What Is Mesothelioma Staging?
Mesothelioma stages are used to categorize the location and spread of this cancer throughout the body. Determining the stage of a patient’s malignant mesothelioma is part of the diagnosis process. Staging helps doctors determine mesothelioma progression and identify appropriate treatment.
The stages of mesothelioma cancer are:
- Stage 1: The cancer is small and hasn’t spread past one area.
- Stage 2: Cancer has spread to nearby lymph nodes.
- Stage 3: Tumors have reached more organs and lymph nodes.
- Stage 4: The cancer has metastasized (spread) throughout the body, reaching distant organs.
Pleural mesothelioma is the only type with a formal staging system. Oncologists (cancer doctors) use other methods for determining cancer spread for patients with the other types of mesothelioma: peritoneal, pericardial, and testicular.
If you’ve been diagnosed with malignant mesothelioma, knowing your cancer stage can help you make informed health care decisions and actively participate in your treatment.
Get our Free Mesothelioma Guide today for key information on mesothelioma staging, symptoms, and treatment.
The 4 Pleural Mesothelioma Stages
Pleural mesothelioma forms in the lining of the lung (pleura) and is the most commonly diagnosed type of mesothelioma. It is the only type with an official staging system, called the tumor-node-metastasis (TNM) system.
Learn more about the four stages of pleural mesothelioma below.
The cancer is in the pleura only and hasn't begun spreading.
Treatments like surgery may improve life expectancy by several months or years.
Median Life Expectancy21 months
The cancer has spread just past the pleura and may have reached nearby lymph nodes.
Patients still have many treatment options to increase life expectancy.
Median Life Expectancy19 months
The cancer has reached nearby tissues, organs, or lymph nodes.
Some patients can get life-extending treatments, while others will opt for palliative care.
Median Life Expectancy16 months
The cancer has reached the other side of the chest and the rest of the body.
Treatments are primarily focused on easing pain, though chemotherapy may be an option.
Median Life Expectancy12 months
TNM Mesothelioma Staging System
The TNM system was created by the American Joint Committee on Cancer (AJCC) to assess cancer spread and determine mesothelioma stages.
It has three main parts:
| Tumor (T) | Node (N) | Metastasis (M) |
|---|---|---|
| Describes the size and spread of the main tumor | Indicates whether the cancer has spread to nearby lymph nodes | Shows if the cancer has spread to other parts of the body |
Doctors assign a numbered stage to the cancer from early to advanced. Stage 1 may be further broken down into either 1A or 1B based on how far the main tumor has spread. The stage helps doctors decide on the best treatments to use and predict how the cancer might respond.
Peritoneal Mesothelioma Stages
There isn’t an official staging system for other types of mesothelioma as they are rarer, have less data available, and don’t spread the same way as pleural mesothelioma does.
However, some doctors use the peritoneal cancer index (PCI) to informally stage peritoneal mesothelioma, which affects the lining of the abdomen (peritoneum).
The PCI divides the abdomen into 13 sections, giving each section a score of 0-3. A score of 0 means there is no cancer, while 3 indicates cancer is present.
- Stage 1: PCI score of 1-10
- Stage 2: PCI score of 11-20
- Stage 3: PCI score of 21-30
- Stage 4: PCI score of 31-39
Despite the lack of an official staging system for the rarer testicular mesothelioma and pericardial mesothelioma, doctors can use MRI (magnetic resonance imaging) scans, CT (computed tomography) scans, and tumor marker tests to see if and how far these cancers have spread.
“We do staging with imaging tools like MRIs, CT, and PET scans for the whole body. Sometimes we do a laparoscopy to look inside the abdomen and determine if it’s grown through the diaphragm. Once we do staging, we come up with a treatment plan.”
Symptoms by Mesothelioma Stage
Mesothelioma is caused by asbestos exposure, and the disease has a long latency period. In many cases, patients don’t experience any symptoms until 10-50 years after being exposed.
Additionally, many symptoms of mesothelioma are nonspecific, so it’s rare for this cancer to be diagnosed in the early stages. Below are some common symptoms of mesothelioma progression by stage.
