What Are the Stages of Mesothelioma?
The four stages of mesothelioma begin with stage 1, which is when the tumor has not spread outside of the mesothelial lining. Stage 2 follows with cancer cells spreading to nearby organs and lymph nodes. At stage 3, cancer cells spread to more distant organs. Finally, at stage 4, cancer cells extend beyond chest or abdominal cavity.
Cancer staging is a key part of mesothelioma diagnosis and treatment. Doctors use cancer stage as a guideline when deciding whether a patient is likely to benefit from treatments such as surgery.
The goal of treatment in all mesothelioma stages is to improve quality of life and extend survival.
Because symptoms don’t develop until later mesothelioma stages, most patients are not diagnosed until stages 3 or 4. The cancer’s cell type and patient’s overall health also affect treatment options.
The most common treatment for malignant mesothelioma is chemotherapy. Some patients are diagnosed early enough to qualify for surgery. Surgical procedures are often combined with chemotherapy and radiation to kill more cancer cells. Meanwhile, clinical trials continue testing new treatments such as immunotherapy.
Stages of Mesothelioma
The stages of peritoneal and 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.
People often wonder if they can determine their stage based on their symptoms. Unfortunately, the symptoms of mesothelioma are not strongly correlated with the stages.
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.
Stage 1 Mesothelioma
- 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.
Stage 1 Symptoms
Most mesothelioma patients do not experience symptoms at stage 1. At this stage, tumors are too small to cause pain or breathing difficulties.
Most cases of stage 1 mesothelioma are found accidentally through a routine X-ray for a separate condition.
Stage 1 Treatment
Stage 1 mesothelioma is treated with surgery, chemotherapy and radiation therapy. This approach is called multimodal therapy. Major surgery to remove the cancer is usually the first line of treatment.
Different surgeries, chemotherapy drugs and types of radiation are selected on an individual patient basis. Clinical trials offer stage 1 patients new approaches to multimodal therapy. Some of them include immunotherapy.
Stage 1 Life Expectancy
Some patients can survive stage 1 mesothelioma for years beyond the average prognosis. Those who respond well to multimodal therapy have lived three to five or even 10 years.
People diagnosed at this stage have the greatest chance of living longer with mesothelioma. Median life expectancy at stage 1 is 22.2 months with surgery.
Stage 2 Mesothelioma
- Stage 2 indicates that tumors are beginning to spread beyond the mesothelial lining and into lymph nodes.
- Tumors remain small enough to be removed by surgery, which positively impacts life expectancy.
Stage 2 Symptoms
Stage 2 pleural mesothelioma symptoms may resemble the common cold such as difficulty breathing during exercise or a mild cough.
Peritoneal patients may lose weight or feel bloated.
It is generally rare for symptoms to appear in stage 2. Symptoms usually arise in stage 3.
Stage 2 Treatment
Stage 2 mesothelioma is treated with surgery, chemotherapy and radiation therapy. The same multimodal approach to treatment used at stage 1 is also used in stage 2.
Treatment is tailored to the patient. Aggressive options are used to remove or kill as much cancer as possible.
Stage 2 Life Expectancy
Some stage 2 patients can survive for years with mesothelioma. The overall survival for all stages is around one year, but stage 2 patients may live years beyond that.
Those who respond well to aggressive treatment may live longer than three to five years. Median life expectancy at stage 2 is 20 months with surgery.
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Stage 3 Mesothelioma
- 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.
- Some stage 3 patients qualify for surgery depending upon the size and location of tumors.
Stage 3 Symptoms
Stage 3 symptoms include difficulty breathing, dry cough, wheezing and chest pain. 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.
Peritoneal patients develop digestive problems (constipation or diarrhea), abdominal pain and bloating. Pleural and peritoneal patients may experience weight loss, fever and night sweats.
Stage 3 Treatment
Stage 3 mesothelioma is typically treated with chemotherapy. Some patients may qualify for surgery and radiation therapy.
Some stage 3 patients are ineligible for surgery and other aggressive treatments. At that point, doctors offer palliative options to control pain and improve quality of life.
Stage 3 patients can join clinical trials to try new chemotherapy drugs and immunotherapies.
Stage 3 Life Expectancy
Some patients can survive for several years with stage 3 mesothelioma. Those who respond well to aggressive treatment may live years beyond their initial prognosis.
Median life expectancy at stage 3 is 17.9 months with surgery.
Stage 4 Mesothelioma
- By stage 4, cancer has spread throughout the area where it first developed and possibly to other parts of the body. Cancer could be present in the liver, brain, bones or elsewhere.
- Tumor-removing surgery is not used at this stage. Minimally invasive surgeries may be used to control symptoms.
Stage 4 Symptoms
Pleural mesothelioma symptoms at stage 4 may include extreme difficulty breathing, trouble swallowing and severe chest pain.
Peritoneal symptoms include constant digestive problems, swelling of the abdomen (abdominal distension), bowel obstruction and difficulty breathing or swallowing.
Pleural and peritoneal patients may experience loss of appetite, weight loss, muscle weakness, nerve pain, night sweats, fever and fatigue.
