What Is Stage 4 Mesothelioma?

Stage 4 mesothelioma is the most advanced stage of this cancer. Tumors have invaded deeper tissue and spread or metastasized to distant areas. Cancer is likely to present in distant lymph nodes and organs.

Therapy options in stage 4 mesothelioma cannot remove all tumors. Palliative options can help control symptoms. Stage 4 is also known as end-stage mesothelioma or late-stage mesothelioma. Patients may also be eligible for clinical trials.

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 are more severe. These may include breathlessness, coughing or chest pain. 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. This metabolic syndrome involves weight loss, muscle atrophy (breakdown), weakness and appetite loss. Stage 4 mesothelioma can also cause blood problems. These include high platelet counts (thrombocytosis) and low red blood cell counts (anemia).

Doctors often diagnose mesothelioma in later stages. Symptoms generally do not appear until stage 3 or 4. These may mimic more common illnesses. A specialized oncologist can confirm a diagnosis.

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Late-Stage Mesothelioma by Type

The TNM staging system defines stage 4 pleural mesothelioma to include metastasis. The Brigham method assigns stage 4 when surgery is not a viable option. Traditional staging systems do not apply to nonpleural types. Characteristics in the final stage vary based on location.

Stage 4 Pleural Mesothelioma

Stage 4 refers to mesothelioma that affects the lungs. This is 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 a stage 4 diagnosis but may limit treatment options at this stage.

Cancer has spread to distant organs during the final stages of pleural mesothelioma. Symptoms include shortness of breath (dyspnea), painful coughing, chest pain and 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. Doctors consider peritoneal patients with extensive tumor spreading to be “stage 4.”

By this point, cancer tissue is extensive. 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. No staging system exists for this variant. The pericardial variant develops on the heart’s protective lining. This sac that surrounds the heart is the pericardium.

This form is quite rare, making diagnosis challenging before the patient’s death. Cancer may spread throughout the chest cavity and esophagus in the late stages. It may also travel to the abdomen or other parts of the respiratory and digestive systems.

Stage 4 Testicular Mesothelioma

Testicular mesothelioma is the rarest type of this cancer. About 100 cases exist in the medical literature and affect less than 1% of all patients. As with the pericardial type, testicular mesothelioma has no official staging system. It does not have a formal stage 4.

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

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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 chemo can shrink tumors to reduce symptoms.

Mesothelioma treatment options are palliative at stage 4. At this stage, cancer has spread into deep tissue. Aggressive surgeries that remove tumors are not an option.

Radiation treatments may ease pain, pressure and breathing. Doctors often prescribe targeted radiation therapy in a palliative treatment plan.

Stage 4 Chemotherapy

A standard treatment option for stage 4 is chemotherapy. The typical therapy is a platinum drug combined with pemetrexed (Alimta). Some patients respond well enough that they qualify for surgery.

A 2020 case report described a woman in her 60s with stage 4 pleural mesothelioma. She became eligible for surgery after responding to chemotherapy. After surgery, she underwent further chemo over two years later.

A recent study concluded chemotherapy doubles the life expectancy of mesothelioma patients. The study included those in stage 4. Chemotherapy with surgery extended survival even longer.

Stage 4 Surgery

Most stage 4 pleural mesothelioma patients do not qualify for extensive tumor-removing surgeries. Pleurectomy and decortication (P/D) or extrapleural pneumonectomy (EPP) are too aggressive.

Stage 4 disease has spread to other areas in the body. Surgeons cannot remove all growths. They will attempt to remove as much tumor mass as possible in a process known as debulking.

Palliative surgery targets symptom-causing tumors. Removing these allows patients to breathe easier and experience less pain. Less invasive options include thoracentesis, paracentesis and pleurodesis. These procedures drain excess fluid to reduce pressure on vital organs.

Stage 4 Radiation Therapy

Radiation therapy is an option for some patients with stage 4 mesothelioma. Doctors prescribe the procedure based on tumor growth, location and patient health.

Radiation therapy at this stage is often palliative and used to reduce the size of tumors. Reducing tumor size or slowing growth can ease symptoms. The therapy 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 study the value of various treatment combinations for late-stage mesothelioma. They also test newer options, such as immunotherapy.

In some cases, experimental treatments can help patients survive past their prognosis. A 2022 clinical study showed that inhalable gene therapy could be viable as a new treatment.

Improve Quality of Life with Palliative Care

Palliative or supportive care can relieve pain and other symptoms. This therapy is most helpful when there are signs that death may be near. Stage 4 palliative care can include pain medication, oxygen therapy and respiratory therapy. These treatments help improve lung function and quality of life.

Many long-term mesothelioma survivors use complementary and alternative medicine. Doctors recommend these options alongside traditional medicine but not as substitutes. Acupuncture and massage may help some patients ease symptoms and reduce side effects.

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Stage 4 Mesothelioma Life Expectancy and Prognosis

The median survival rate for stage 4 mesothelioma is about 12 months with treatment. For pleural patients, survival 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 some patients respond better to chemotherapy. Survival of stage 4 patients was 7.9 months for patients who responded well. The median survival was 2.4 months for the chemoresistant group.

Patients with good prognostic factors often live longer than average. These factors, such as epithelial cell type, correlate with better prognosis and survival. Other factors include health, young age, female gender and no signs of blood disorders.

Mesothelioma is variable, and no two cases are the same. Survival statistics cannot predict how long someone with mesothelioma will live. Some people have particularly slow-developing cancer. These patients tend to respond better to treatment.

Life Expectancy Without Treatment

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

Survival without treatment depends on stage, health and tumor growth. Traditional therapies have the most impact on stage 4 survival. Treatment often extends life expectancy by several months.

“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

What To Do After a Stage 4 Mesothelioma Diagnosis

Many patients seek a second opinion after a stage 4 mesothelioma diagnosis. Specialists provide valuable information on the latest treatments available through clinical trials. They may also offer financial assistance to offset the high costs of treatment.

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.

Support resources help patients live years beyond their predicted life expectancy. Many survivors respond well to new therapies through clinical trials. Connecting with other mesothelioma survivors can inspire new ways of managing your diagnosis.

End-of-Life Planning

End-of-life choices include palliative care, pain management and many other decisions. These choices are essential for stage 4 patients. Knowing your family will honor your end-of-life care plan will lessen anxiety.

Document your decisions in clear, concise language. Find a trusted lawyer to draft binding documents. Ask your medical team for a blank copy of all documents they recommend. These can help you plan 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. It doesn’t mean you can’t control some aspects of your cancer. Taking a proactive approach can reduce stress and worry. It can also clarify how you wish to manage your end-of-life care for family and friends.

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.

What signs should I expect when dying from mesothelioma?

Everyone’s experience during end-of-life care is different. You may feel some combination of cold, tiredness or pain. Let your family and caregivers know exactly how you wish to be cared for in your last moments.

Caregivers and family members should prepare themselves for signs that death may be near in a loved one with mesothelioma. These signs can include reduced sensation, lack of hunger or thirst, shallow or irregular breathing and loss of reflexes.

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.

How can you help a loved one who may be dying from mesothelioma?

There are several ways to give comfort to a loved one dying from mesothelioma, such as providing warm blankets and repositioning them for easier breathing. Other methods include moisturizing their lips with lip balm, offering ice chips or small sips of water or juice, and ensuring their skin remains clean and dry.

A physician or a social worker can guide you through any paperwork to finalize choices in end-of-life care, such as a Do Not Resuscitate order or palliative sedation. Participating in a support group is also an excellent way for patients and families to share their thoughts and feelings about death.

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