Mesothelioma Stages

The four stages of mesothelioma describe development of tumors from stage 1, where cancer cells are in one place, to stage 4, where cancer cells have spread throughout chest or abdominal cavity. Prognosis, survival rates and life expectancy decrease 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

Understanding the Mesothelioma Stages

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.

What Are the Stages of Mesothelioma?

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.

  • Stage 1: Cancer cells are in one place. Surgery is an option.
  • Stage 2: Cancer cells enter lymph nodes. Surgery remains an option.
  • Stage 3: Cancer cells spread to nearby organs and distant lymph nodes. Surgery may be an option. Chemotherapy is more common at this stage.
  • Stage 4: Cancer cells extend beyond chest or abdominal cavity. Surgery is no longer an option. Chemotherapy may improve life expectancy and ease symptoms.

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.
Learn More About Stage 1 Mesothelioma

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.

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

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.
Learn More About Stage 2 Mesothelioma

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.
Learn More About Stage 3 Mesothelioma

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.
Learn More About Stage 4 Mesothelioma

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.

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.

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.

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

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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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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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Last Modified April 25, 2019

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