What Is Stage 4 Mesothelioma?

Stage 4 mesothelioma is the most advanced and final stage of this asbestos-related cancer. Extensive tumor spread makes it difficult to treat. 

Surgery cannot remove this end stage of mesothelioma because mesothelioma cells and resulting tumors have spread beyond the mesothelial lining. They have grown into nearby or distant tissues and organs.

Most mesothelioma patients I speak with have received a stage 4 diagnosis. It doesn’t necessarily mean the end stages of life. Many patients can still prolong survival time with clinical trials, immunotherapy and chemotherapy.

Mesothelioma is different from other cancers in the way it progresses. It has a unique pattern of metastasis, which is the way it spreads in the body. 

It tends to occur locally. Tumors may spread beyond where they initially began, but typically in nearby areas. For example, it may spread from your chest cavity to your abdominal cavity. In rare instances, mesothelioma can spread distantly to other areas of your body such as the liver, brain and bones.

Key Facts About Stage 4 Mesothelioma
  • More than 7% of stage 4 pleural mesothelioma patients live five years or more.
  • Peritoneal patients have a better prognosis. Nearly 30% survive for at least five years with treatment.
  • A 2023 study found adding Keytruda to platinum-pemetrexed chemotherapy significantly improved overall survival for patients with advanced mesothelioma.
  • Without treatment, people with late-stage mesothelioma live an average of six to eight months.

Stage 4 Mesothelioma by Type

Stage 4 is the most severe stage of this type of cancer for all mesothelioma types. There are four types of mesothelioma that are based on where tumors first developed in the body.

Mesothelioma Types at Stage 4

Stage 4 Pleural Mesothelioma Illustration
Stage 4 Pleural Mesothelioma

Stage 4 mesothelioma that affects the lungs is the most common type. Epithelial or sarcomatoid cell tumors spread to the liver or kidneys.

Stage 4 Peritoneal Mesothelioma Illustration
Stage 4 Peritoneal Mesothelioma

There is no official stage 4 definition for peritoneal mesothelioma. This type occurs in the abdomen. End-stage extensive tumor spreading may involve the liver.

Stage 4 Pericardial Mesothelioma Illustration
Stage 4 Pericardial Mesothelioma

This variant develops on the heart’s protective lining. Cancer may spread to the esophagus. Doctors use general staging guidelines for pericardial mesothelioma.

Stage 4 Testicular Mesothelioma Illustration
Stage 4 Testicular Mesothelioma

Testicular mesothelioma is the rarest type. There is no official staging system and no formal stage 4. It can spread to distant pelvic tissue.

For all mesothelioma types at stage 4, tumors have invaded deeper tissues and spread to distant sites. Malignant mesothelioma tumors can spread to your remote lymph nodes and organs.

What Are the Symptoms of Stage 4 Mesothelioma?

Stage 4 mesothelioma cancer symptoms can include pain, fatigue and fever. You may have few symptoms, which can be vague and mimic common signs of other cancers. Some symptoms appear where the cancer has spread, including the liver, kidneys and spleen.

You may feel generally unwell and need help moving around. Physical changes may affect your hormone levels and leave you with low energy or feeling depressed. Always seek mental health resources when needed.

Common End-Stage Mesothelioma Symptoms
  • A general feeling of discomfort (malaise)
  • Abdominal pain
  • Anemia (low red blood cells)
  • Cachexia (muscle breakdown)
  • Coughing up blood (hemoptysis)
  • Difficulty swallowing (dysphagia)
  • Fatigue and poor well-being
  • Fluid buildup in the chest or abdomen (pleural effusion or pleural fluid)
  • Night sweats and fever
  • Pain and tightness in the chest
  • Severe weight loss or anorexia (lack of appetite)
  • Shortness of breath (dyspnea)
  • Thrombocytopenia (low platelet count)

Rare brain metastasis causes some of the most disturbing symptoms. You may lose control of your emotions, memory or muscle function. Remember to utilize all your support resources, including loved ones. Your medical team will also work to help you regain control.

Living with this cancer can be challenging and is likely to impact your quality of life significantly. Inform your doctor of any new or changing signs with your health. Not knowing what to expect can be frightening, but your medical team can help.

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Mesothelioma Metastasis
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Eating the right diet throughout mesothelioma treatment can ease your symptoms.

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Stage 4 Mesothelioma Prognosis 

While the prognosis for stage 4 mesothelioma patients is poor, life expectancy and survival rates can vary depending on responsiveness to treatment. Some stage 4 mesothelioma patients have gone into partial remission. 

Mesothelioma survival rate statistics cannot predict how long someone with mesothelioma will live. No two cases of mesothelioma are the same. Pleural mesothelioma survivor Andy Ashcraft, for example, was diagnosed with stage 4 and spoke to The Mesothelioma Center after surpassing the 3-year survival mark.

I’m doing great right now. I really am. I don’t look like a stage 4 cancer patient. I consider myself extremely lucky.

Treatments and palliative care can extend stage 4 mesothelioma life expectancy by years for many patients. Immunotherapy or chemotherapy in combination with a targeted drug or Tumor Treating Fields, for example, can extend survival for mesothelioma survivors to 18 months. 

Your prognosis depends mainly on the extent of tumor growth and how well you respond to treatments. Other factors that can affect a person’s prognosis are the age of the patient and their overall health. Diet and nutrition and regular exercise can improve your prognosis. Smoking doesn’t cause mesothelioma, but quitting can also help improve your overall health.

