Stage 3 Mesothelioma

In Stage 3 mesothelioma, the cancer has spread to several areas beyond the point of the initial tumor.

Key Points

  • 1

    More patients are diagnosed with stage 3 mesothelioma than any other stage.

  • 2

    This stage often indicates spreading to other organs, including the lymph nodes.

  • 3

    Symptoms for stage 3 are usually more severe and greatly impact quality of life.

  • 4

    Curative therapy is still an option, though plans often focus on relieving symptoms.

Stage 3 mesothelioma is classified as advanced disease given that, by this point, it has spread to areas beyond where it originated, though the cancer is still localized to some extent. The mesothelioma has spread throughout the lung lining and chest on one side of the body, and the cancer has invaded the lymph nodes.

There may also be tumors beyond the chest membranes affecting the chest wall itself, fatty tissue in the chest, or the heart lining (the pericardial membrane), regardless of whether local lymph node involvement is identified.

The majority of mesothelioma patients (roughly 70% according to one study) are diagnosed at Stage 3 or 4. In that same study, 57% of pleural mesothelioma patients were Stage 3 when diagnosed. Curative treatment becomes less likely, and prognosis is often poor.

Prognosis of Stage 3 Mesothelioma

Prognosis for Stage 3 patients depends on a number of factors, including the success of treatment. In general, most Stage 3 patients are not eligible for curative surgery, and the overall median survival for Stage 3 mesothelioma patients is between 12 and 24 month

Stage 3 Defined By Three Staging Systems

There are three systems used to stage mesothelioma known as the Butchart System, the Tumor, Node, Metastasis System (TNM), and the Brigham System. Each system defines the four stages of mesothelioma with slight differences.

The characteristics of Stage 3 mesothelioma according to the three systems are as follows:

Butchart SystemTNM SystemBrigham System
The disease has spread from the primary area in the pleura to the lungs, abdominal cavity, and other parts of the body. Both nearby and distant lymph node groups may also be involved.The cancer has spread from the lining of the lungs to other parts of the chest cavity including the esophagus, diaphragm, and other vital organs including the heart. The lymph nodes are also involved at this stage, including distant groups.Surgery for tumor removal is no longer a possibility because the disease is now affecting other organs in the chest cavity as well as one or more groups of lymph nodes.

Symptoms of Stage 3 Mesothelioma

In Stage 3, symptoms become much more severe and negatively impact a patient’s quality of life. Symptoms may result from tumors invading the lung tissue and chest cavity, but vary depending on how the cancer is advancing. In some mesothelioma patients, the symptoms are similar to the symptoms of lung infections like pneumonia and bronchitis.

  • Chest pain or tightness
  • Difficulty breathing
  • Shortness of breath (dyspnea)
  • Fever
  • Fatigue
  • Weight loss

Stage 3 Treatment Options

At this stage, treatment generally focuses on symptom relief (palliative) and improving prognosis, though curative surgery may still be an option in some eligible patients. For patients who aren’t candidates for curative surgery, palliative options include thoracentesis, paracentesis, or pericardiocentesis, depending on the type of mesothelioma.

Multimodal therapy is standard and recommended for overall healthy and eligible patients at this stage, and a combination of the following three standard treatment options has resulted in the most favorable survival rates:

While many Stage 3 patients aren’t candidates for surgery, an extrapleural pneumonectomy may be recommended in order to remove tumors spreading to nearby organs and lymph nodes. In Stage 3 patients whose surgery was successful in removing all visible tumors, the median survival was 34 months.Chemotherapy is used after surgery to eliminate any remaining mesothelioma cells.Radiation may be administered before or after surgery, either to reduce the risk of recurrence or shrink tumors. A study of Stage 3 patients who underwent radical pleurectomy surgery followed by combined chemotherapy and radiation therapy resulted in a median survival of 21 months, with 28% still alive after 5 years.
Send Me a Free Guide Guide Photo
Sources [+]
  • 1 Berk, S., et al. (2012). "Clinical characteristics, treatment and survival outcomes in malignant mesothelioma: eighteen years' experience in Turkey." Asian Pac J Cancer Prev 13(11): 5735-5739.
  • 2 Bolukbas, S., et al. (2013). "Factors predicting poor survival after lung-sparing radical pleurectomy of IMIG stage III malignant pleural mesothelioma." Eur J Cardiothorac Surg 44(1): 119-123.
  • 3 Cao, C., et al. (2011). "Staging of patients after extrapleural pneumonectomy for malignant pleural mesothelioma--institutional review and current update." Interact Cardiovasc Thorac Surg 12(5): 754-757.
  • 4 Cao, C., et al. (2012). "Systematic review of trimodality therapy for patients with malignant pleural mesothelioma." Ann Cardiothorac Surg 1(4): 428-437.
  • 5 De Laet, C., et al. (2014). "Malignant Pleural Mesothelioma : Rationale for a New TNM Classification." Acta Chir Belg 114(4): 245-249.
  • 6 Flores, R. M., et al. (2008). "The impact of lymph node station on survival in 348 patients with surgically resected malignant pleural mesothelioma: implications for revision of the American Joint Committee on Cancer staging system." J Thorac Cardiovasc Surg 136(3): 605-610.
  • 7 Friedberg, J. S., et al. (2012). "Radical pleurectomy and intraoperative photodynamic therapy for malignant pleural mesothelioma." Ann Thorac Surg 93(5): 1658-1665; discussion 1665-1657.
  • 8 Heelan, R. T., et al. (1999). "Staging of malignant pleural mesothelioma: comparison of CT and MR imaging." AJR Am J Roentgenol 172(4): 1039-1047.
  • 9 Kao, S. C., et al. (2013). "Use of cancer therapy at the end of life in patients with malignant pleural mesothelioma." Support Care Cancer 21(7): 1879-1884.
  • 10 Nickell, L. T., Jr., et al. (2014). "Multimodality imaging for characterization, classification, and staging of malignant pleural mesothelioma." Radiographics 34(6): 1692-1706.
  • 11 Okubo, K., et al. (2009). "Survival and relapse pattern after trimodality therapy for malignant pleural mesothelioma." Gen Thorac Cardiovasc Surg 57(11): 585-590.
  • 12 Raja, S., et al. (2011). "Malignant pleural mesothelioma." Curr Oncol Rep 13(4): 259-264.
  • 13 Rice, D.C. (2015). Staging of Malignant Pleural Mesothelioma: A Guideline for Patients. M.D. Anderson Cancer Center, University of Texas.
  • 14 Rosenzweig, K. E., et al. (2012). "Pleural intensity-modulated radiotherapy for malignant pleural mesothelioma." Int J Radiat Oncol Biol Phys 83(4): 1278-1283.
  • 15 Rusch, V. W., et al. (2012). "Initial analysis of the international association for the study of lung cancer mesothelioma database." J Thorac Oncol 7(11): 1631-1639.
  • 16 Tan, W.W. (2014). Malignant Pleural Mesothelioma Staging.  Emedicine  Accessed 2/25/2016.
  • 17 Van Schil, P. E., et al. (2010). "Trimodality therapy for malignant pleural mesothelioma: results from an EORTC phase II multicentre trial." Eur Respir J 36(6): 1362-1369.
  • 18 Zauderer, M. G. and L. M. Krug (2012). "Pleurectomy/decortication, chemotherapy, and intensity modulated radiation therapy for malignant pleural mesothelioma: rationale for multimodality therapy incorporating lung-sparing surgery." Ann Cardiothorac Surg 1(4): 487-490.