What Is Stage 3 Mesothelioma?

Stage 3 is an advanced stage of mesothelioma cancer when tumors have spread beyond their point of origin. In stage 3 pleural mesothelioma, tumors have spread throughout the lining of the lungs on one side of the chest and also occur in the centralized glands known as the mediastinal lymph nodes.

Pleural stage 3 tumors can affect nearby structures such as the diaphragm and heart sac. They can also grow on the chest wall and central chest region between the lungs, known as the mediastinum.

About 25%

Percentage of pleural mesothelioma patients diagnosed with stage 3 mesothelioma.

Source: U.S. Cancer Statistics Working Group, 2023

Other forms of mesothelioma cancer occur in different areas. Peritoneal mesothelioma, which affects the abdomen, doesn’t have an official staging system. Doctors use an existing indexing tool to help stage peritoneal mesothelioma. Using that system, stage 3 peritoneal tumors are in the peritoneal lining and nearby lymph nodes. 

Key Facts About Stage 3 Mesothelioma
  • The 5-year survival rate at stage 3 for peritoneal mesothelioma is 29%.
  • The 5-year survival rate at stage 3 for pleural mesothelioma is about 16%.
  • Tumor-removing surgery is still a possibility in stage 3 for some patients.
  • Emerging treatments through clinical trials may extend survival.

Stage 3 Mesothelioma Symptoms

Stage 3 mesothelioma symptoms may include shortness of breath, fever or fatigue. In stage 3, symptoms may become more noticeable than in stage 2 mesothelioma, but any symptoms before stage 3 are generally rare. 

Symptoms and characteristics in stage 3 can vary between patients depending on where the cancer spreads and if it damages vital organs. As tumors grow and spread throughout the chest or abdomen, symptoms worsen.

Stage 3 Mesothelioma Symptoms
  • Fatigue
  • Fever
  • Fluid buildup
  • Gastrointestinal problems
  • Pain in the chest or abdomen
  • Recurring dry cough
  • Shortness of breath
  • Weight loss

Pleural mesothelioma tumors cause increased pleural fluid, which puts pressure on the lungs. Peritoneal mesothelioma tumors cause peritoneal fluid buildup that places stress on the abdomen.

Some patients may experience referred pain in the neck, back or shoulders. Pleural tumors may cause chest pain and breathing difficulties. Peritoneal tumors may cause bloating, constipation and diarrhea. 

Stage 3 Mesothelioma Life Expectancy and Prognosis

Stage 3 mesothelioma life expectancy ranges from 16 to 26 months. A patient’s medical history, health and treatment all impact life expectancy. 

The prognosis is your doctor’s estimate of how mesothelioma will affect you and how it will respond to treatment. Mesothelioma life expectancy and prognosis can improve after trying a new therapy.

When I was first diagnosed with stage 3 inoperable mesothelioma and told I had a year to live, I figured I’d better hurry up and finish projects I was working on. But now my goal is to make it to the 10-year mark.

Some patients live for many years with successful treatment. Survival rates are not the only indicators of a mesothelioma patient’s prognosis.

Survival statistics don’t apply to everyone and can’t predict an individual’s prognosis. Age, gender, cancer cell type, response to treatment and general health affect survival. Surgery and other therapies may help patients live past the typical prognosis.

Survivor Story
Survivor Story
Russell Lamkin Pleural Mesothelioma

Survivor Diagnosed in Stage 3 Has Success in Clinical Trial

When Russell Lamkin was first diagnosed with stage 3 mesothelioma, he was told it was inoperable and his life expectancy was about a year. He was then able to find success participating in a transarterial chemoperfusion study at the Moffitt Cancer Center in Tampa. Russell says, “My neighbors don’t even know I’m sick. I still look and feel pretty good.”

Read Russell’s Story

Mesothelioma Stage 3 Survival Rates

About 16% of stage 3 pleural mesothelioma patients live 5 years after diagnosis. Roughly 29% of stage 3 peritoneal mesothelioma patients live at least 5 years.

