What Is Stage 4 Mesothelioma?
Stage 4 is the final stage of mesothelioma. It means the cancer has spread (metastasized) far beyond where it first formed.
Doctors use the TNM staging system — which stands for tumor, nodes, and metastasis — to determine how far the cancer has progressed and which treatments might help. This system is used across all four stages of mesothelioma.
At stage 4, the cancer may:
- Grow into nearby organs and tissues
- Spread to lymph nodes on both sides of the chest
- Reach distant organs like the liver, kidneys, or lungs
The TNM staging system is used specifically for pleural mesothelioma. Doctors use other methods to determine if and how far peritoneal mesothelioma has spread.
Get help with an advanced-stage mesothelioma diagnosis. Use our Free Doctor Match to connect with specialists near you today.
Stage 4 Mesothelioma By Cancer Type
Mesothelioma is caused by asbestos exposure. Asbestos is a toxic mineral that was used in many products until the early 1980s. Breathing in or swallowing asbestos can lead to the development of mesothelioma in four main parts of the body.
The four types of mesothelioma include:
- Pleural mesothelioma: Cancer of the pleura (lung lining). Stage 4 pleural mesothelioma has spread through tissue, lymph nodes, or blood vessels to distant parts of the body, forming new tumors.
- Peritoneal mesothelioma: Cancer of the peritoneum (abdominal cavity). Stage 4 peritoneal mesothelioma isn’t a formal diagnosis, but it indicates a significant amount of cancer present throughout the abdomen. The further the spread of cancer, the higher the stage.
- Pericardial mesothelioma: Cancer of the pericardium (heart lining). In its advanced stages, this type may spread to the lungs, kidneys, or liver.
- Testicular mesothelioma: Cancer of the tunica vaginalis (membrane lining the testes). It can spread to lymph nodes, lungs, peritoneum, or pleura.
The other types of mesothelioma don’t have an official staging system, as they are rarer and spread differently than pleural mesothelioma.
However, some oncologists (cancer doctors) use the peritoneal cancer index (PCI) to informally stage peritoneal mesothelioma.
Mesothelioma Stage 4 Symptoms
As mesothelioma progresses and spreads to other parts of the body, symptoms may worsen or extend to other areas.
Common stage 4 mesothelioma symptoms include:
- Abdominal pain
- Anemia
- Chest pain
- Chronic fatigue
- Coughing up blood
- Difficulty swallowing
- Fever
- Muscle atrophy
- Night sweats
- Shortness of breath
- Weight loss
If you’re experiencing symptoms of stage 4 mesothelioma, our team is here to help. Contact us any time for information, support, and recommendations for mesothelioma specialists in your area.
Treatment Options for Mesothelioma Stage 4
Stage 4 malignant mesothelioma treatment may involve chemotherapy, immunotherapy, radiation, and participation in clinical trials.
While each patient’s experience is different, the most commonly used stage 4 mesothelioma treatment is chemotherapy.
Surgery
Stage 4 mesothelioma cancer patients are not typically candidates for surgery. At this stage, it may not be possible to remove all the cancer as it has usually spread to different parts of the chest wall or grown through the diaphragm, pleura, or thoracic organs.
In some cases, doctors may recommend surgery to debulk or reduce the size of tumors, which could help make chemotherapy and other cancer treatments more effective.
Palliative mesothelioma surgery may also help ease discomfort caused by tumors pushing on bones or nearby organs. For example, surgery may improve breathing by reducing tumors around the pleura.
Chemotherapy
Chemotherapy is the standard treatment option for stage 4 mesothelioma patients. It uses powerful drugs to kill cancer cells.
The preferred regimen for stage 4 mesothelioma is a combination of two chemotherapy drugs called cisplatin and pemetrexed (Alimta®).
Adding a targeted therapy called bevacizumab to standard chemotherapy has also shown promise as an effective mesothelioma treatment option. According to the American Cancer Society (ACS), these targeted cancer drugs sometimes work when standard chemotherapy drugs don’t — often with less severe side effects.
Chemotherapy Story: Stage 4 Mesothelioma Survivor
John Stahl, a retired construction worker from Nevada, was diagnosed with stage 4 malignant pleural mesothelioma in 2019. Despite his advanced-stage diagnosis and poor prognosis, John is still alive 6 years later, living out his dream retirement with his wife.
