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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. This end stage of mesothelioma cannot be removed by surgery because mesothelioma cells and resulting tumors have spread beyond the mesothelial lining and have grown into nearby or distant tissues and organs.

In Stage 4 Mesothelioma, tumors have spread via metastasis throughout the body.

Mesothelioma is different from other cancers in its unique pattern of metastasis, which tends to occur locally rather than distantly. It may spread from the chest cavity to the abdominal cavity. In rare instances mesothelioma can spread to distant areas of the body, including the liver, brain, bones or other remote locations.

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. The life expectancy of stage 4 mesothelioma is about one year with treatment. Choosing immunotherapy or chemotherapy in combination with a targeted drug or Tumor Treating Fields can extend the survival of those with mesothelioma to 18 months.

Stage 4 Mesothelioma Key Facts
  • Over 7% of stage 4 pleural mesothelioma patients live five years or more.
  • Peritoneal patients have a better prognosis. Neary 30% survive for at least five years with treatment.
  • A 2021 research study found that stage 4 survival was 7.9 months for patients who responded well. The median survival was 2.4 months for those resistant to chemotherapy.
  • Without treatment, people with late-stage mesothelioma live an average of six to eight months.

No two cases of mesothelioma are the same. Life expectancy and survival rate for late-stage mesothelioma cancer depends mainly on the extent of tumor growth and how well you respond to treatments. Survival statistics cannot predict how long someone with mesothelioma will live. Some stage 4 mesothelioma patients have gone into partial remission. Mesothelioma treatment options, such as chemotherapy and palliative care can extend survival. 

Many survivors have lived a long time with stage 4 mesothelioma. Pleural mesothelioma survivor Andy Ashcraft 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,” Ashcraft said, attributing his improved prognosis to his participation in an immunotherapy clinical trial. “I consider myself extremely lucky for a lot of reasons. I haven’t won the lottery yet, but I’m working on that.”

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Symptoms of Stage 4 Mesothelioma

Stage 4 mesothelioma symptoms include pain, fatigue, fever and more. Some patients have few symptoms, and those 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. 

Symptoms of end-stage mesothelioma may include:
  • 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
  • General feeling of discomfort (malaise)
  • 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)

Brain metastasis, which is rare, 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 significantly impact quality of life. 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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Stage 4 Mesothelioma by Type 

The definition of stage 4 differs for the four types of mesothelioma. These details generally refer to an “end-stage” diagnosis. In stage 4, tumors have invaded deeper tissues and spread to distant sites. This metastasis means tumors have reached remote lymph nodes and organs.

Mesothelioma Types at Stage 4:
  • 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. 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. 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. Testicular mesothelioma is the rarest type. There is no official staging system and no formal stage 4. It can spread to distant pelvic tissue.

Stage 4 is the most severe stage of this type of cancer. For some patients there may be an opportunity to participate in a clinical trial that could provide researchers with much-needed insight on how to better treat mesothelioma in these last stages.

Memorial Sloan Kettering Cancer Center, in conjunction with SELLAS Life Sciences Group, is working on a study combining immunotherapy with a targeted cancer vaccine for late-stage pleural mesothelioma patients.

“We’ve seen some very, very positive results,” Dr. Dragan Cicic, director of clinical development at SELLAS, told The Mesothelioma Center at “Patients in advanced stages can still go forward with a solid quality of life. This is very promising.”

Stage 4 Mesothelioma Treatment

This cancer has no cure, but chemotherapy and immunotherapy are often the best options to extend survival and improve symptoms at stage 4. Chemotherapy, immunotherapy and radiation therapy can shrink tumors to reduce pain and pressure. Dealing with symptoms in stage 4 is not easy. The proper treatment can help you cope.

Stage 4 Treatment Options:
  • Chemotherapy. A common therapy for stage 4 mesothelioma, chemotherapy can double the life expectancy of some stage 4 patients.
  • Immunotherapy. First-line treatment with nivolumab and ipilimumab, known by the brand names Opdivo and Yervoy, 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 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 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.

Many people with stage 4 mesothelioma participate in clinical trials to access new therapies. New immunotherapy drugs and different combinations of treatments become available through clinical trials.

Factors to Consider When Choosing Treatment

When you choose a treatment, it’s crucial to consider likely side effects. Chemotherapy can lead to nausea, vomiting, fatigue and anemia. Radiation causes fatigue and irritates the skin. Immunotherapy also causes fatigue, body aches and fever. Talk to your doctor about the risks and benefits of each treatment.

Patient Advocate Dr. Snehal Smart likes to remind people she speaks with that most mesothelioma patients receive a stage 4 diagnosis. 

“It doesn’t necessarily mean the end stages of life,” said Smart. “Many patients can still prolong survival time with clinical trials, immunotherapy and chemotherapy.”

What to Do Following a Stage 4 Diagnosis

Coping with stage 4 mesothelioma can feel overwhelming. You don’t need to overcome the physical and emotional challenges alone. Support resources and assistance can also ease the burdens caregivers face.

Support resources help patients live years beyond their predicted life expectancy. With help, you can build a support network for yourself and your loved ones. 

Steps to Consider After a Stage 4 Diagnosis
  • Take time to learn about resources for your family.
  • Improve your emotional well-being through mental health counseling.
  • Share your experiences and learn coping strategies through a mesothelioma support group.
  • Choose where you want to receive care. You may prefer a hospice program over a hospital.
  • Tell your medical team your priorities for symptom and pain management.
  • You can also choose a caregiver and arrange for in-home medical services.

A stage 4 mesothelioma diagnosis can be devastating. It doesn’t mean you can’t control some aspects of living with this condition, and improve your quality of life. Taking a proactive approach can reduce stress and worry.

Talk to your family and medical team about documenting how you wish to manage your end-of-life care. These steps will bring peace of mind to your family and loved ones.

“It is important to provide these patients the best supportive care, make them comfortable and preserve dignity,” said Dr. Jacques Fontaine, director of the Mesothelioma Research and Treatment Center at Moffitt Cancer Center in Tampa, Florida. 

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 symptoms. Talk to your doctor first. These treatments do not 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 and estimate the patient’s prognosis.

Should I consider end-of-life planning?

End-of-life planning is important for stage 4 patients. Knowing your family will honor your end-of-life care plan may help lessen your anxiety. 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.