Median survival refers to the length of time that half of patients are expected to live after diagnosis. It represents the midpoint, where half of the patients live longer than the median, and the other half live for a shorter duration.

2-Year Survival Rate of All Stages 5-Year Survival Rate at Stage 3 Median Survival
Pleural Mesothelioma 22% 16% 16 months
Peritoneal Mesothelioma 35% 29% 26 months
Source: SEER and various medical studies

Patients with late-stage testicular mesothelioma have a median survival of about 2 years. Late-stage pericardial mesothelioma patients live around 10 months. Some live longer after surgery or chemotherapy.

How Lymph Nodes Affect Mesothelioma Life Expectancy

The body’s lymph nodes play a role in the spread of cancer. Cancer cells in lymph nodes can condition immune cells to protect cancer rather than attack it. This factor contributes to metastasis, or the spread of cancer throughout the body, after which surgery is no longer helpful. Early treatment can limit metastasis and extend life expectancy.

Cancerous tumors spreading to lymph nodes
In stage 3 mesothelioma, tumors have grown and spread deeper to nearby tissues, organs and lymph nodes.

Patients with stage 3 mesothelioma can have varying degrees of lymph node involvement. Patients with more cancerous lymph nodes have a life expectancy of about 13 months. 

Surgery may not be an option for all stage 3 patients. Patients with more progressed stage 3, sometimes referred to as stage 3B, may have tumors in the diaphragm or heart sac. In this case, surgery is not a viable option.

How Is Stage 3 Mesothelioma Treated?

A multimodal treatment plan uses surgery, chemotherapy and radiation. It has produced the best survival rates for people with stage 3 pleural mesothelioma.Stage 3 tumors grow and spread quickly, but removal may be possible. Extensive surgery and aggressive cancer treatment provide benefits in specific circumstances.

Some stage 3 mesothelioma patients may not qualify for aggressive surgery, but they may be eligible for immunotherapy, chemotherapy and palliative therapies that control symptoms. These patients may also qualify for emerging treatments available through experimental clinical trials.

Most Common Treatment Options for Stage 3 Mesothelioma

Treatment for stage 3 varies depending upon cancer growth and personal factors like age and overall health. Patients diagnosed with stage 3A may qualify for more aggressive treatments than those diagnosed with stage 3B because their cancer is less advanced.

Treatment Options for Stage 3 Mesothelioma
  • Chemotherapy: Most patients receive 2 chemotherapy drugs via IV, but intracavitary therapy that injects chemotherapy directly into specific areas of the body is used for some patients.
  • Immunotherapy: The FDA in 2020 approved Opdivo (nivolumab) and Yervoy (ipilimumab) to treat pleural cases.
  • Palliative Care: This type of care uses medication, therapy and procedures to control symptoms and improve quality of life.
  • Radiation Therapy: Radiation for stage 3 pleural patients helps pain related to their cancer. Patients who qualify for multimodal therapy receive radiation to prevent recurrence.
  • Surgery: Surgery for stage 3 pleural cases may be palliative, but some patients qualify for aggressive surgery. Stage 3 peritoneal patients may receive tumor removal surgery (cytoreductive surgery) with heated chemotherapy.
  • Targeted Therapy: Treatments sometimes combine the targeted drug Avastin (bevacizumab) with chemotherapy to extend survival.
  • Tumor Treating Fields: This therapy uses alternating electric fields in combination with chemotherapy to control tumor growth.

Treatment options are more limited than in earlier mesothelioma stages. Surgery is possible but less likely to be successful for advanced cases.

Mesothelioma clinical trials provide hope for stage 3 patients who don’t qualify for aggressive surgery. These trials provide experimental treatments that may improve prognosis and extend stage 3 mesothelioma life expectancy. Patients should ask their mesothelioma specialists about appropriate clinical trials in their area.

Dr. Jacques Fontaine and Dr. Andrea Wolf
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Characteristics of Stage 3 Mesothelioma by Type

Characteristics of stage 3 mesothelioma include localized tumors and tumor spread to distant lymph nodes. Different staging systems use additional features to define the respective stages.

