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What Is Stage 4 Mesothelioma?

Stage 4 mesothelioma is the most advanced stage of asbestos-related cancer in which tumors have spread or metastasized. Unlike earlier stages, cancer has developed in deeper tissues or metastasized to distant lymph nodes and organs. Treatment options in this stage are limited.

Therapy options in stage 4 mesothelioma cannot remove all tumors. Stage 4 is also known as end-stage mesothelioma or late-stage mesothelioma. Patients may be eligible for clinical trials or supportive care, such as palliative surgeries and other therapies, to reduce symptoms and improve comfort.

Stage 4 mesothelioma tumors spreading from the lungs to other vital organs
By stage 4 mesothelioma, cancer has spread from the lungs to other vital organs throughout the chest, abdomen, neck or bones.

Symptoms of Stage 4 Mesothelioma

At stage 4, common symptoms of mesothelioma cancer such as breathlessness and coughing are more severe. As tumors spread, symptoms can involve many different parts of the body.

Common symptoms of late-stage mesothelioma include:

  • Shortness of breath (dyspnea)
  • Pain and tightness in the chest
  • Night sweats and fever
  • Difficulty swallowing (dysphagia)
  • Coughing up blood (hemoptysis)
  • Fluid buildup in the chest or abdomen
  • Abdominal pain
  • Fatigue
  • Severe weight loss or anorexia (lack of appetite)
  • General feeling of discomfort (malaise)

A typical cancer symptom in stage 4 mesothelioma is cachexia, a metabolic syndrome involving weight loss, muscle atrophy (breakdown), weakness and appetite loss. Stage 4 mesothelioma can cause blood problems such as high platelet counts (thrombocytosis) and low red blood cell counts (anemia).

Doctors often diagnose mesothelioma in later stages because symptoms generally do not appear until stage 3 or 4. Mesothelioma symptoms mimic many other common cancers and illnesses and require a specialized oncologist to confirm a diagnosis.

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Late-Stage Mesothelioma by Type

The Butchart and TNM staging systems specify that stage 4 pleural mesothelioma happens when cancer has metastasized to distant organs. The Brigham method designates stage 4 when surgery is not a viable option. Traditional staging systems do not apply to nonpleural mesothelioma types, and characteristics in the final stage vary based on location.

Stage 4 Pleural Mesothelioma

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

The pleural disease can take the form of epithelial or sarcomatoid cell tumors. Cell type does not affect how stage 4 disease is diagnosed but how it can be treated at this stage.

Cancer has spread to distant organs during the final stages of pleural mesothelioma. Symptoms at this stage may include shortness of breath (dyspnea), painful coughing, pain and tightness in the chest and severe weight loss.

Stage 4 Peritoneal Mesothelioma

There is no official stage 4 for peritoneal mesothelioma. This type of cancer accounts for roughly 20% of all mesothelioma cases. 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 moved outside the peritoneum. Surgery usually is not an option for end-stage peritoneal mesothelioma.

Stage 4 Pericardial Mesothelioma

Doctors use general staging guidelines for pericardial mesothelioma since no staging system exists for this variant. Pericardial mesothelioma develops on the heart’s protective lining, which is known as the pericardium.

This mesothelioma is exceedingly rare, making it challenging to diagnose before the patient’s death. In the late stages of pericardial mesothelioma, cancer may spread throughout the chest cavity, esophagus, abdomen or other parts of the respiratory and digestive system.

Stage 4 Testicular Mesothelioma

Testicular mesothelioma is the rarest type of this cancer, with about 100 cases documented in medical literature that affect less than 1% of all patients. As with the pericardial type, testicular mesothelioma has no official staging system and may not be defined as stage 4.

Due to its rarity, doctors diagnose testicular mesothelioma as an advanced disease in most cases. Testicular mesothelioma can spread to distant lymph nodes and pelvic tissue in its later stages.

Treatment for Mesothelioma at Stage 4

Chemotherapy is often the best treatment option for patients with stage 4 mesothelioma. There is no cure for the disease, but chemotherapy can shrink tumors to improve the quality and length of life.

