lung function.

Many long-term mesothelioma survivors have incorporated complementary and alternative medicine into their stage 4 mesothelioma treatment plan. Certain complementary therapies may improve survival, ease symptoms, reduce treatment side effects and enhance quality of life.

Examples include mind-body therapies, nutritional support, acupuncture, massage and herbal treatments.

Life Expectancy Without Treatment

Patients diagnosed in stage 4 who decide against treatment live an average of 6 months. In contrast, those diagnosed with stage 1A disease who elect no treatment live an average of two years.

Everyone’s case is unique. Ultimately, how long someone lives with mesothelioma without treatment depends the cancer’s stage, their overall health and tumor growth rates.

Researchers use tumor grading to estimate how fast a tumor may grow. Cell abnormalities and how rapidly the cancer cells are dividing play a role in overall tumor growth. These factors are associated with survival.

Stage 4 Mesothelioma Life Expectancy and Prognosis

The median survival rate for stage 4 mesothelioma is approximately 12 months with treatment. For pleural mesothelioma patients, the stage 4 survival rate is approximately 14.9 months.

At stage 4, the cancer is likely to continue to spread, which can lead to respiratory failure. If the tumors spread to the heart the patient may experience heart failure.

A positive response to treatment can extend survival. A 2021 clinical research study discovered that patients who were sensitive to platinum-based chemotherapies had better results. The median progression-free survival of the platinum-sensitive group at stage 4 was 7.9 months, compared to 2.4 months for the platinum-resistant group.

Patients with good prognostic factors often live longer than average. Prognostic factors associated with better survival include having the epithelioid cell type, being in good overall health, younger in age, female and having no signs of blood disorders.

Mesothelioma is considered a variable cancer and no two cases are the same. For this reason, survival statistics cannot predict how long someone with mesothelioma will live. Some people have particularly slow-developing mesothelioma, and some respond surprisingly well to treatment.

Metastasis in the Final Stage of Mesothelioma

Metastasis means that cancer has spread to a different body part from where it first developed, either locally or distantly. Once metastasis has occurred, doctors automatically classify cancer as stage 4, the last stage of mesothelioma. The most common sites of distant mesothelioma metastasis include the liver, kidneys and spleen. Unlike other cancers, mesothelioma tends to metastasize locally rather than distantly. Mesothelioma is more likely to spread throughout the body cavity where it originated, for example the chest cavity or the abdominal cavity, rather than travel to distant body parts such as the brain.

Stage 4 Mesothelioma Survivors

A number of stage 4 mesothelioma patients have far outlived the average prognosis.

Andy Ashcraft lived with stage 4 pleural mesothelioma for seven years. He joined a clinical trial combining immunotherapy with chemotherapy. Andy responded better than anyone else in the trial.

He continued to take just the immunotherapy drug for more than three years. When it stopped working, he used medicinal cannabis to manage symptoms and lived several more years.

Lannie Chitwood lived for 10 years with stage 4 pleural mesothelioma. He received treatment at Duke University Medical Center in Durham, North Carolina, including experimental chemotherapy.

Lannie and his wife enjoyed traveling together during those years and took a second honeymoon in 2015.

Comedian Quincy Jones was diagnosed with stage 4 peritoneal mesothelioma in 2015 at the age of 31. Doctors told him that he might have only one year to live. He has lived more than three years thanks to chemotherapy and his love for laughter.

Next Step To Take After a Stage 4 Mesothelioma Diagnosis

After a stage 4 mesothelioma diagnosis, patients may wish to consider getting a second opinion from a specialist, trying experimental treatments and focusing on improving their quality of life. Although stage 4 is the most advanced of the mesothelioma stages, some patients, especially those in good overall health, live far beyond predicted life expectancy.

Through a variety of treatments, groundbreaking clinical trials and healthy life choices, you may beat the odds and become a survivor. Consider the following:

Steps To Consider After A Stage 4 Diagnosis

  • Get a second opinion from a mesothelioma specialist.
  • Find financial assistance available to offset potential monetary burden.
  • Enroll in a clinical trial. Consult with your doctor to determine if you are eligible.
  • Try alternative and complementary treatment options.
  • Exercise and maintain a healthy diet to improve mood and quality of life.
  • Join a support group to connect with others coping with mesothelioma.
  • Make time for hobbies and activities that bring you joy.
  • Read stories about other mesothelioma survivors for hope and inspiration.

End-of-Life Planning

Palliative care to manage pain plus ongoing communication with your medical team can vastly improve your quality of life with mesothelioma.

In addition to these options, you’ll want to make a plan for your end-of-life choices and tell your family why these decisions are important to you. Knowing your family will honor your end-of-life care plan will lessen anxiety.

Documenting your decisions in clear, concise, legally binding documents can help you feel better, too. Ask your medical team for a blank copy of all documents they recommend when planning for end-of-life medical care.

