Stage 4 Mesothelioma

Stage 4 mesothelioma is the most advanced form of the disease, often accompanied by severe symptoms and an extremely poor prognosis.

Key Points

  • 1

    A Stage 4 mesothelioma diagnosis indicates that the disease has spread significantly and usually involves the lymphatic system.

  • 2

    Stage 4 symptoms of mesothelioma are systemic and are the most severe at this stage.

  • 3

    Because of the extensive nature of Stage 4 mesothelioma, treatment is mostly focused on palliative care (symptom relief).

  • 4

    Prognosis is the least favorable for Stage 4 patients.

Stage 4 mesothelioma is the most advanced form of the disease. In stage 4, the disease has traveled from the primary site to distant locations on one or both sides of the body. In the case of mesothelioma, Stage 4 cancer usually spreads throughout the chest cavity, into the abdomen, and may also travel to the brain. The lymph nodes are extensively involved and curative surgery is typically not a treatment option, leading to a very poor prognosis.

Prognosis of Stage 4 Mesothelioma

A mesothelioma patient’s prognosis varies depending on a number factors. However, mesothelioma patients diagnosed with Stage 4 generally have a median survival rate of about 12 months. Because curative treatment isn’t likely an option, the cancer will continue to spread and cause respiratory or heart failure. Survival may be prolonged due to a number of factors, including cell type, overall patient health, response to treatment, age, and gender.

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Stage 4 Defined By Three Staging Systems

The three systems commonly used to define the stages of mesothelioma include the Butchart System, the Tumor, Node, Metastasis System (TNM), and the Brigham System. Each system categorizes the four stages based on slightly different cancer characteristics and behaviors.

The characteristics of Stage 4 mesothelioma as defined by the three systems are as follows:

Butchart System

The disease has spread through the bloodstream to distant organs.

TNM System

The tumor has metastasized to the other side of the body and both lungs may be affected. Often, the organs in the neck are involved and nearby and distant lymph nodes are also affected.

Brigham System

Stage 4 indicates that surgery is no longer a possibility because of the spread of the disease and the likelihood for recurrence if tumors were indeed removed.

Symptoms of Stage 4 Mesothelioma

In Stage 4, symptoms become even more severe and may affect other parts of the body, depending on where the cancer has spread.

Stage 4 Mesothelioma Symptoms

  • Fever and night sweats
  • Chest tightness and pain
  • Shortness of breath and difficulty breathing
  • Abdominal pain
  • Fluid accumulation in chest or abdomen
  • Weight loss
  • Difficulty swallowing (dysphagia)
  • Coughing up blood (hemoptysis)

Stage 4 Treatment Options

Treatment of Stage 4 mesothelioma is individualized for each patient based on the tumor location and type, the likelihood of response to treatment, and ability to tolerate surgery. The tumors, however, have usually spread so much that complete resection with surgery is not an option. Stage 4 patients with poor general health and unresectable mesothelioma tumors may choose palliative treatment.

In general, standard multimodal treatment plans that combine surgery, radiation, and chemotherapy are not an option for Stage 4 mesothelioma patients. However, some combination of the following may be used in addition to palliative options to manage pain and improve quality of life.


Surgery may be performed for palliative reasons in order to reduce symptoms, ease pain, and improve quality of life. In addition to tumor removal, doctors may also perform procedures to reduce fluid buildup, including thoracentesis, paracentesis, or pericardiocentesis, depending on the type of mesothelioma.


Preoperative (neoadjuvant) chemotherapy may reduce tumor size and aid surgical resection when doctors are trying to remove tumor mass. Successful chemotherapy can reduce symptoms and prolong survival. The most common chemotherapy combination for Stage 4 patients is cisplatin and pemetrexed, which has been shown to achieve a median survival of 12.1 months.


Radiation therapy may be used to reduce tumor size and thus alleviate chest pressure, though radiation is not often recommended at this stage.

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Sources & About the Writer [+]
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  • About The Writer Photo of Dan Heil Dan Heil

    Dan is a contributing writer for The Mesothelioma + Asbestos Awareness Center. He hopes to help educate on everything related to a mesothelioma diagnosis and answer any questions patients or family members may have.