Stage 4 mesothelioma cancer is the most advanced stage and is terminal. Cancer has spread to distant organs and parts of the body in this stage. You may have difficulty breathing, chest pain and fatigue. Treatment options are palliative to manage and ease mesothelioma symptoms until the end of life.
Learn more about mesothelioma, asbestos and the steps you can take to fight this disease.
Stage 4 mesothelioma is the most advanced stage of this asbestos-related cancer. In this late stage, the mesothelioma cells have spread to distant body parts. Extensive tumor spread makes it difficult to treat.
Surgery cannot remove this end stage of mesothelioma because mesothelioma cells and resulting tumors have spread beyond the mesothelial lining. They have grown into nearby or distant tissues and organs.
Key Facts About Stage 4 Mesothelioma
More than 7% of stage 4 pleural mesothelioma patients live 5 years or more.
Peritoneal patients have a better prognosis. Nearly 30% survive for at least 5 years with treatment.
A 2023 study found adding Keytruda to platinum-pemetrexed chemotherapy significantly improved overall survival for patients with advanced mesothelioma.
Without treatment, people with late-stage mesothelioma live an average of 6 to 8 months
Mesothelioma is different from other cancers in the way it progresses. It has a unique pattern of metastasis, which is the way it spreads in the body.
It tends to occur locally. Tumors may spread beyond where they initially began, but typically in nearby areas. For example, it may spread from your chest cavity to your abdominal cavity. In rare instances, mesothelioma can spread distantly to other areas of your body such as the liver, brain and bones.
Most mesothelioma patients I speak with have received a stage 4 diagnosis. It doesn’t necessarily mean the end stages of life. Many patients can still prolong survival time with clinical trials, immunotherapy and chemotherapy.
What Are the Symptoms of Stage 4 Mesothelioma?
Stage 4 mesothelioma cancer symptoms can include pain, fatigue and fever. You may have few symptoms, which can be vague and mimic common signs of other cancers. Some symptoms appear where the cancer has spread, including the liver, kidneys and spleen. You may feel generally unwell and need help moving around.
Physical changes may affect your hormone levels and leave you with low energy or feeling depressed. Always seek mental health resources when needed. Living with this cancer can be challenging and can impact your quality of life. Inform your doctor of any new or changing signs. Not knowing what to expect can be frightening, but your medical team can help.
Rare brain metastasis causes some of the most disturbing symptoms. You may lose control of your emotions, memory or muscle function. Remember to utilize all your support resources, including loved ones. Your medical team will also work to help you regain control.
Toward the end of life, mesothelioma patients may face severe symptoms such as intense chest pain, difficulty breathing, persistent coughing and fatigue. During this stage, many patients find comfort in hospice care, where they can receive specialized care and emotional support from loved ones.
Stage 4 is the most severe stage of this type of cancer for all mesothelioma types. There are four types of mesothelioma that are based on where tumors first developed in the body.
Stage 4 Symptoms by Mesothelioma Type
Pleural Mesothelioma
Peritoneal Mesothelioma
Fatigue
16%
18%
Chest pain
14%
5%
Abdominal pain
4%
17%
Weakness
14%
12%
Trouble breathing
13%
5%
Loss of appetite
7%
11%
Coughing or weezing
11%
3%
Unexplained weight loss
8%
11%
Source:
The Mesothelioma Center at Asbestos.com, 2025
Mesothelioma Types at Stage 4
For all mesothelioma types at stage 4, tumors have invaded deeper tissues and spread to distant sites. Malignant mesothelioma tumors can spread to your remote lymph nodes and organs.
There is no official stage 4 definition for peritoneal mesothelioma. This type occurs in the abdomen. End-stage extensive tumor spreading may involve the liver.
Stage 4 Pericardial Mesothelioma
This variant develops on the heart’s protective lining. Cancer may spread to the esophagus. Doctors use general staging guidelines for pericardial mesothelioma.
Stage 4 Testicular Mesothelioma
Testicular mesothelioma is the rarest type. There is no official staging system and no formal stage 4. It can spread to distant pelvic tissue.