Considerations For End-Of-Life Decision Making

  • Symptoms Versus Cancer & Control: Treatments can focus on killing tumors or solely on managing symptoms. Tell your medical team which goal is more important to you.
  • Care Location: Tell your doctors and nurses where you want to receive care if you are unable to go to an outpatient clinic. Some people want to be in the hospital or a 24-hour, staffed hospice program. Others want to designate a caregiver and arrange for in-home medical services.
  • Financial Affairs: Make sure all the beneficiaries for insurance policies, employer or union benefits, lawsuits, tax returns, checking and savings accounts, personal possessions and investments (IRA or 401k) are clearly specified in your will.
  • Personal Records: Provide your social security number, passwords and important contacts to a trusted family member.
  • Other Family Care Needs: Identify who will take care of children or pets.
  • Funeral Arrangements: Provide detailed information on how you want your body handled, the type of memorial or funeral service you’d like and how it will be paid for.

A stage 4 mesothelioma diagnosis can be devastating, but it doesn’t mean you can’t control some aspects of your cancer.

Taking a proactive approach, combined with a variety of treatments, may help people live longer.

Frequently Asked Questions (F.A.Q) About Stage 4 Mesothelioma

Question: What does stage 4 mesothelioma mean?

Answer: When someone is diagnosed with stage 4 mesothelioma, it means the cancer has reached its final stage of development. At this stage, the cancer has spread throughout the body cavity where it originally developed. In rare cases the cancer may spread to distant organs, but this is unusual for mesothelioma.

Question: Can stage 4 mesothelioma be treated?

Answer: Yes, stage 4 mesothelioma is primarily treated with chemotherapy and palliative care. Chemotherapy can alleviate symptoms and extend survival. Palliative care helps patients cope with pain and other symptoms, which can improve quality of life.

Question: What is the life expectancy of someone with late-stage mesothelioma?

Answer: The life expectancy of stage 4 mesothelioma is around one year with treatment. Electing chemotherapy can extend survival of people with mesothelioma by several months. Without treatment, people with late-stage mesothelioma live an average of six to eight months.

Question: Are there any survivors of stage 4 mesothelioma?

Answer: A number of people have lived a long time with stage 4 mesothelioma. For example, Andy Ashcraft lived with stage 4 mesothelioma for more than seven years. His treatment included chemotherapy, immunotherapy and medical marijuana.

Pleural Mesothelioma Staging Systems

Mesothelioma specialists use multiple tests, such as CT and MRI imaging and surgical biopsy, to match patients to a cancer stage. These tests inform doctors on which treatment will be most beneficial based on tumor location, size and lymph node involvement.

Various staging systems serve different purposes for measuring and classifying disease, but comparable stages between systems typically result in similar treatment options for the patient.

TNM Staging System: The TNM staging system is the most widely used and accepted system for staging malignant pleural mesothelioma. The American Joint Committee on Cancer developed this system over eight iterations, and it has replaced the other staging systems. The AJCC stage is the same as the TNM stage.

Doctors will also indicate staging in this system as clinical or pathological. The results from imaging tests and physical examinations determine the clinical stage. Surgeons define the pathological stage based on biopsy results found after surgery.

Brigham Staging System: Dr. David Sugarbaker developed the Brigham system at Brigham and Women’s Hospital in Boston. His objective was to help identify which pleural patients would respond best to mesothelioma surgery.

Mesothelioma surgeons continue to use this system in conjunction with other methods for greater accuracy when determining a patient’s surgical eligibility.

Butchart Staging System: Dr. Eric Butchart developed the Butchart system in the late 1970s to help doctors identify which pleural patients could handle aggressive treatment options. Butchart understood that patients with early-stage disease tolerated aggressive surgery and chemotherapy better than patients with advanced cancer.

The Butchart system is no longer in use, but it helped doctors develop more modern staging systems that specialists use today.

SEER Staging System: The Surveillance, Epidemiology and End Results (SEER) database hosted by the National Cancer Institute uses a unique system to classify mesothelioma by the extent of disease furthest from its starting point.

SEER stages include local, regional and distant, based on whether cancer is localized in the pleura, affecting regional lymph nodes or creating new sites in other parts of the body. This system is no longer in practice for physicians but is still relevant in research.

Peritoneal, Pericardial & Testicular Mesothelioma Staging

Malignant pleural mesothelioma is the only type of mesothelioma with an officially adopted staging system. Mesothelioma specialists use staging methods adopted for other cancers to approximate the relative stage of nonpleural variants.

The peritoneal cancer index, or PCI, helps doctors approximate the peritoneal mesothelioma stage based on progression in similar abdominal cancers.

Due to their extreme rarity, pericardial and testicular mesothelioma have no appropriate staging systems.

