Mesothelioma Stages

The four stages of mesothelioma describe how far the cancer has spread. Staging is a major factor in determining a patient’s prognosis and treatment options. Patient prognosis becomes poorer and treatment options become limited as stage number increases.

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Thoracic surgeon Dr. Jacques Fontaine explains the difference between mesothelioma stages.

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This page features: 11 cited research articles

Cancer staging is a key part of mesothelioma diagnosis and treatment. Knowing how far the cancer has spread helps doctors decide which treatments to use. For example, doctors use cancer stage as a guideline when deciding whether a patient is likely to benefit from surgery.

What are the Stages of Mesothelioma?

  • Stage 1: Cancer cells are in one place and surgery is an option.
  • Stage 2: Cancer cells have entered lymph nodes and surgery remains an option.
  • Stage 3: Cancer cells have spread to nearby organs and distant lymph nodes. Surgery might be an option for certain patients, but chemotherapy is more common at this stage.
  • Stage 4: Cancer cells have spread throughout chest or abdominal cavity. Surgery is no longer an option, but chemotherapy can improve life expectancy and ease symptoms.

Early-stage patients may benefit from surgery by living longer and experiencing fewer symptoms. Late-stage patients benefit more from treatment focused on symptom management. The goal of treatment in all stages is to improve quality of life and help people live longer.

Because mesothelioma symptoms don’t develop until later stages, most patients are not diagnosed until stage 3 or 4. The cancer’s cell type and the patient’s overall health also affect treatment options.

The most common treatment for mesothelioma is chemotherapy. Some patients get diagnosed early enough to qualify for surgery. Surgery is often combined with chemotherapy and radiation therapy to kill more cancer cells. Clinical trials are testing new therapies such as immunotherapy.

Stages of Mesothelioma

The stages of pleural mesothelioma are based upon the size of tumors and how far they have spread. The location and size of tumors has a direct impact on the symptoms a person may feel.

Tumor size and location also determines whether a person can undergo surgery. Unfortunately, surgery is no longer an option when tumors become too big or spread too far.

Stage 1

Initially, tumor growth is within a single area. The life expectancy of stage 1 mesothelioma is significantly better than later stages. It is difficult to catch the cancer this early because people with this stage do not usually experience symptoms.

Major surgery to remove the cancer is the first line of treatment. Doctors usually recommend an aggressive multimodal approach including surgery, chemotherapy, radiation therapy or immunotherapy.

Median life expectancy at stage 1 is 22.2 months with surgery.

Learn more about stage 1 mesothelioma

Stage 2

Stage 2 symptoms are vague and mild, and patients and doctors often mistake them for signs of other illnesses such as the flu.

The available treatment options are generally the same as for stage 1 mesothelioma. Median life expectancy at stage 2 is 20 months with surgery.

Learn more about stage 2 mesothelioma

Stage 3

Once the cancer progresses to stage 3, it may have spread to several tissues, organs and lymph nodes in the same region of the body where it formed.

Pleural mesothelioma patients may have difficulty breathing and chest pain even when resting. Discomfort may be felt in other parts of the body as well.

Some stage 3 cancer patients are ineligible for surgery and other aggressive treatments. At that point, doctors offer palliative options.

Median life expectancy at stage 3 is 17.9 months with surgery.

Learn more about stage 3 mesothelioma

Stage 4

By stage 4, cancer has spread to other parts of the body. Cancer could be present in the liver, brain, bones or elsewhere. Patients may experience extreme difficulty breathing and swallowing, digestive problems and severe pain.

For stage 4 patients, doctors typically fall back on palliative treatments designed to ease pain and control other symptoms. Most stage 4 patients do not qualify for surgery.

Median life expectancy at stage 4 is 14.9 months or less with or without surgery.

Learn more about stage 4 mesothelioma

Stages for Different Types of Mesothelioma

Pleural mesothelioma is the only type of this cancer that has an official staging system.

Researchers are working on formalizing a staging system for peritoneal mesothelioma, which currently only has three defined stages.

Patients generally don’t experience any symptoms in the early stages of peritoneal mesothelioma. As the cancer progresses, patients may lose weight but feel bloated.

In the later stages of peritoneal mesothelioma, patients typically experience abdominal pain and digestive problems.

The fourth stage of peritoneal mesothelioma is generally accepted as the stage where the cancer has spread to other parts of the body. The reason doctors haven’t officially defined a fourth stage is because the current staging system is based upon patients who qualified for surgery.

Only early-stage patients qualify for surgery, which means researchers did not study enough late-stage patients to clearly define a fourth stage.

There are no staging systems for pericardial mesothelioma or testicular mesothelioma.