Stage 4 Treatment
Stage 4 mesothelioma is treated with chemotherapy and sometimes radiation therapy. Doctors use palliative treatments designed to ease pain and control other symptoms.
Most stage 4 patients do not qualify for aggressive surgery, but they do qualify for many clinical trials testing chemotherapy and immunotherapy.
Stage 4 Life Expectancy
Some stage 4 patients have lived longer than a year with mesothelioma. Treatments such as chemotherapy, radiation and immunotherapy help people live longer at this stage.
Median life expectancy at stage 4 is 14.9 months or less with or without surgery.
Mesothelioma Stages Life Expectancy
People diagnosed in early stages of mesothelioma have a better prognosis and longer life expectancy compared to those diagnosed in the later stages. Some people with end stages of 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.
These figures can’t tell you how long you will live. Every patient is different. Even though late-stage patients tend to not survive 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.
|Stage||2-Year Survival Rate||5-Year Survival Rate|
|Stage 4||17%||Less than 1%|
|Stage 4||Not Available*|
* Survival rate data is not available because a fourth stage hasn’t been defined yet.
Staging 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. During the final stages of the cancer, patients may lose weight but feel bloated.
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.
Mesothelioma Staging Methods and Systems
There are three systems for mesothelioma staging: TNM, Brigham and Butchart.
TNM is the most widely used and accepted system for pleural mesothelioma stages.
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.
The Brigham system was developed at Brigham and Women’s Hospital in Boston by Dr. David Sugarbaker. It was created to help identify which pleural patients would respond best to surgery.
The Butchart system was developed in the late 1970s by Dr. Eric Butchart. He created it to help doctors identify which pleural patients could handle aggressive treatment.
Seek a Second Opinion
A person diagnosed with mesothelioma should seek a second opinion to make sure their 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 determine the stage without using surgery as the metric. They use imaging scans, such as CT and PET scans, and biopsies to estimate stage. These techniques are less invasive than surgery.
These techniques come close to estimating a patient’s true stage, but often they over-stage or under-stage the 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 March 15, 2019
27 Cited Article Sources
Chahinian, A., & Robinson, B. Mesothelioma. London: Martin Dunitz, 2002.
Butchart, E.G., et al. (1976). Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Thorax.
Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC470356/pdf/thorax00145-0021.pdf
Vanderbilt University Medical Center. (n.d.). Department of Thoracic Surgery - Mesothelioma.
Retrieved from: http://www.mc.vanderbilt.edu/root/vumc.php?site=thoracic&doc=3594
American College of Chest Physicians. (1995). A proposed new international TNM staging system for malignant pleural mesothelioma.
Retrieved from: http://mdmeso.com/wp-content/uploads/2015/05/A-Proposed-New-INternational-TNM-Staging-System-for-Malignant-Pleural-Mesothelioma.pdf
Baldi, A. (Ed.). Mesothelioma from bedside to clinic. New York, NY: Nova Science Publishers, Inc., 2008.
Dodson, R.F., & Hammar, S. P. (Eds.). Asbestos: Risk assessment, epidemiology, and health effects. Boca Raton, FL: Taylor & Francis Group, 2006.
National Cancer Institute. (2015, March 9). Cancer staging.
Retrieved from: http://www.cancer.gov/cancertopics/factsheet/detection/staging
O’Bryne, K., & Rusch, V. (Eds.). Malignant pleural mesothelioma. New York, NY: Oxford University Press, 2006.
Pass, H., Vogelzang, N. & Carbone, M. Malignant Mesothelioma: Advances in pathogenesis, diagnosis, and transitional therapies. New York: Springer, 2005.
Patz, E. F., Jr., Rusch, V. W., & Heelan, R. (1996). The proposed new international TNM staging system for malignant pleural mesothelioma: Application to imaging. American Journal of Roentgenology, 166, 323-327.
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
American Cancer Society. (2016, February 17). Treatment of Mesothelioma Based on the Extent of the Cancer.
Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/treating/by-extent.html
NYU Langone Medical Center. (n.d.). Is your patient a candidate?
Retrieved from: http://hipec.med.nyu.edu/physicians/your-patient-candidate
American Cancer Society. (2017, December 20). Malignant mesothelioma stages.
Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/staging.html
Tan, W.W. (2016, January 4). Malignant pleural mesothelioma staging.
Retrieved from: https://emedicine.medscape.com/article/1999306-overview
Nowak, A.K. et al. (2016). The IASLC mesothelioma staging project: proposals for revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for pleural mesothelioma. Journal of Thoracic Oncology, 11(12), 2089-2099. doi: 10.1016/j.jtho.2016.08.147
Bonomi, M. et al. (2017). Clinical staging of malignant pleural mesothelioma: Current perspectives. Lung Cancer: Targets and Therapy, 8, 127-139. doi: 10.2147/LCTT.S102113
Yan, T.D. et al. (2011). A Novel Tumor-Node-Metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database. Cancer, 117(9), 1855-1863.
- Gill, R.R. et al. (2017). Quantitative clinical staging for patients with malignant pleural mesothelioma. : Retrieved from: https://academic.oup.com/jnci/article/110/3/djx175/4222833