Stage 4 Mesothelioma

Stage 4 is the final, most advanced stage of mesothelioma. Traditional surgery is usually not an option, and most treatments aim to ease symptoms and reduce pain.

  • Overview

    • Cancerous cells found throughout the body
    • Aggressive tumor growth
    • Advanced symptoms
  • Treatment

    • Chemotherapy slows tumor growth
    • Radiation reduces tumors
    • Removal of fluid buildup
    • Pain medication and oxygen therapy

By stage 4 mesothelioma, the cancer has metastasized, or spread beyond the point of origin to other parts of the body. It is the most advanced stage and the most difficult to treat because the few traditional treatment options available cannot remove all the tumors.

Your outlook depends largely on the extent of tumor growth and how well you respond to treatments. At this end-stage cancer, many patients are too weak to withstand aggressive surgeries.

While stage 4 mesothelioma — commonly expressed with Roman numerals as stage IV — is considered terminal, continued advancements in palliative treatments 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.

Fast Fact: The three systems commonly used to define stages of pleural mesothelioma (Bringham, TNM and Butchart) categorize stage 4 on similar characteristics and behaviors. Butchart and TNM note that the cancer has metastasized to distant organs, while Brigham designates that surgery is not a viable option.

Symptoms of Stage 4 Mesothelioma

Symptoms of stage 4 mesothelioma are quite severe because tumors have spread beyond the lungs. Common symptoms of late-stage mesothelioma include:

  • Fever
  • Night sweats
  • Chest pain
  • Shortness of breath
  • Tightness of chest
  • Fluid buildup in chest or abdomen
  • Abdominal pain
  • Fatigue
  • Weight loss
  • Anorexia
  • Malaise

Fast Fact: Some patients also suffer from cachexia, a syndrome involving weight loss, muscle atrophy, weakness and appetite loss. Stage 4 cancer sometimes causes blood problems, including thrombocytosis (high platelet count) and anemia (low red blood cell count).

Learn more about symptoms

Stage 4 Mesothelioma Treatment Options

In most cases, stage 4 mesothelioma, also known as end-stage mesothelioma, cannot be successfully cured. Traditional surgery is typically not an option, but palliative treatments, such as chemotherapy and radiation therapy, slow tumor growth and reduce tumor size.

Surgery Icon


While the spread of tumors is usually too vast at stage 4 for doctors to remove all growths, some patients can benefit from less extensive surgical procedures. Surgeons can attempt to remove as much tumor mass as possible. They can also target only problematic tumors so patients breathe more comfortably and experience less pain.

Less invasive procedures, such as a thoracentesis, paracentesis and pericardiocentesis remove fluid buildup near the main tumor, relieving pain and breathing difficulties.

Learn more about mesothelioma surgeries
Chemotherapy Icon


Chemotherapy is one of the most common treatment options for stage 4 mesothelioma. Chemotherapy drugs slow tumor growth and may shrink tumors in some cases, helping to alleviate symptoms and extend survival. Wayne State University researchers in 2016 found chemotherapy more than doubles life expectancy for malignant mesothelioma patients, including those in stage 4. Combining chemotherapy with surgery extended survival even longer.

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

Learn more about chemotherapy
Radiation Therapy Icon

Radiation Therapy

Doctors don't always treat stage 4 mesothelioma with radiation therapy, but they may recommend the procedure depending on your tumor growth and overall health. Radiation therapy at this stage might be able to reduce the size of tumors, which can lessen chest pressure, decrease pain and improve breathing.

Learn more about radiation therapy
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Clinical Trials

Certain people in stage 4 may qualify for mesothelioma clinical trials. Some clinical trials investigate the value of various treatment combinations for late-stage mesothelioma.

A 2016 study published in The Annals of Thoracic Surgery showed a correlation between the use of light energy or photodynamic therapy and late-stage mesothelioma survival. A subset of patients with pleura mesothelioma achieved a median overall survival of 7.3 years compared to the usual one-year prognosis.

Learn more about clinical trials
Supportive Care Icon

Supportive Care

Supportive care helps to relieve symptoms and improve quality of life. At stage 4, doctors may recommend pain medication, oxygen therapy and respiratory therapies to control pain and improve lung function.

Numerous long-term mesothelioma survivors have incorporated complementary and alternative medicine therapies into their treatment plan. Certain complementary therapies are known to improve survival, ease symptoms, reduce treatment side effects and enhance quality of life. These treatments include herbal medicine and holistic therapies, mind-body therapies (yoga, qigong and tai chi) and nutritional therapy.

Learn more about alternative therapies

You have to look way outside the box to find good information on alternative treatment. There’s not a lot of stuff out there in the mainstream medical community, and that’s discouraging. But when you learn about it, and how integrative medicine works, it will blow you away.”— Beth Mixon, diagnosed with peritoneal mesothelioma in 2000

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Late Stages by Mesothelioma Type

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

There is no official stage 4 for peritoneal mesothelioma, which accounts for roughly 20 percent of all cases. However, 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 spread outside of the peritoneal lining — the protective lining of the abdomen where the cancer initially develops.

Like pleural mesothelioma, surgery is likely not an option at this phase. This includes heated intraperitoneal chemotherapy (HIPEC), a promising peritoneal treatment that combines surgery and heated chemotherapy.

Mary Lyons, pleural mesothelioma survivor

“A stage 4 mesothelioma diagnosis doesn’t mean there is no hope or options. It’s important to connect with a medical oncologist that is experienced with mesothelioma to understand your treatment options. Remember, you are the decision maker.  Your specialist is there to give you guidance. ” Karen Selby, RN

Stage 4 Prognosis & Life Expectancy

At stage 4 the cancer is likely to continue to spread, which can lead to respiratory failure or heart failure if tumors spread to the heart.

The median survival rate for stage 4 mesothelioma is 12 months. A positive response to treatment can extend survival, and patients with good prognostic factors often live longer than average. Prognostic factors associated with better survival include having the epithelial cell type, being in good overall health, younger in age, female and having no signs of blood disorders.

Mesothelioma is considered a heterogeneous cancer, meaning 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.

What’s Next After a Stage 4 Mesothelioma Diagnosis?

Although stage 4 is the most advanced of the mesothelioma stages, some patients, especially those in good overall health, live far beyond their prognosis. Through a variety of treatments, groundbreaking clinical trials and healthy life choices, you can beat the odds and become a survivor. Consider the following:

  • Get a second opinion from a mesothelioma specialist.
  • Find financial assistance available to offset potential financial 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.

A stage 4 mesothelioma diagnosis can be devastating, but it doesn’t mean it’s a death sentence. A positive outlook will do wonders when combined with a variety of treatments.

Additional Resources

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Karen Selby joined in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections.

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