Survivor Story
Survivor Story
Andy A. Pleural Mesothelioma Survivor

Survivor Andy A. Beating the Odds Again

Andy beat the odds in 2004 by surviving a horrific, 70 mph motorcycle crash that propelled him into a concrete retaining wall, breaking his pelvis and collarbone, three ribs, both feet, puncturing one lung and bruising most other parts of his body.

Read Andy’s Story

Stage 4 Mesothelioma Life Expectancy and Survival Statistics

The life expectancy for stage 4 mesothelioma patients ranges from about one to two years. The median survival time for these patients is 14.9 months. Researchers are continuing to explore many treatments in studies that could improve survival time further.

According to the American Cancer Society, 7% of those with late-stage mesothelioma survive for 5 years or more. About half of these patients live for at least a year, and roughly 25% of those with stage-4 disease live for two or more years.

Stage 4 Mesothelioma Treatment

While there is no cure for mesothelioma yet, studies have shown that treatment with immunotherapy and chemotherapy improves overall survival in some patients in advanced stages. Treatment options typically recommended for stage 4 patients shrink tumors to reduce pain and pressure, extending survival and improving symptoms.

Stage 4 Mesothelioma Treatments
  • Chemotherapy: A standard therapy for stage 4 mesothelioma, chemotherapy can double the life expectancy of some stage 4 patients.
  • Immunotherapy: First-line treatment with Opdivo (nivolumab) and Yervoy (ipilimumab) helps many patients live at least 18 months.
  • Palliative Care: Patients who receive early palliative care, which focuses on easing pain and other symptoms, have an almost 400% increase in survival time.
  • Radiation: Radiation therapy can lessen chest pressure, decrease pain and improve your breathing. Proton therapy, a newer type of radiation, can boost survival to more than 30 months for stage 4 patients.
  • Surgery: Some stage 4 pleural mesothelioma patients qualify for tumor-removing surgeries, but palliative options can extend your survival by months.
  • Targeted Therapies: Targeted drugs, such as bevacizumab, may be combined with chemotherapy to improve survival from 12 months to 18 months.
  • Tumor Treating Fields: Adding Tumor Treating Fields therapy to chemotherapy also improves survival from one year to 18 months.

For some patients, there may be an opportunity to participate in a clinical trial that could provide researchers with much-needed insight on treating mesothelioma in these last stages better. For example, Memorial Sloan Kettering Cancer Center and SELLAS Life Sciences Group recently worked on a study combining immunotherapy with a targeted cancer vaccine for late-stage pleural mesothelioma patients.

We’ve seen some very, very positive results. Patients in advanced stages can still go forward with a solid quality of life. This is very promising.

Side Effects of Mesothelioma Treatment to Consider 

When choosing a treatment plan, it’s important to discuss possible side effects with your doctor. Together, you’ll weigh the benefits against the risks of side effects and determine the best plan for you.

Chemotherapy, immunotherapy, radiation and TTFields can all cause fatigue, nausea and coughing. Radiation and TTFields can cause skin problems such as rashes. Chemotherapy and immunotherapy can cause mouth sores. 

More serious complications can also occur such as serious infections. Some serious side effects can also develop. For example, though rare, patients taking immunotherapy drugs have reported hormone, kidney and liver problems.

Dr. Jacques Fontaine and Dr. Andrea Wolf
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Tips & Resources for Stage 4 Mesothelioma Patients

Support resources for your family and for you as a patient. Not only can support and assistance help survivors and their loved ones manage stress when coping with stage 4 mesothelioma, some resources can help patients live beyond their predicted life expectancy and improve quality of life.

Woman Speaking to a Mental Health Counselor
Mental Health Counseling

Improve your emotional well-being through mental health counseling.

People in a Support Group
Support Group

Share your experiences and learn coping strategies through a mesothelioma support group.

Woman laughing with her doctor
Receiving Care

Choose where you want to receive care. You may prefer a hospice program over a hospital.

Patient speaking with his doctor
Your Priorities

Tell your medical team your priorities for symptom and pain management.

Woman opening door for doctor house visit
Choosing a Caregiver

You can also choose a caregiver and arrange for in-home medical services.

A stage 4 mesothelioma diagnosis doesn’t mean you can’t control some aspects of living with this condition. Taking a proactive approach can sometimes reduce your anxiety.

Common Questions About Stage 4 Mesothelioma

What role can alternative and complementary medicine play in treating stage 4 mesothelioma?

Stage 4 mesothelioma patients may choose to use complementary or alternative therapies. Options such as acupuncture or massage may reduce your symptoms. Talk to your doctor first. These treatments don’t offer a cure and are not a substitute for standard care. The best options for wellness are often exercise and nutrition. A cancer nutritionist can guide you toward a healthy cancer diet.

What does the stage of cancer mean?

The stage of cancer refers to how advanced and widespread it is. A staging system called TNM determines the stage for pleural mesothelioma. TNM stands for Tumor, Node and Metastasis. The rating describes the size of the tumor, whether it has spread to lymph nodes and if it has metastasized.

Doctors assign a stage ranging from 0 to 4. This helps them determine the best treatment for you and estimate your prognosis.

Should I consider end-of-life planning?

Some patients find talking in advance with their family and medical team about end-of-life care preferences can bring peace of mind, allowing them to focus on the present and their treatment.

Ask your medical team for a blank copy of all documents they recommend. Find a trusted lawyer to draft binding documents. These can help you plan for end-of-life medical care.

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