Stage 4 Mesothelioma Prognosis
While the prognosis for stage 4 mesothelioma patients is poor, life expectancy and survival rates can vary depending on responsiveness to treatment. Some stage 4 mesothelioma patients have gone into partial remission.
Treatments and palliative care can extend stage 4 mesothelioma life expectancy by years for many patients. Immunotherapy or chemotherapy in combination with a targeted drug or Tumor Treating Fields, for example, can extend survival for mesothelioma survivors to 18 months.
Your prognosis depends mainly on the extent of tumor growth and how well you respond to treatments. Other factors that can affect a person’s prognosis are the age of the patient and their overall health. Diet and nutrition and regular exercise can improve your prognosis. Smoking doesn’t cause mesothelioma, but quitting can also help improve your overall health.
Mesothelioma survival rate statistics can’t predict how long someone with mesothelioma will live. No two cases of mesothelioma are the same. Pleural mesothelioma survivor Andy Ashcraft, for example, was diagnosed with stage 4 and spoke to us after surpassing the 3-year survival mark.
Andy A.
Verified Asbestos.com Survivor
Survivor Andy A. Beating the Odds Again
Andy survived a 70 mph motorcycle crash in 2004 that broke numerous bones and punctured a lung. Years later, he brought that same determination to his battle with pleural mesothelioma. Andy enrolled in an immunotherapy clinical trial and faced the challenge head on. He tells us, “I’m doing great right now. I really am.”
Stage 4 Mesothelioma Life Expectancy and Survival Statistics
The life expectancy for stage 4 mesothelioma patients ranges from about one to two years. The median survival time for these patients is 14.9 months. Researchers are continuing to explore many treatments in studies that could improve survival time further.
According to the American Cancer Society, 7% of those with late-stage mesothelioma survive for 5 years or more. About half of these patients live for at least a year, and roughly 25% of those with stage-4 disease live for two or more years.
I’m doing great right now. I really am. I don’t look like a stage 4 cancer patient. I consider myself extremely lucky.
Stage 4 Mesothelioma Treatment
While there is no cure for mesothelioma yet, studies have shown that treatment with immunotherapy and chemotherapy improves overall survival in some patients in advanced stages. Treatment options typically recommended for stage 4 patients shrink tumors to reduce pain and pressure, extending survival and improving symptoms.
Stage 4 Mesothelioma Treatments
Chemotherapy: A standard therapy for stage 4 mesothelioma, chemotherapy can double the life expectancy of some stage 4 patients.
Immunotherapy: First-line treatment with Opdivo (nivolumab) and Yervoy (ipilimumab) helps many patients live at least 18 months.
Palliative Care: Patients who receive early palliative care, which focuses on easing pain and other symptoms, have an almost 400% increase in survival time.
Radiation: Radiation therapy can lessen chest pressure, decrease pain and improve your breathing. Proton therapy, a newer type of radiation, can boost survival to more than 30 months for stage 4 patients.
Surgery: Some stage 4 pleural mesothelioma patients qualify for tumor-removing surgeries, but palliative options can extend your survival by months.
Targeted Therapies: Targeted drugs, such as bevacizumab, may be combined with chemotherapy to improve survival from 12 months to 18 months.
Tumor Treating Fields: Adding Tumor Treating Fields therapy to chemotherapy also improves survival from one year to 18 months.
For some patients, there may be an opportunity to participate in a clinical trial that could provide researchers with much-needed insight on treating mesothelioma in these last stages better. For example, Memorial Sloan Kettering Cancer Center and SELLAS Life Sciences Group published a study in 2025 on combining immunotherapy with a targeted cancer vaccine for late-stage pleural mesothelioma patients.
We’ve seen some very, very positive results. Patients in advanced stages can still go forward with a solid quality of life. This is very promising.
Side Effects of Mesothelioma Treatment to Consider
When choosing a treatment plan, it’s important to discuss possible side effects with your doctor. Together, you’ll weigh the benefits against the risks of side effects and determine the best plan for you.