Mesothelioma treatment options to extend survival are limited at stage 4. Aggressive surgeries to remove tumors are not an option because cancer has spread too far.

Traditional therapies can reduce symptoms and discomfort through palliative care. Doctors often prescribe targeted radiation therapy in a palliative treatment plan. Radiation treatments may alleviate pain and pressure and ease breathing.

Stage 4 mesothelioma treatment options video

Watch: Mesothelioma specialist Dr. Jacques Fontaine explains what factors patients should consider when deciding treatment options for stage 4 mesothelioma.

Stage 4 Chemotherapy

One of the most common treatment options for stage 4 mesothelioma is chemotherapy with cisplatin or carboplatin combined with pemetrexed (Alimta). These drugs slow tumor growth and may shrink tumors, alleviating symptoms and extending survival. Some patients’ tumors respond so well to chemotherapy that they qualify for surgery.

A 2020 case report published in General Thoracic and Cardiovascular Surgery described a woman in her 60s with stage 4 pleural mesothelioma who was eligible for surgery after responding to chemotherapy. She tolerated the surgery and underwent further chemotherapy 30 months later.

A 2016 Wayne State University study revealed that chemotherapy doubles life expectancy for malignant mesothelioma patients, including those with stage 4. Combining chemotherapy with surgery extended survival even longer.

Stage 4 Surgery

Most patients with stage 4 pleural mesothelioma do not qualify for extensive tumor-removing surgeries, such as a pleurectomy and decortication (P/D) or extrapleural pneumonectomy (EPP). However, a 2022 study described a 72-year-old woman with pericardial mesothelioma who underwent surgery and remained healthy nine months later.

Due to the extensive spread of tumors in stage 4 disease, doctors cannot remove all growths with EPP or P/D but will attempt to remove as much tumor mass as possible in a process known as debulking.

Palliative surgery targets symptom-causing tumors so patients can breathe more comfortably and experience less pain. Less extensive surgical procedures, such as thoracentesis, paracentesis and pleurodesis, drain fluid from the chest and abdomen to reduce pressure on vital organs.

Stage 4 Radiation Therapy

Radiation therapy is an option for some patients with stage 4 mesothelioma. Doctors may recommend the procedure depending on the patient’s tumor growth and overall health.

Radiation therapy at this stage is often palliative and used to reduce the size of tumors. Reducing tumor size or slowing growth can lessen chest pressure, decrease pain and improve breathing.

Immunotherapy and Clinical Trials

Some stage 4 mesothelioma patients may qualify for clinical trials. Clinical trials investigate the value of various treatment combinations for late-stage mesothelioma or test newer options such as immunotherapy.

In some cases, experimental treatments such as gene therapy can help stage 4 patients survive far past their prognosis. A 2022 clinical study showed that gene therapy taken via orally inhalable drugs could be a viable treatment for malignant pleural mesothelioma.

Improve Quality of Life with Palliative Care

Palliative or supportive care can relieve symptoms and improve quality of life. In stage 4 mesothelioma, doctors may recommend palliative care such as pain medication, oxygen therapy and respiratory therapy. These treatments control pain and improve lung function.

Many long-term mesothelioma survivors have incorporated complementary and alternative medicine into their stage 4 treatment plan. Complementary therapies, such as acupuncture and massage, may help some patients when used alongside traditional medicine to ease symptoms and reduce treatment side effects.

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Stage 4 Mesothelioma Life Expectancy and Prognosis

The median survival rate for stage 4 mesothelioma is approximately 12 months with treatment. The stage 4 survival rate for pleural mesothelioma patients is approximately 14.9 months.

At stage 4 the cancer is likely to spread, leading to respiratory failure. If the tumors spread to the heart the patient may experience heart failure.

A positive response to treatment can extend survival and improve prognosis. A 2021 clinical research study discovered that patients who were sensitive to platinum-based chemotherapies had better results. The median progression-free survival of the platinum-sensitive group at stage 4 was 7.9 months, compared to 2.4 months for the platinum-resistant group.

Patients with good prognostic factors often live longer than average. Factors associated with better prognosis and survival include having the epithelioid cell type, being in good overall health, younger in age, female and having no signs of blood disorders.