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Effect of Mesothelioma Stages on Life Expectancy & Prognosis

People diagnosed in early stages of mesothelioma have a better prognosis and longer life expectancy. Some people with late-stage mesothelioma have lived for years with the disease, but it is less common.

Research shows varying survival rates for each stage of mesothelioma. These survival statistics tell you what portion of people with the same type and stage of cancer are alive years after diagnosis.

Dr. Fontaine explains how the stage of mesothelioma affects the treatment options

These figures can’t tell you how long you will live. Every patient is different. Even though late-stage patients tend to not live as long, some far outlive the average prognosis.

Survival rates are different for peritoneal mesothelioma and pleural mesothelioma. People with peritoneal mesothelioma tend to live longer.

Two-year and five-year survival rates are available for pleural mesothelioma. The following figures are based upon patients who were diagnosed between 2000 and 2013.

2-Year and 5-Year Survival Rates for Pleural Mesothelioma by Stage
Stage 2-Year Survival Rate 5-Year Survival Rate
Stage 1A 46% 16%
Stage 1B 41% 13%
Stage 2 38% 10%
Stage 3A 30% 8%
Stage 3B 26% 5%
Stage 4 17% Less than 1%
5-Year Survival Rates for Peritoneal Mesothelioma by Stage
Stage Survival Rate
Stage 1 87%
Stage 2 53%
Stage 3 29%
Stage 4 Not Available*

* Survival rate data is not available because a fourth stage hasn’t been defined yet.

Mesothelioma Stages Symptoms

People wonder if they can determine their stage based on their symptoms. Unfortunately, the symptoms of mesothelioma are not strongly correlated with the stages.

Mesothelioma Symptoms by Stage
Stages Pleural Mesothelioma Peritoneal Mesothelioma
Stage 1 No symptoms are associated with stage 1 No symptoms are associated with stage 1
Stage 2 While rare, patients may experience symptoms that resemble the common cold such as difficulty breathing during exercise or a mild cough Peritoneal patients may lose weight or feel bloated
Stage 3 Difficulty breathing, dry cough, wheezing, fluid around the lungs and chest pain Digestive problems (constipation or diarrhea) and abdominal pain
Stage 4 Extreme difficulty breathing, trouble swallowing, severe chest pain, loss of appetite, weight loss, muscle weakness, night sweats, fever and fatigue Constant digestive problems, weight loss, swelling of the abdomen (abdominal distension), bowel obstruction, loss of appetite, fever, night sweats, fatigue and difficulty breathing or swallowing

One of the reasons mesothelioma tends to be diagnosed in a late stage is the fact that early stages of mesothelioma cause no symptoms. The cancer is small in early stages and does not affect the body the way larger, late-stage tumors do.

Learn more about mesothelioma symptoms

Mesothelioma Staging Systems

There are three systems for mesothelioma staging: TNM, Brigham and Butchart.

TNM is the most widely used and accepted staging system for pleural mesothelioma.

A TNM staging system is in the works for peritoneal mesothelioma, but it has not been officially adopted yet. There are currently no formal staging systems for the other types of mesothelioma.

If you are diagnosed with mesothelioma, you should seek a second opinion to make sure your cancer has been staged correctly.

Many oncologists do not have experience with asbestos-related cancers. Always find a doctor who does.

Learn more about mesothelioma staging systems

Improving Staging Methods

Doctors are working to improve the ways they stage mesothelioma. The goal is to accurately stage the cancer with minimally invasive procedures.

Currently, the most accurate way to stage mesothelioma is with surgery.

Doctors do their best to estimate the stage without surgery. They use imaging scans and biopsies, which are less invasive than surgery.

These techniques come close to estimating a patient’s true stage, but often they over- or under-stage cancer. This inaccurate staging results in patients not receiving the best treatments for their true stage.

An improved approach to estimating stage is under development. Doctors are using new methods to analyze imaging scans.

These new methods measure the volume and thickness of tumors in the images. The measurements give doctors a better understanding of how far the cancer has grown and spread, which leads to more accurate staging.

Improvements to staging methods will help ensure patients receive the most effective treatments. This could result in longer survival rates among people diagnosed with mesothelioma regardless of their stage.

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Last Modified November 6, 2018

Registered Nurse and Patient Advocate

Karen Selby joined in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the regional 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. She is also a member of the Academy of Oncology Nurse & Patient Navigators.

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19 Cited Article Sources

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  11. Kadota, K. et al. (2012). A nuclear grading system is a strong predictor of survival in epithelioid diffuse malignant pleural mesothelioma. Mod Pathol, 25(2), 260–271. doi: 10.1038/modpathol.2011.146
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