Mesothelioma metastasis means cancer that starts in the lining around your lungs or abdomen spreads to other parts of your body, usually through lymph nodes. Your cancer stage, cell type and treatment affect how this spread can happen.
Yes, mesothelioma metastasis is possible. Metastasis means your cancer has spread from where it started to other areas in your body. With mesothelioma, this spread happens through the bloodstream or the lymphatic system, allowing cancer cells to travel and form tumors in new places.
Metastatic mesothelioma is another name for stage 4 mesothelioma, which means your cancer has moved beyond its original site. While mesothelioma typically begins in the lining around your body’s organs called the mesothelium, it can spread to nearby tissues and distant organs.
As Dr. Jacques Fontaine, a thoracic surgeon at Moffitt Cancer Center, tells us, “Lymph nodes are the normal filters of the blood. They are like the toll gate before you get on a highway. Once cancer cells are in the bloodstream, they can go to other organs and start growing there.”
When Does Mesothelioma Metastasize?
Mesothelioma spreads mostly in the late stages of the disease. Doctors diagnose people with metastatic mesothelioma when their cancer spreads further in the area where it started and to more distant parts of the body. This is the case during stage 4 mesothelioma.
Mesothelioma diagnosed in early stages exists only on its primary site and doesn’t metastasize. Primary sites where mesothelioma develops are specific areas of the mesothelium. These include the pleura (lining of the lungs), peritoneum (lining of the belly), pericardium (lining around the heart) or tunica vaginalis (lining of the testicles).
In later stages, cancerous cells detach from where they originally developed. Some people may experience more aggressive spreading than others, with cells spreading quickly over time. Other people may enter the later stages of mesothelioma with a more gradual spread, depending on their specific diagnosis.
Where Does Mesothelioma Metastasize?
Metastatic mesothelioma may spread to the liver, lungs, kidneys, adrenal glands or spleen. When mesothelioma spreads, it infiltrates organs and creates secondary tumors.
Mesothelioma metastasis is more common within the body cavity in which it originally formed. Doctors refer to this as local spread.
Imaging scans are used to see if mesothelioma tumors are growing in different areas beyond their initial site. These include CT scans, PET scans and MRIs.
Metastatic Pleural Mesothelioma
Metastasis in pleural mesothelioma spreads to the bone, intestines, kidneys, liver and other structures. A 2024 German study in the journal Cancers revealed that 13.3% of those with a pleural diagnosis also had distant metastasis (not inclusive of the brain) at the time of diagnosis.
A recent retrospective study found that of 164 pleural patients, roughly 67% had distant metastatic tumors at diagnosis. The most common sites were the other lung, the peritoneum and bone. Previous studies found the most common metastasis sites are the liver, adrenal glands and kidneys. The tongue and scalp are less common.
Common Sites of Pleural Mesothelioma Metastasis
Adrenal glands
Bone
Intestines
Kidneys
Liver
Other lung
Peritoneum (lining of the abdomen)
Mesothelioma metastasizing to the brain or central nervous system is more rare. Studies conducted in 2022 and 2024 found only about 5% of people with pleural mesothelioma experienced metastasis to the brain.
A May 2025 Perelman School of Medicine study found pleural patients receiving only immunotherapy were 4% more likely to experience brain metastasis than those receiving only chemo. Immunotherapy activates the immune system, revealing hidden brain metastases through inflammation that makes tumors easier to detect. Researchers recommend brain imaging before immunotherapy to find any hidden spread early and guide treatment. The study doesn’t discuss metastasis for those receiving both immunotherapy and chemo.
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The most frequent sites for metastasis of peritoneal mesothelioma are the liver, peritoneal lining and abdominal lymph nodes. Less common sites include the lungs, heart, brain, bone and kidneys.
Common Sites of Peritoneal Mesothelioma Metastasis
Peritoneal lymph nodes
Peritoneum (lining of the abdomen)
Liver
Peritoneal mesothelioma doesn’t metastasize outside the abdominal cavity during the early onset. Your abdominal cavity consists of your stomach, spleen, intestines, liver and other organs contained in your belly. Distant metastases occur in about 50% of people
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Metastatic Pericardial and Testicular Mesothelioma
The local spread of pericardial mesothelioma usually involves the pleura, lung and the rest of the chest cavity. Pericardial mesothelioma metastasizes in about 25% to 45% of cases. Frequent sites are the regional lymph nodes, lungs and kidneys.