Mesothelioma is considered a variable cancer, and 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.

Life Expectancy Without Treatment

Patients diagnosed in stage 4 who decide against treatment live an average of six months. In contrast, those diagnosed with stage 1A disease who elect no treatment live an average of two years.

Mesothelioma survival without treatment depends on cancer stage, overall health and tumor growth rates. Cancer management with traditional therapies has the most statistically significant impact on stage 4 mesothelioma survival, often extending life expectancy by several months.

Karen Selby, RN, patient advocate for the Mesothelioma Center
“A stage 4 mesothelioma diagnosis doesn’t mean there is no hope or options. It’s important to connect with a medical oncologist who 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

What To Do After a Stage 4 Mesothelioma Diagnosis

Many patients pursue a second opinion from a specialist after a stage 4 mesothelioma diagnosis. Mesothelioma specialists can provide valuable information on the latest treatments available through clinical trials. Finding financial assistance to offset the high costs of treatment can also be beneficial at this time.

Steps To Consider After a Stage 4 Diagnosis
  • Get a second opinion from a mesothelioma specialist.
  • Exercise and maintain a healthy diet to improve mood and quality of life.
  • Join a support group to connect with others coping with mesothelioma.

Staying healthy and utilizing support resources may help patients live years beyond their predicted life expectancy. Connecting with other mesothelioma survivors can inspire new ways of managing your diagnosis. Andy Ashcraft lived with stage 4 pleural mesothelioma for seven years after joining a clinical trial combining immunotherapy with chemotherapy. Lannie Chitwood underwent experimental chemotherapy and lived for 10 years with stage 4 pleural mesothelioma.

End-of-Life Planning

Planning your end-of-life choices, such as palliative care and pain management, is essential for stage 4 mesothelioma patients. Knowing your family will honor your end-of-life care plan will lessen anxiety.

Document your decisions in clear, concise, legally binding documents. Ask your medical team for a blank copy of all documents they recommend when planning for end-of-life medical care.

Considerations For End-of-life Decision Making
  • Medical Care Decisions: Tell your medical team your priorities for symptom and pain management and where you want to receive care, whether it’s a hospital or a 24-hour staffed hospice program. You may also wish to designate a caregiver and arrange for in-home medical services.
  • Financial Affairs and Personal Records: Specify the beneficiaries in your will for insurance policies, employer or union benefits, lawsuits, tax returns, bank accounts, possessions and investments such as an IRA or 401(k). Provide your Social Security number, passwords and important contacts to a trusted family member.
  • Future Family Care and Funeral Arrangements: Designate someone to care for children or pets. Provide detailed information on how you want your body handled and the type of memorial or funeral service you’d like.

A stage 4 mesothelioma diagnosis can be devastating, but it doesn’t mean you can’t control some aspects of your cancer. Taking a proactive approach can reduce stress and worry while clarifying for family and friends how you wish to manage your end-of-life care.

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Common Questions About Stage 4 Mesothelioma

Is mesothelioma terminal?

Mesothelioma is a terminal cancer. While many patients go into remission, especially with treatment, there is no cure for mesothelioma. Life expectancy with advanced-stage mesothelioma cancer depends largely on the extent of tumor growth and how well you respond to treatments.

Can stage 4 mesothelioma be treated?

Yes, stage 4 mesothelioma is primarily treated with chemotherapy and palliative care. Chemotherapy can alleviate symptoms and extend survival. Palliative care helps patients cope with pain and other symptoms, improving their quality of life.

What is the life expectancy of someone with late-stage mesothelioma?

The life expectancy of stage 4 mesothelioma is about one year with treatment. Electing chemotherapy can extend the survival of those with mesothelioma by several months. Without treatment, people with late-stage mesothelioma live an average of six to eight months.

Are there any survivors of stage 4 mesothelioma?

Many survivors have lived a long time with stage 4 mesothelioma. For example, Andy Ashcraft lived with stage 4 mesothelioma for more than seven years. His treatment included chemotherapy, immunotherapy and medical marijuana.


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