Chemotherapy, immunotherapy, radiation and TTFields can all cause fatigue, nausea and coughing. Radiation and TTFields can cause skin problems such as rashes. Chemotherapy and immunotherapy can cause mouth sores.
More serious complications can also occur such as serious infections. Some serious side effects can also develop. For example, though rare, patients taking immunotherapy drugs have reported hormone, kidney and liver problems.
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Tips & Resources for Stage 4 Mesothelioma Patients
Support resources for your family and for you as a patient. Not only can support and assistance help survivors and their loved ones manage stress when coping with stage 4 mesothelioma, some resources can help patients live beyond their predicted life expectancy and improve quality of life.
Choose where you want to receive care. You may prefer a hospice program over a hospital.
Your Priorities
Tell your medical team your priorities for symptom and pain management.
Choosing a Caregiver
You can also choose a caregiver and arrange for in-home medical services.
A stage 4 mesothelioma diagnosis doesn’t mean you can’t control some aspects of living with this condition. Taking a proactive approach can sometimes reduce your anxiety.
The 2025 National Comprehensive Cancer Network Guidelines explain that patients with late-stage mesothelioma, such as stage 4, are usually not eligible for surgery. In face, less than one-third of patients are eligible surgery candidates.
A 2023 study showed that stage 4 patients who are ineligible for surgery and who have not undergone treatment will benefit from a combination of immunotherapy drug Keytruda and chemotherapy. Results showed significant improvements to median overall survival.
“These patients tend to have more limited treatment options because the mesothelioma has spread to other distant organs, and therefore, usually only systemic treatments such as chemotherapy or immunotherapy are options in this setting.”
Common Questions About Stage 4 Mesothelioma
What role can alternative and complementary medicine play in treating stage 4 mesothelioma?
Stage 4 mesothelioma patients may choose to use complementary or alternative therapies. Options such as acupuncture or massage may reduce your symptoms. Talk to your doctor first. These treatments don’t offer a cure and are not a substitute for standard care. The best options for wellness are often exercise and nutrition. A cancer nutritionist can guide you toward a healthy cancer diet.
What does the stage of cancer mean?
The stage of cancer refers to how advanced and widespread it is. A staging system called TNM determines the stage for pleural mesothelioma. TNM stands for Tumor, Node and Metastasis. The rating describes the size of the tumor, whether it has spread to lymph nodes and if it has metastasized.
Doctors assign a stage ranging from 0 to 4. This helps them determine the best treatment for you and estimate your prognosis.
Should I consider end-of-life planning?
Some patients find talking in advance with their family and medical team about end-of-life care preferences can bring peace of mind, allowing them to focus on the present and their treatment.
Ask your medical team for a blank copy of all documents they recommend. Find a trusted lawyer to draft binding documents. These can help you plan for end-of-life medical care.
Recommended Reading
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The Mesothelioma Center at Asbestos.com has provided patients and their loved ones the most updated and reliable information on mesothelioma and asbestos exposure since 2006.
Our team of Patient Advocates includes a medical doctor, a registered nurse, health services administrators, veterans, VA-accredited Claims Agents, an oncology patient navigator and hospice care expert. Their combined expertise means we help any mesothelioma patient or loved one through every step of their cancer journey.
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About The Mesothelioma Center at Asbestos.com
Assisting mesothelioma patients and their loved ones since 2006.
Helps more than 50% of mesothelioma patients diagnosed annually in the U.S.
A+ rating from the Better Business Bureau.
5-star reviewed mesothelioma and support organization.
My family has only the highest compliment for the assistance and support that we received from The Mesothelioma Center. This is a staff of compassionate and knowledgeable individuals who respect what your family is experiencing and who go the extra mile to make an unfortunate diagnosis less stressful. Information and assistance were provided by The Mesothelioma Center at no cost to our family.
Dr. Jacques Fontaine is a thoracic surgeon at Moffitt Cancer Center in Tampa, Florida, where he heads up the Mesothelioma Research and Treatment Center. He specializes in minimally invasive robotic surgery and aggressive surgeries for mesothelioma.
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