Common Sites of Pericardial and Testicular Mesothelioma Metastasis
Kidneys
Liver
Lungs
Omentum (fatty tissues around the abdominal organs)
Regional lymph nodes
Vertebrae, chest (thorax) and lumbar
As testicular mesothelioma progresses, it tends to spread from the lining of the testes to the lymph nodes in the lower body. Metastasis in this type of mesothelioma is rare. When it occurs, it can spread to the vertebrae of the spine, the omentum, the liver and the lungs.
What Causes Mesothelioma Metastasis?
The main cause of mesothelioma metastasis is cancer cells entering the bloodstream or lymphatic system. Factors such as cancer stage, tumor cell type and response to treatment influence the risk of metastasis. People have a lower risk if they have an early-stage diagnosis with a favorable cell type that responds well to treatment.
Factors Influencing Mesothelioma Spread
Cancer stage: The risk of metastasis is low in early-stage mesothelioma (stages 1 and 2) and high in advanced stages (stages 3 and 4).
Tumor cell type: Epithelioid mesothelioma spreads more slowly than the more aggressive sarcomatoid or biphasic types.
Response to treatment: Chemo, radiation, anti-angiogenesis drugs, Tumor Treating Fields and tumor-removing or cytoreductive surgery can all reduce the risk of metastasis.
Angiogenesis is when new capillaries form from existing blood vessels, usually helping healthy growth and healing. However, this process can also help cancer tumors grow and spread, as the new blood vessels allow cancer cells to travel through the bloodstream.
Metastatic mesothelioma can cause belly pain, blood pressure changes and memory problems. If it spreads to the adrenal glands, it can cause weight loss and weak muscles. Doctors often don’t find these signs until they do scans or tests.
Cancer can spread and cause different mesothelioma symptoms depending on where it goes. In the lungs, it can make it hard to breathe and cause chest pain. In the brain, it can cause nerve problems. Sometimes, the symptoms affect the whole body.
Common Symptoms of Mesothelioma Metastasis
Difficulty breathing
Fatigue
Fever
Neurological symptoms (changes in vision, seizures, etc.)
Pain
Weakness
Weight loss
If you’re experiencing mesothelioma symptoms that aren’t typical, this could be a sign the cancer has advanced. It’s important to speak to your doctor right away if you feel any new or worsening symptoms.
Pleural mesothelioma survivor Barbara Lapalla tells us after months of chemo, CT scans showed her cancer had spread. She shares, “I figured maybe my time had come.” But she began immunotherapy with Keytruda and it worked very well for her. She tells us, “I just feel like I’ve been blessed with what I’ve been given, and that’s extra time.”
Barbara Lapalla’s chemotherapy side effects were debilitating. Her CT scan results showed it didn’t stop or slow her pleural mesothelioma from metastasizing too far for surgery. She attributes her miraculous turnaround to Keytruda (pembrolizumab). “Keytruda has worked like a charm for me, although I’m not exactly sure why,” Barbara said. “For me, it’s the magic bullet.”
Treating Metastatic Mesothelioma
Using a combination of therapies is often the most effective approach to treating metastatic mesothelioma. A mesothelioma specialist can recommend the best course of treatment after metastasis.
In combination with chemo, Tumor Treating Fields can delay or prevent mesothelioma from spreading. Immunotherapy may reduce the rate of metastasis when received before surgery.
Treatment Options
Chemotherapy: Destroys cancer cells throughout the body in systemic therapy or can be delivered locally to delay metastasis
Immunotherapy: Targets proteins crucial for cancer cell growth and spread
Radiation: Shrinks tumors and prevents local spread of mesothelioma
Tumor Treating Fields: Noninvasively reduces cancer spread, stimulates the body’s immune response and may increase the benefits of chemo
Because cancer can use angiogenesis to spread, scientists are testing medicines that stop this process. Some of these medicines for mesothelioma include semaxanib, an anti-angiogenic drug, and tetrathiomolybdate, which blocks copper. In studies, these medicines have kept mesothelioma from getting worse.
Once cancer has spread to distant parts of the body, mesothelioma treatment options tend to center around palliative care. These therapies relieve symptoms and provide comfort rather than attempt to cure the disease.
Common Questions About Mesothelioma Metastasis
Can metastasis be prevented in mesothelioma patients?
Mesothelioma treatments can reduce, if not always prevent, local spread of disease and the risk of distant metastases. Options include chemotherapy, radiation, immunotherapy and Tumor Treating Fields.
What is the prognosis for patients with metastatic mesothelioma?
Metastatic stage 4 mesothelioma has an average life expectancy of 14.9 months. However, individual prognoses vary based on mesothelioma location, cell type, age and overall health. Your response to treatment will affect your personal prognosis.
Are there support groups or resources for patients with metastatic mesothelioma?
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