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Last Edited On: 02/02/2024

Written by Karen Selby, RNEdited By Walter PachecoMedically Reviewed By Dr. Jacques Fontaine

Key Facts About Mesothelioma Staging
  • Mesothelioma staging assesses the extent of tumor progression.
  • There are four stages of pleural mesothelioma.
  • Doctors use the Tumor Node Metastasis system to stage pleural mesothelioma tumor progression.
  • Without an official staging system for peritoneal mesothelioma, doctors often use a version of the TNM system.
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What Does My Mesothelioma Stage Mean?

Cancer staging significantly impacts treatment options. People with mesothelioma can learn how staging affects treatment to make more informed choices. 

Stages of Pleural Mesothelioma:
  • Stage 1: Early tumor growth occurs along the mesothelial lining of one lung.
  • Stage 2: Mesothelioma has spread to nearby lymph nodes.
  • Stage 3: Tumors have invaded deeper tissues in nearby organs and distant lymph nodes.
  • Stage 4: Metastasis is present, and tumors have formed in distant body parts.

Early-stage patients often consider aggressive treatment combinations with surgery. Mid-stage patients may face tough choices about whether they want to pursue more aggressive treatment options. Those diagnosed with late-stage mesothelioma may consider palliative care to extend survival and improve symptoms of mesothelioma.

Why Is Mesothelioma Staging Done During Diagnosis?

Staging is a part of diagnosing mesothelioma because it describes how much the cancer has progressed. Beyond being a diagnostic tool, staging serves as a compass, guiding healthcare professionals and patients through the intricate landscape of treatment decisions. 

The mesothelioma stage is a standard set of describing factors that doctors observe and influence how they treat cancer. The best treatment for a particular stage may involve surgery, chemotherapy, immunotherapy, radiation or a combination.

Our goal at The Mesothelioma Center is to identify what type of specialist is going to be right for each patient. And it’s going to be different depending on where their cancer is, the stage of their cancer, where they are demographically.

Cancer staging provides critical insights that inform your doctor about the location of your tumors. Staging during diagnosis ensures your provider can treat all your tumors and limit the impact of cancer spread.

Knowledge about staging empowers patients to not only understand the implications of the disease’s spread, but to make informed choices about their care with their medical team. And specialists who stage mesothelioma assist patients everywhere, providing an exchange of data and research that other doctors can follow.

How Do Mesothelioma Stages Affect Prognosis and Treatment Options?

Doctors also use staging to help inform a patient’s prognosis. Early-stage mesothelioma has a better prognosis and prolonged survival. The extent of the disease determines the likelihood of success with the available treatments.

Early-stage mesothelioma patients have more treatment options than late-stage patients. Treatment is more effective in the early stages when patients have fewer tumors. Treatment still improves the prognosis for late-stage patients. Other factors, such as overall health, can also determine the most appropriate treatments.

Mesothelioma patients who are our best candidates for surgery have early stage mesothelioma, meaning the cancer is just in the lining around the lung. It hasn’t spread to the lymph nodes, and it hasn’t metastasized or gone to other organs.

Dr. Jacques Fontaine, Director of the Mesothelioma Research and Treatment Center at the Moffitt Cancer Center

The more treatment options a patient has, the more likely they will have a favorable prognosis. “If we see the mesothelioma is only in the chest, for example, the best treatment is usually a combination of surgery and chemotherapy,” Dr. Fontaine told The Mesothelioma Center.

The typical mesothelioma life expectancy ranges from 22.2 months at stage 1 to 14.9 months at stage 4. Mesothelioma survival rate data is based on cases diagnosed years ago and cannot predict individual survival. Recent advancements in treatment have also helped people at all stages live longer with mesothelioma.

How Do Mesothelioma Staging Systems Determine Pleural Stages?

Doctors primarily use biopsy procedures and imaging tests, such as CT scans or X-rays, to stage pleural mesothelioma. “The way we determine the stage is with a CT or PET scan,” Dr. Jacques Fontaine, director of the Mesothelioma Research and Treatment Center at the Moffitt Cancer Center, shared with The Mesothelioma Center. 

“If we see the mesothelioma is only in the chest, for example, the best treatment is usually a combination of surgery and chemotherapy,” said Fontaine. Biopsies can detect cancer in lymph nodes. Biopsies can detect cancer in lymph nodes. Imaging scans visualize the size and location of tumors.

Stages of Mesothelioma

Stage 1 Mesothelioma Illustration
Stage 1 Mesothelioma

Tumors begin to form on the pleura.

Stage 2 Mesothelioma Illustration
Stage 2 Mesothelioma

Tumors begin to spread from original origin.

Stage 3 Mesothelioma Illustration
Stage 3 Mesothelioma

Tumors keep spreading on the pleura.

Stage 4 Mesothelioma Illustration
Stage 4 Mesothelioma

Tumors nearly encapsulate the lung.

The Tumor Node Metastasis staging system is the gold standard for staging malignant pleural mesothelioma. As Sean Marchese, RN, explains, “The stages of mesothelioma progress from stage one to stage four. Stages one and two are considered early stage, while stages three and four are considered later stage.”

