What Is Stage 4 Mesothelioma?

This type of cancer is known to have a long latency period. This means that the time between initial asbestos exposure and the onset of symptoms is delayed, sometimes upwards of 50 years. This is why most patients are diagnosed with the disease at later stages. It’s not until the cancer begins to advance, often at stage 4 mesothelioma, that symptoms become severe enough that a patient sees a doctor.

When diagnosed at stage 4, mesothelioma is no longer localized and has begun spreading throughout the body. Symptoms are typically the most intense at this stage. While limited, palliative treatment can still be an option for managing stage 4 mesothelioma and keeping patients comfortable.

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Location of the disease in a patient’s body can determine how the tumors develop.

This is an image of a lung with stage 4 cancer.

Stage 4 Pleural Mesothelioma

Pleural mesothelioma is the most common form of the disease, affecting the pleura (lining of the lungs and chest). This is the only form with a defined staging system.

Of the three staging systems — the Brigham, the Butchart, and the TNM — the TNM staging system has become the go-to for doctors when staging the disease. It evaluates the extent and location of the tumors (T), lymph node involvement (N), and metastasis (M) or spread of the cancer.

At stage 4, the cancer has metastasized throughout the body, reaching distant organs. Resective surgery to remove the cancer is no longer an option, however, there are treatment options available to improve the quality of life while living with the disease.

The TNM scale categorizes stage 4 mesothelioma as:

  • The primary tumor is no longer resectable (able to be removed via surgery)
  • Spread is no longer localized and has reached the lymphatic system
  • Distant spread to other organs

This is an image of stage 4 peritoneal mesothelioma.

Stage 4 Peritoneal Mesothelioma

Peritoneal mesothelioma occurs in the abdomen and is a very rare condition. As a result, there is no defined staging system for this form of the disease.

Doctors often rely on the Peritoneal Cancer Index (PCI) for staging tumors that develop in the peritoneum. It measures the extent of metastasis and provides a score between 0 and 39, with higher scores representing more aggressive cancers. Stage 4 patients usually have a high PCI score, indicating a likely terminal cancer. At this stage, there is extensive spread throughout the body, and a viable treatment plan is likely limited to palliative care to lessen symptoms and offer pain relief.

This is an image of stage 4 pericardial mesothelioma.

Stage 4 Pericardial Mesothelioma

The rarest form of the disease, pericardial mesothelioma, targets the lining of the heart. As with peritoneal, there is no established staging system. Doctors can look to the American Joint Committee on Cancer (AJCC) 1 through 4 scale, however, the pericardial form is often not diagnosed until advanced stages or after the patient has passed away.


When diagnosed at stage 4, mesothelioma patients experience worsening symptoms. Symptoms will vary based on where the cancer is located in the body. Treatment options may be available to relieve symptoms and improve the patient’s quality of life.

Symptoms can encompass:

  • Abdominal or chest pain
  • Anemia
  • Chronic fatigue
  • Coughing up blood (hemoptysis)
  • Difficulty swallowing (dysphagia)
  • Fluid buildup in the abdomen or chest
  • Night sweats
  • Shortness of breath (dyspnea)
  • Pain or tightness in the chest
  • Severe weight loss

Survival Rates

Unfortunately, stage 4 mesothelioma carries the poorest prognosis. Patients diagnosed at this stage usually have a life expectancy of around a year. There are many support resources available to help patients and their families through this difficult time.

It’s also important to keep in mind that each case is different. Treatment may be available to extend a patient’s life expectancy, and patients have exceeded their original prognoses.

Treatment Options

If you or a loved one has experienced symptoms or received a positive diagnosis, it’s important to seek out a second opinion. A specialist will be able to provide an accurate diagnosis and help you decide on a tailored treatment plan.

Treatment options are largely dependent on patient health. Surgery, chemotherapy, radiation, immunotherapy, and clinical trials may all still be available to stage 4 patients as a form of cancer and pain management.

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