Peritoneal Mesothelioma Staging

A TNM staging system is in the works for peritoneal mesothelioma, which will define tumor, lymph node and metastasis development within the abdomen. Many doctors approximate the TNM system to stage peritoneal patients, while some may still use a more straightforward approach that defines only an early and a late stage.

Other doctors use the peritoneal cancer index, which assigns a stage to many other abdominal cancers. The PCI determines a score based on tumor size in 13 different regions throughout the abdomen.

According to a 2020 study published in Scientific Reports, PCI is an accurate tool for predicting prognosis and a patient’s response to treatment. In this way, PCI helps doctors make clinical decisions and serves as a substitute for an official staging system.

Pericardial Mesothelioma Staging

There is no staging system for pericardial mesothelioma because of its extreme rarity. There have been less than 150 cases of this variant, and it hasn’t amounted to enough data to create a staging system.

One of the challenges of creating a staging system for pericardial mesothelioma is the lack of data in the early stages of the disease. Up to 45% of these cases involved tumors that had spread to regional lymph nodes, lungs and kidneys by the time of diagnosis.

Testicular Mesothelioma Staging

There have been less than 100 cases of testicular mesothelioma, and no official staging system exists for the variant.

Because surgery is the preferred approach, doctors stage testicular mesothelioma based on a patient’s eligibility for surgery. They may also choose to describe testicular mesothelioma based on the TNM system for general testicular cancer.

How Staging Affects Mesothelioma Treatment and Prognosis

Staging is the most significant factor doctors consider when coming up with your treatment plan. They also evaluate your age and overall health, but the cancer’s stage primarily determines which mesothelioma treatments are appropriate for you. Doctors will continue to restage your cancer as treatment or disease progresses.

Doctors also use staging to help inform a patient’s prognosis. The extent of the disease determines the likelihood of success with the treatments available to you. An earlier malignant mesothelioma stage typically relates to a better prognosis and more prolonged survival.

Surgery: Early-stage mesothelioma tumors (stages 1 and 2) are small and haven’t spread far beyond their origin. Their smaller size makes them easier to remove with surgery and more manageable to target with chemotherapy and radiation therapy. Immunotherapy is also more effective when tumors are small.

Staging that allows for surgery as a treatment option is termed resectable staging and means doctors can perform major surgery to remove cancer during the first line of treatment. If staging results indicate that surgery is no longer an option, doctors refer to the outcome as nonresectable staging.

Late-stage mesothelioma tumors (stages 3 and 4) have grown and spread to the point that surgically removing them becomes impossible without removing vital organs. In other words, surgery could be life-threatening for people with late-stage mesothelioma.

Chemotherapy and Immunotherapy: These treatments are available to patients at any stage of mesothelioma. They are more effective at reducing tumor size and halting tumor spread at earlier stages, but they can still extend the survival rate for mesothelioma patients in late stages.

Palliative chemotherapy and immunotherapy in later stages help reduce or maintain tumor size and prevent symptoms from worsening.

Radiation Therapy: While radiation therapy is available at any stage of mesothelioma, the application and outcomes differ between the early and late stages. Doctors use radiation therapy for early-stage mesothelioma to prevent local recurrence after surgery.

When used in late-stage pleural mesothelioma, radiation aims to shrink painful tumors growing into the chest wall. Palliative treatments such as radiation therapy provide significant pain relief.

Clinical Trials: Clinical trials test a variety of treatments for all stages of mesothelioma. For example, some research studies require early-stage patients, while others are looking for late-stage patients. Trials are also available for patients who have tried previous treatments or have had no prior therapy.

Clinical research trials offer access to new, innovative therapies for mesothelioma, including immunotherapy. Ask your doctor whether you may qualify for experimental treatment based on your stage and diagnosis.

Frequently Asked Questions (F.A.Q) About the Stages of Mesothelioma

Question: Is stage 4 mesothelioma always terminal?

Answer: Mesothelioma is considered a terminal cancer because it has no cure. Stage 4 mesothelioma, also known as end-stage cancer or late-stage cancer, is the most advanced form of the disease. Treatment can be painful and varies between patients, but remission is possible. Palliative treatment options, which can improve symptoms and quality of life, also are available.

Question: How does staging impact a mesothelioma diagnosis?

Answer: Doctors use staging to develop mesothelioma treatment plans for a given diagnosis based on the extent of cancer progression. Physicians determine a patient’s mesothelioma prognosis by the stage of their cancer and their response to treatment.

Question: Which staging system is used to stage for pleural mesothelioma?

Answer: The TNM staging system is the most commonly accepted method for pleural mesothelioma staging. The acronym TNM stands for Tumor Nodule Metastasis and measures the extent of tumor growth into organ tissues, lymph nodes and distant sites in the body.

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