The TNM is the official pleural mesothelioma staging system. The system’s initials relate to certain aspects of mesothelioma tumors: tumor size and location, lymph nodes and metastasis. Doctors are using a version of the TNM system for peritoneal mesothelioma while researchers work on developing definitions for peritoneal stages.

Stage 1 Mesothelioma

Identifying cancer is difficult at this early stage. Tumors are too small to cause pain or breathing difficulties. Patients with a known history of asbestos exposure undergo screening before experiencing symptoms. In stage 1 mesothelioma, cancer has not spread past the outer lung lining. All treatment options are most effective at this mesothelioma stage.

My wife is a nurse and noticed I was short of breath. She convinced me to see a doctor, and it basically saved my life.

Because McCarthy was diagnosed at an earlier stage, surgery was an option for him. Patients with early-stage mesothelioma often have a more favorable prognosis thanks to a broader range of treatment options. 

Continued Learning

Stage 1 Mesothelioma

Stage 2 Mesothelioma

Stage 2 mesothelioma spreads locally and develops in nearby lymph nodes. It’s generally rare for symptoms to appear in stage 2, so most diagnoses occur when seeking medical care for another condition. 

If the cancer has spread to some of the lymph nodes around the lung, that’s slightly more advanced and may qualify as stage 2 or stage 3. Doctors treat stage 2 mesothelioma with surgery, chemotherapy and radiation therapy. 

Couple using the Nutrition Guide from the Mesothelioma Center
Free Mesothelioma Nutrition Guide
Eating the right diet throughout mesothelioma treatment can ease your symptoms.

Continued Learning

Stage 2 Mesothelioma

Stage 3 Mesothelioma

Stage 3 mesothelioma tumors spread deeper to nearby tissues, organs and lymph nodes. Most symptoms appear in stage 3. New symptom developments, such as difficulty breathing or chest pain, often lead to a diagnosis at this cancer stage. 

When I was first diagnosed with stage 3 inoperable cancer and told I had a year to live, I figured I’d better hurry up and finish projects I was working on. But now my goal is to make it to the 10-year mark.

Doctors typically treat stage 3 mesothelioma with immunotherapy or chemotherapy. Some stage 3 patients are eligible for surgery. Palliative options can help control pain, improve quality of life and extend survival.

“If a doctor refers to peritoneal mesothelioma as stage 3, it usually means tumors have spread throughout the abdominal lining and to nearby lymph nodes,” Dr. Daniel Landau, medical director of Virtual Hematology at the Medical University of South Carolina, told The Mesothelioma Center.

Continued Learning

Stage 3 Mesothelioma

Stage 4 Mesothelioma

In stage 4 mesothelioma, also called late-stage mesothelioma, cancer spreads throughout the body cavity where it originated. Unlike other cancers, mesothelioma tends to metastasize locally rather than distantly. It may spread to the chest cavity or the abdominal cavity. In rare cases, mesothelioma spreads to distant body parts such as the liver, brain, bones or elsewhere.

Curative treatments are limited. Aggressive surgery for tumor removal is typically not beneficial at this mesothelioma stage. In our 2023 Mesothelioma Report: Latest Mesothelioma Survey, 37% of the Stage 4 patients we surveyed indicated they were using chemotherapy to treat their cancer.

Palliative care options include chemotherapy, Tumor Treating Fields, immunotherapy or radiation therapy. These can reduce symptoms, extend survival and improve quality of life. Clinical trials could offer experimental treatments. 

Survivor Story
Andy A. Pleural Mesothelioma Survivor

Andy A. Beating the Odds Again

Survivor Story

Andy A. 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

Continued Learning

Stage 4 Mesothelioma

Expert Q&A: Mesothelioma Stages

At what stage is mesothelioma diagnosed?

Mesothelioma can be diagnosed at any stage, from I through IV.

Answered By: Anna Nowak, internationally renowned asbestos researcher and mesothelioma advocate

How fast does mesothelioma progress?

Mesothelioma will progress at a different rate in every individual. Some people have very slow-growing diseases, and others will grow more rapidly. Sarcomatoid mesothelioma usually progresses more quickly than epithelioid mesothelioma.

Answered By: Anna Nowak, internationally renowned asbestos researcher and mesothelioma advocate

Is stage 4 mesothelioma always terminal?

Mesothelioma is a terminal cancer because it has no cure. Treatment can be painful and varies between patients, but remission is possible. Palliative treatment options may improve symptoms and quality of life, also are available.

How does staging impact a mesothelioma diagnosis?

Doctors use staging to develop mesothelioma treatment plans for a given diagnosis based on the extent of cancer progression. Physicians determine a patient’s mesothelioma prognosis by the stage of their cancer and their response to treatment.

Which staging system is used to stage for pleural mesothelioma?

The TNM staging system is the most accepted method for pleural mesothelioma staging. TNM stands for Tumor Nodule Metastasis. It measures extent of tumor growth into organ tissues, lymph nodes and distant sites in the body.

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