Only pleural mesothelioma has an official staging system. In 2011, researchers suggested a staging system for peritoneal mesothelioma using lymph nodes, metastasis and the existing Peritoneal Cancer Index. This index measures cancer on the peritoneal lining of the abdomen. The system hasn’t been officially adopted for peritoneal mesothelioma because doctors need data from more patients to confirm its accuracy.

Illustration of Stage 3A Pleural Mesothelioma

Stage 3 Pleural Mesothelioma

Stage 3 pleural mesothelioma has two substages. In stage 3A, cancer is found in the pleura and possibly the chest wall, mediastinum or heart sac. The cancer remains on one side of the chest and has spread to lymph nodes on that side of the body. Stage 3B includes two variations where cancer grows into other lymph nodes or nearby structures like the diaphragm, spine, opposite pleura or abdominal lining.

Illustration of Stage 3 Peritoneal Mesothelioma

Stage 3 Peritoneal Mesothelioma

In stage 3, cancer is found throughout the peritoneal lining and nearby lymph nodes. Spreading outside the abdomen is possible. The Peritoneal Cancer Index ranges from 0 to 39, measuring cancer across 13 parts of the abdominal lining. A score between 30 and 39 with cancer spreading into lymph nodes or beyond the abdomen indicates stage 3 peritoneal mesothelioma.

Illustration of Stage 3 Pericardial Mesothelioma

Stage 3 Pericardial Mesothelioma

Researchers haven’t defined stage 3 pericardial mesothelioma because it’s too rare for an official staging system. Diagnosis of pericardial mesothelioma often occurs after cancer has metastasized to the lungs or chest cavity, indicating a late stage of disease progression.

Illustration of Stage 3 Testicular Mesothelioma

Stage 3 Testicular Mesothelioma

Testicular mesothelioma also doesn’t have a staging system because of its rarity. Doctors use staging guidelines for general testicular cancer. They may refer to stage 3 testicular mesothelioma as late-stage cancer. This describes the spread beyond the lining of the testes to other tissues, such as lymph nodes or bone.

Stage 3 symptoms are more severe than stage 2. Patients have fewer treatment options and cancer has invaded nearby tissues and organs. Compared to stage 4, tumors haven’t yet metastasized to distant areas of the body. Many therapies, such as immunotherapy, chemotherapy and radiation, can limit metastasis, extend survival and control pain.

If a doctor refers to peritoneal mesothelioma as stage 3, it usually means tumors have spread throughout the abdominal lining and to nearby lymph nodes.

What to Do After a Stage 3 Mesothelioma Diagnosis

After receiving a stage 3 mesothelioma diagnosis, you should find a mesothelioma specialist. Seek treatment as soon as possible following a stage 3 mesothelioma diagnosis.

Working with experienced mesothelioma doctors gives you the best chance of improving your prognosis. Improving health through nutrition and exercise may help extend your life expectancy.

Not all hospitals or major metropolitan cancer centers have doctors focusing on mesothelioma. Joining a mesothelioma support group is a great way to build a network of information. You can learn about clinical trials and physicians specializing in this rare cancer. 

Mesothelioma support groups help patients come to terms with their diagnosis. They often provide resources for improving quality of life and mental health.

Common Questions About Stage 3 Mesothelioma

Is stage 3 pleural mesothelioma curable?

There is no mesothelioma cure for any stage of the disease. A small number of stage 3 patients are eligible for surgery, which may significantly extend survival.

What are the most common symptoms of stage 3 mesothelioma?

Symptoms of stage 3 mesothelioma may include shortness of breath, pain in the chest or abdomen, dry cough and fatigue.

How can stage 3 life expectancy be improved?

There are a number of factors affecting mesothelioma life expectancy in stage 3.

Lifestyle changes, such as diet and exercise, can improve overall health and may extend survival for patients undergoing chemotherapy, immunotherapy or other treatment in stage 3 mesothelioma.

Are stage 3 mesothelioma patients eligible for clinical trials?

Clinical trials for stage 3 mesothelioma patients are available in many cancer centers across the United States. They test new cancer drugs and different combinations of innovative therapies.

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