“I’m doing very well, as a matter of fact. I play golf twice a week. I ride the side-by-side. I go hang out with my friends when they’re around. Yeah, I’m pretty well back to normal.”
Immunotherapy
Immunotherapy is a newer type of mesothelioma treatment that works by enhancing the immune system’s ability to target and destroy cancer cells.
Immunotherapy may be an option for stage 4 patients since it is less aggressive than surgery and has a shorter downtime between treatments. However, every patient’s experience is different.
Approved immunotherapy drugs for mesothelioma include:
- Opdivo® (nivolumab) with Yervoy® (ipilimumab)
- Keytruda® (pembrolizumab)
Learn more about this treatment by downloading our Free Guide to Immunotherapy for Mesothelioma.
Radiation Therapy
During radiation therapy, doctors use high-energy rays to damage the DNA of cancer cells.
For stage 4 mesothelioma, radiation therapy is most commonly used to help shrink painful tumors that are pressing on nearby nerves or organs.
Radiation may also be used alongside chemotherapy to destroy as much of the cancer as possible.
Clinical Trials
Stage 4 mesothelioma patients who aren’t eligible for or haven’t responded to traditional treatments may want to consider enrolling in a clinical trial.
These studies explore promising new therapies and help researchers discover better ways to treat mesothelioma.
Some current end-stage mesothelioma trials include:
- SW-682 in Advanced Solid Tumors. This trial is testing an experimental pill called SW-682 in people with advanced mesothelioma that can’t be removed by surgery.
- IAG933 in Patients With Advanced Mesothelioma. This clinical trial is looking at a new pill called IAG933 for people with late-stage mesothelioma, especially those with a change in the NF2 gene that helps cancer grow and spread.
- MEDI5752 in Combination With Carboplatin Plus Pemetrexed (eVOLVE-Meso). In this phase III trial, doctors are testing a combination of chemotherapy and the immunotherapy drug Keytruda® in people with inoperable pleural mesothelioma.
Interested in pursuing a clinical trial? Our Oncology Nurse Navigator can help you find one that fits your situation. Call us at (866) 608-8933 to get started.
Side Effects of Treatment
Each of these treatments for stage 4 mesothelioma may have side effects. It can be helpful to know what you may expect before starting a new treatment protocol.
Common side effects of treatment include:
- Constipation
- Diarrhea
- Fatigue
- Flu-like symptoms
- Hair loss
- Loss of appetite
- Mouth sores
- Nausea
- Skin irritation
Your mesothelioma doctor can help you manage any side effects and make treatment more tolerable.
Stage 4 Mesothelioma Without Treatment
Some patients choose not to pursue treatment for their stage 4 mesothelioma cancer diagnosis. They may not want to experience treatment side effects or may be unable to pay for their medical costs.
Without treatment, the average pleural mesothelioma stage 4 life expectancy is around 6 months. In most cases, stage 4 mesothelioma patients are encouraged to pursue palliative care to ease their symptoms.
Even if doctors can’t stop or slow the cancer, palliative treatment can still help improve quality of life for people with advanced mesothelioma.
Additionally, there are many options to manage treatment-related side effects. In many cases, financial compensation is available to help cover medical bills and out-of-pocket expenses.
Stage 4 Mesothelioma Palliative Care
Palliative care describes treatment that relieves pain and increases comfort and well-being.
Palliative care options for stage 4 mesothelioma include:
- Fluid removal: Doctors may perform a thoracentesis to drain fluid buildup in the chest cavity and around the lungs to make breathing easier. Paracentesis can also be used to drain abdominal fluid buildup to help with swelling and appetite loss.
- Medication: Doctors may prescribe medication such as morphine to help with pain management.
- Tumor debulking surgeries. Palliative surgery for mesothelioma may include resection, or partially removing tumors to alleviate pain or pressure.
Get connected with a mesothelioma doctor who can help design a treatment plan for your diagnosis. Use our Free Doctor Match to get started.
Mesothelioma Stage 4 Life Expectancy
The average amount of time doctors expect a patient to live after their diagnosis is known as mesothelioma life expectancy. Life expectancy is usually measured in months.
The average stage 4 mesothelioma life expectancy is 12 months. Stage 4 has the lowest survival time due to the cancer’s spread, which can limit patients from undergoing more aggressive life-extending treatments.
