Infographic showing how mesothelioma stage 4 metastasizes in the liver, lymph nodes, abdomen, and distant organs and has a 12% survival rate.
What Is Stage 4 Mesothelioma?

Stage 4 mesothelioma is the final and most severe form of this cancer. A good portion of diagnoses for mesothelioma happens in stage 4 as the ongoing symptoms of the disease become harder to ignore. Symptoms like severe, persistent chest pain, trouble breathing from fluid buildup in the chest or abdomen, and coughing up blood may occur in stage 4.

Doctors often diagnose mesothelioma using imaging scans like X-rays, CT scans, PET scans, and MRI scans. On the scan, stage 4 mesothelioma is easily spotted through the deformities present in or around the lungs. Since the lining of the lungs is typically the first to be infected, the doctors may look for any disturbances first before moving to examine other organs in the body.

When this far along, tumors have already spread to other regions in the body and symptoms are the most severe. Stage 4 usually has the poorest prognosis, with a life expectancy of approximately a year. Treatments at this stage will most likely be palliative. Palliative treatments don’t cure the patient but help them better manage their symptoms in order to have a more comfortable end of life.

Stage 4 Life Expectancy and Treatment by Mesothelioma Type

What type of mesothelioma you have depends on where the cancer is located. The cancer can be found in the chest, abdomen, heart, and testicle areas, but is most often found in the lungs. Life expectancy for a person with mesothelioma can vary greatly from stage to stage. By the time a person is into stage 4, there are minimal treatment options and general life expectancy is low.

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

Stage 4 Pleural Mesothelioma

After receiving a mesothelioma diagnosis, your doctor should discuss what form you have. Pleural mesothelioma is the most commonly diagnosed form of this cancer. The infected areas include the pleura or lining of the lungs and chest. A person with stage 4 pleural mesothelioma has hit metastasis. The cancer has moved from the primary spot of infection and spread into other areas and organs.

Three staging systems for pleural mesothelioma can be used to diagnose stage 4. The Brigham, the Butchart, and the TNM staging systems all are used for various cancer staging. The TNM staging system has become the go-to for doctors when staging mesothelioma because it evaluates the extent and location of the tumors (T), lymph node involvement (N), and metastasis (M) or spread of cancer.

The TNM scale categorizes stage 4 mesothelioma as:

  • Primary tumor is no longer removable with 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

A second area where mesothelioma may occur is in the peritoneum. Peritoneal mesothelioma occurs in the abdomen and is rarely diagnosed because of low infection rates. Doctors may use the Peritoneal Cancer Index (PCI) to stage peritoneal mesothelioma correctly. It measures the extent of metastasis and provides a score between 0 and 39. The higher scores represent more aggressive cancers, whereas lower numbers signal less intrusive cancers. Stage 4 patients usually have a high PCI score indicating a likely terminal cancer diagnosis.

Many people with this cancer don’t show signs of symptoms until advanced stages. Symptoms specific to peritoneal mesothelioma may be abdominal pain, nausea, and changes in bowel movements. Women are also more likely to be diagnosed with this form than men.

This is an image of stage 4 pericardial mesothelioma.

Stage 4 Pericardial Mesothelioma

Having any issues with your heart can cause significant problems. Pericardial mesothelioma is a form of cancer where tumors are found in and around the heart. It is extremely rare to be diagnosed with it, but there are cases found. Metastasis of pericardial mesothelioma in stage 4 may be deadly. If the heart isn’t able to function then it won’t be able to pump blood and oxygen into the rest of the body, ultimately causing death.

Similar to peritoneal, there is no established staging system for pericardial. Doctors can look to the American Joint Committee on Cancer (AJCC) and their stages 1 through 4 scales for guidance. Pericardial mesothelioma is often not diagnosed until advanced stages or after the patient has passed away.

Stage 4 Testicular Mesothelioma

Stage 4 testicular mesothelioma is the rarest form of this cancer. Less than a couple hundred cases have been identified, leaving little information available. Diagnosing testicular tumors may need the help of a specialist doctor. To diagnose testicular mesothelioma, imaging scans and biopsies may be used to find the tumors.

The rarity of this form means little research has been performed to learn about testicular mesothelioma and how it occurs. Survival rates for stage 4 testicular mesothelioma are very slim, with less than half of people diagnosed living past 5 years. Testicular mesothelioma is mostly diagnosed in men between the ages of 50 and 75 years old.

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What are the Symptoms at Stage Four?

A patient in stage 4 mesothelioma may experience aggressive, painful symptoms. Stage 4 cancer means the infection has metastasized and spread to other organs in the body. This process may be very painful and can cause a person unknown to their disease to seek information about what is causing their pain. A lot of mesothelioma diagnoses come in stage 3 or 4 because of the painful onset of symptoms.

Symptoms will vary based on where the cancer is located. Treatment options may be available to relieve symptoms and improve the patient’s quality of life. Oftentimes treatment options are minimal in stage 4 and patients turn to palliative care to manage their symptoms. Many of the symptoms in stage 4 are similar to other stages but are typically more persistent.

Possible symptoms may include:

  • 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

Stage 4 Survival Rates by Age

Unfortunately, stage 4 mesothelioma carries the poorest prognosis. Patients diagnosed at this stage usually have a life expectancy between 6 to 26 months. Looking at the 5-year survival rate isn’t any better at prognoses being less than a year. Survival rates vary vastly because of many factors; one that may impact the patient’s age significantly. A generally healthy person younger than the age of 50 may have a better prognosis than a person 70 or older. Again, prognoses are not always accurate and cannot be attributed to everyone.

What Are the Treatment Options for Late Stage Cancer

Treatment for stage 4 mesothelioma may be difficult to navigate. Since the cancer has metastasized and is no longer resectable with surgery, other traditional options for treating cancer can be explored. Chemotherapy, radiation, targeted therapy, and palliative care may all be viable options in stage 4.

Patients may also seek out a mesothelioma clinical trial. There are trials aimed at finding new treatments and therapies to cure mesothelioma. Each clinical trial has specific guidelines to join and may include requirements such as type of mesothelioma, location of tumors, age, gender, and more.

How Long do you Live With Stage 4 Mesothelioma?

How long a person can survive with stage 4 mesothelioma depends on a few factors. One that could have a huge impact is whether you decide to seek treatment. By the time you hit stage 4 cancer, your chances of survival are very small. Treatment can extend your prognosis, but it ultimately may not help you survive in the long run.

Survival without treatment is estimated to be 6 months. Those who seek various treatments may survive between 12 and 26 months. All survival rates are estimated and can vary greatly from patient to patient. Other factors that may contribute to your mesothelioma survival rate are age, gender, location and type of tumor, and general health of the person.

Questions After a Stage 4 Diagnosis

Feelings of being overwhelmed, scared, or nervous may occur after receiving a stage 4 mesothelioma diagnosis. Knowing the right questions to ask could help relieve your feelings of anxiousness. These are some questions that may be worth asking your doctor:

It can be a scary reality to learn about a stage 4 diagnosis with mesothelioma, but support is available to help you through your journey. Our patient advocate team is well-versed in mesothelioma support, either financially or medically. Connect with our team today to learn about your rights and feel prepared.


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