Written By: Dr. Daniel A. Landau,
Last modified: April 5, 2021

What Is Stage 3 Mesothelioma?

Stage 3 is an advanced stage of mesothelioma cancer. Tumors have spread throughout the pleura (lining of the lungs) on one side of the chest and to mediastinal lymph nodes on the same side of the body as the main tumor.

The diaphragm, heart sac, area between the lungs (mediastinum) and layers of the chest wall near the main tumor may be affected. The biggest difference between stage 3 and stage 4 mesothelioma is that tumors have not yet spread to distant organs.

Stage 3 mesothelioma tumor progression
Stage 3 mesothelioma tumors spreading on the lung.

Stage 3 Mesothelioma Facts

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

What to Do After a Stage 3 Mesothelioma Diagnosis

The most important thing a person can do after receiving a diagnosis of mesothelioma is to find a team of specialists who are well-equipped to treat the rare cancer. It is essential to seek treatment as soon as possible following a stage 3 mesothelioma diagnosis.

Working with doctors who have successfully treated mesothelioma patients through surgery and the latest therapies gives you the best chance to outlive your mesothelioma prognosis.

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.

Often, patients must travel long distances to find the best care at a specialty cancer center, but it is the smartest decision you can make when it comes to your health.

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    Stage 3 Mesothelioma Symptoms

    By stage 3, symptoms are much more noticeable and intense compared to stage 2 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, the symptoms will become more problematic. Symptoms vary from patient to patient depending on how the cancer is spreading.

    A tumor invading the chest wall may cause increased chest pain, while tumors forming around the lung may lead to increased breathing difficulties.

    Characteristics of Stage 3 Mesothelioma

    Stage 3 mesothelioma presents in different ways, depending on cancer origin and the staging system used to measure disease.

    In most cases, symptoms are more severe, treatment options are limited and cancer has invaded nearby tissues and organs. Compared to stage 4, tumors have not yet metastasized to distant areas of the body.

    Pleural and Peritoneal Mesothelioma

    Most doctors stage pleural mesothelioma using the American Joint Committee on Cancer’s TNM system. It was last updated in January 2018. Physicians using this system divide stage 3 pleural mesothelioma into two parts: 3A and 3B.

    • 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.

    Peritoneal mesothelioma is the second-most common form of the disease, but there is not yet a formal staging system to measure progression. Physicians typically use the Peritoneal Cancer Index (PCI) to grade tumors in the abdomen.

    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.

    Pericardial and Testicular Mesothelioma

    Mesothelioma doctors and researchers have not yet defined stage 3 for pericardial or testicular variants, due to their rare nature. Approximately 1% to 2% of mesothelioma cases are pericardial and form within the heart sac. Oncologists diagnose this disease most often in its late stages when it has spread to the lungs or throughout the chest cavity.

    Doctors use general staging guidelines to diagnose testicular mesothelioma. Stage 3 or late-stage testicular mesothelioma indicates that cancer has spread beyond the lining of the testicles to other tissues such as lymph nodes or bone.

    How Is Stage 3 Mesothelioma Treated?

    Stage 3 tumors are considered locally advanced, but surgical removal may be possible with extensive surgery in specific circumstances.

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

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

    Watch: Learn the treatment options available to people with stage 3 mesothelioma.


    At stage 3, tumors have likely spread to surrounding tissues and lymph nodes. Pleural mesothelioma patients may be eligible for an extrapleural pneumonectomy, an extensive procedure that removes the entire affected lung and its lining (pleura) as well as the lining around the heart (pericardium) and diaphragm.

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


    Mesothelioma surgeries show better survival rates when combined with chemotherapy.

    Most patients receive combinations of chemotherapy drugs through an IV. Chemotherapy can begin as soon as a patient recovers from surgery. It may also be administered before or during surgery.

    An experimental approach to chemotherapy has been used to shrink tumors down to an earlier stage in order to operate on a patient.

    In a 2020 report published in General Thoracic and Cardiovascular Surgery, a stage 3 patient responded well to chemotherapy and was downstaged to stage 2. The patient then qualified for aggressive surgery. At 30-month follow-up, 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. Some research reports better 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. They can improve their quality of life with palliative therapies.

    While these treatments aren’t expected to cure your cancer, they usually can help you feel better and live longer. Palliative chemotherapy and radiation might be used to lessen cancer-related pain and extend survival. Palliative surgery drains fluid buildup around the tumor, which helps with difficulty breathing.

    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. Neither is FDA approved for mesothelioma, but clinical trials are testing immunotherapy drugs and new therapies with promising results.

    Complementary and Alternative Therapies

    Complementary therapies, such as acupuncture, yoga and nutritional counseling, are often integrated with conventional mesothelioma treatments. They may improve overall health 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, which is why financial assistance is essential for many mesothelioma patients.

    Grants are available to help cover travel expenses to top mesothelioma cancer centers. Additional compensation 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.

    Mesothelioma patient and wife reading financial aid guide
    Mesothelioma Trust Funds Contain More than $32 Billion
    Companies that exposed people to asbestos were forced to create trust funds before filing for bankruptcy. Find out if you or your family are eligible to file a mesothelioma trust fund claim.

    Stage 3 Mesothelioma Life Expectancy & Prognosis

    About 26% to 38% of stage 3 mesothelioma patients live at least two years after diagnosis.

    Life expectancy for stage 3 mesothelioma depends on response to treatment and the extent of lymph node involvement.

    A successful response to surgery and post-surgery therapies helps patients live longer.

    Pleural Mesothelioma Stage 3 Survival Rates

    2-year survival rate 5-year survival rate
    25% 38%
    5% 10%
    Source: American Society of Clinical Oncology, 2019

    How Lymph Nodes Affect Cancer

    Lymph nodes play a key role in the spread of cancer. Lymph nodes are the normal filters of the blood, blocking bacteria and viruses from entering the bloodstream. When cancer cells invade lymph nodes, they are more likely to enter the bloodstream and spread into distant organs. Once cancer spreads to other organs, it is considered metastasized and generally inoperable.

    That’s why beginning treatment soon after diagnosis is essential to living longer. The key is to remove as much of the cancerous growth as possible before it spreads to other areas of the body.

    Patients with minor lymph node involvement often live more than two years. This compares to a 13-month average for patients with more extensive involvement of nearby lymph nodes.

    Even if the cancer has not spread to the lymph nodes, surgery may not be an option for some stage 3B patients if tumors have grown too far to be removed completely.

    Mesothelioma survivor Russell Lamkins celebrating his 70th birthday
    When I was first diagnosed with stage 3 inoperable cancer and told I had a year to live, I figured I’d better hurry up and try to finish this house quickly. But now, things have changed. My goal is to make it to the 10-year mark.
    Russell Lamkins
    Diagnosed with pleural mesothelioma in 2014

    Survival Rates Don’t Tell the Whole Story

    Survival statistics cannot predict how long a person will live.

    All patients with stage 3 mesothelioma have varying factors that can affect prognosis and life expectancy. These factors include age, gender, cancer cell type, response to treatment and overall health.

    Certain patients respond particularly well to treatment and outlive their prognosis by years.

    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 can extend survival. However, in this stage, care is palliative and focuses on reducing symptoms and improving quality of life.

    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
    How can stage 3 life expectancy be improved?

    Factors affecting mesothelioma life expectancy in stage 3 include:

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

    Are stage 3 mesothelioma patients eligible for clinical trials?

    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.

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