However, stage 4 mesothelioma survival rates are just an average — they aren’t set in stone and don’t dictate your future. Many patients have outlived their initial life expectancy and led fulfilling lives after a diagnosis.
“Patients can have hope by saying, ‘I may not get cured of this cancer, but I can live with this cancer — and I’m going to do everything I can to have the best quality of life and get the most enjoyment out of my life with whatever time I have.'”
Stage 4 Mesothelioma Prognosis
Prognosis describes how a patient’s disease is expected to progress. Patients diagnosed at stage 4 may have a poorer mesothelioma prognosis due to fewer available treatment options.
However, chemotherapy and immunotherapy can help some patients live longer. Palliative treatment may also relieve symptoms and improve quality of life.
Learn more about mesothelioma stages, prognosis, and treatment in our Free Mesothelioma Guide.
End-of-Life Planning for Stage 4 Mesothelioma
In addition to palliative and life-extending treatments, stage 4 mesothelioma cancer patients may want to consider end-of-life planning. Knowing what to expect can ease your anxiety and improve your overall well-being.
Considerations for end-of-life planning may include:
- Care setting: Decide where to receive care (hospital, hospice, at home, etc.) and designate a primary caregiver if needed.
- Dependent care: Arrange for the care of children, grandchildren, pets, or other dependents.
- Funeral arrangements: Plan for cremation or burial, funeral service details, and any religious preferences, and share these wishes with your loved ones.
- Medical preferences: Specify treatment choices, such as whether to pursue life-sustaining therapies like CPR, ventilation, or artificial nutrition and hydration.
- Personal records: Ensure your loved ones have access to important documents, including social security numbers, banking information, and passwords.
- Will and financial planning: Draft or review a will, ensuring you account for income, assets, investments, and personal possessions.
While these conversations can be challenging, discussing your plans with loved ones and your doctor in advance will ensure your wishes are respected.
Get Support for Stage 4 Mesothelioma
If you or a loved one has been diagnosed with stage 4 mesothelioma cancer, you are not alone. Our team is standing by to provide support and guidance at every step.
We can help you:
- Find a doctor to pursue life-extending or palliative care
- Connect with support groups and peer mentors
- Answer questions about what to expect during treatment
- Pursue financial compensation for your family
Contact us or call us at (866) 608-8933 for support right now.
Stage 4 Mesothelioma FAQs
How long do you live with stage 4 mesothelioma?
The average mesothelioma stage 4 life expectancy is 12 months. However, each patient is unique. Depending on which treatments you qualify for and how your cancer responds, you could live much longer.
A mesothelioma doctor can give you a better idea of your prognosis after you’ve been diagnosed.
What is the final stage of mesothelioma?
The mesothelioma final stages can last years, months, weeks, or days, depending on the individual. End-stage mesothelioma symptoms will be different for each patient but may include difficulty breathing, severe pain, coughing, or abdominal swelling.
Patients may benefit from hospice care during the final stages of mesothelioma to address symptoms, live more comfortably, and receive support from caregivers and family members.
How bad is stage 4 mesothelioma?
Stage 4 mesothelioma is usually considered terminal. In this final stage, the cancer has spread to other areas of the body through blood, tissue, and lymph nodes.
Late-stage mesothelioma patients are generally not eligible for tumor-removing surgeries and usually receive chemotherapy and palliative care to reduce their pain and make them more comfortable.
However, stage 4 mesothelioma cancer is not a guaranteed death sentence. Some survivors have outlived their initial prognosis by several years, and some are still living life to the fullest today.
What are stage 4 mesothelioma survival rates?
Stage 4 mesothelioma survival rates describe the percentage of mesothelioma patients who are still alive a specific number of years after being diagnosed.
Late-stage mesothelioma has a 5-year survival rate of 8%, according to the ACS.
Can stage 4 mesothelioma go into remission?
Technically, yes — but it’s uncommon. Some mesothelioma patients have experienced remission, and many others have reached stable disease status, meaning the cancer is not shrinking or growing.
Targeted treatments from a mesothelioma specialist will give you or your loved one the best shot at reaching remission or stable disease.
What is stage 4 peritoneal mesothelioma?
Peritoneal mesothelioma doesn’t have an official staging system like pleural mesothelioma does.
Oncology doctors may use the peritoneal cancer index (PCI), which measures how far the cancer has spread from where it originated.
Late-stage peritoneal mesothelioma may refer to cancer that has spread significantly.
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