Early-stage symptoms may include:
- Body aches
- Dry, persistent cough
- Fever
- Mild chest pain
- Shortness of breath
- Slight difficulty breathing
- Tightness of the chest
- Unexpected weight loss
As the cancer worsens or spreads, symptoms may become more severe. Many patients aren’t diagnosed until stage 3 or stage 4, when symptoms are persistent and noticeable.
Advanced-stage symptoms may include:
- Abdominal pain
- Anemia
- Chronic fatigue
- Coughing up blood
- Difficulty breathing
- Fatigue
- Fever
- Muscle atrophy
- Night sweats
- Weight loss
- Worsened chest pain
If you’re experiencing any of these symptoms, contact us for help getting in touch with a mesothelioma specialist for an evaluation.
Registered Nurse Amy Fair discusses the 4 stages of mesothelioma and why it's important to talk to your doctor about mesothelioma staging. View Transcript.
Duration: 1 min 06 sec
What are the stages of mesothelioma?
There are 4 stages of mesothelioma just as there are in most cancers. Stage 1 the mesothelioma is contained within the pleura. Stage 2 the disease has come outside the pleura and invaded into the fatty tissue of lung or the diaphragm. Stage 3 is where it’s metastasized into local organs and stage 4 is where it’s metastasized into distant organs, lymph nodes, and tissue.
Staging is important in mesothelioma as is in any cancer. It drives your prognosis; it drives your treatment modalities. It’s important to know if you’re a surgical candidate and the staging of your disease drives that decision. It’s important to discuss staging after you’ve had your CT or PET scan with your surgeon or oncologist.
Treatment for the 4 Stages of Mesothelioma
The stages of mesothelioma cancer play a significant role in planning treatments. Medical teams use the mesothelioma stage to determine if the cancer is resectable (removable) and if a patient is likely to respond well to surgery.
Doctors may decide to focus mesothelioma treatment on life-extending or palliative (symptom-relieving) options depending on the spread of the cancer, the patient’s personal wishes, and other factors.
Stage 1 Mesothelioma Treatment
Since stage 1 mesothelioma means the cancer has only just started to form, patients have the best prognosis and are usually good candidates for various types of treatment.
Stage 1 mesothelioma can usually be treated with:
- Chemotherapy
- Radiation
- Surgery
- Other treatment options such as immunotherapy
It’s not common to be diagnosed with stage 1 mesothelioma because of the cancer’s long latency period. However, stage 1 patients may qualify for surgery to fully remove all visible tumors. This may be harder to achieve in later mesothelioma stages.
Stage 2 Mesothelioma Treatment
Stage 2 mesothelioma patients are often good candidates for curative (life-extending) surgery if the cancer has not spread far into surrounding tissues and lymph nodes.
Treatment options for stage 2 mesothelioma may include chemotherapy, radiation, surgery, and immunotherapy.
Surgeries such as pleurectomy with decortication (P/D) may be helpful for patients with early-stage mesothelioma. According to the American Cancer Society (ACS), surgery is more likely to show long-term benefits in the early stages since there is a greater chance that most tumors can be removed.
Stage 3 Mesothelioma Treatment
Stage 3 mesothelioma may be more difficult to treat, especially if the tumors are no longer resectable. Chemotherapy and radiation therapy are often used as the main treatment options for patients who cannot have surgery.
Though it’s less common, some stage 3 patients are still candidates for surgery. For example, 13+ year survivor John Panza was diagnosed with stage 3 malignant pleural mesothelioma in 2012. He underwent an extrapleural pneumonectomy (EPP) surgery followed by chemotherapy and is still living life to the fullest today.
Immunotherapy may also be a treatment option for advanced-stage mesothelioma when surgery isn’t feasible. It can be used alone or alongside other therapies to slow down mesothelioma disease progression, manage symptoms, and improve quality of life.
Other non-invasive therapies like Tumor Treating Fields (TTFields) may be used with chemotherapy to disrupt cancer cell growth and increase survival time.
Stage 4 Mesothelioma Treatment
Stage 4 mesothelioma often cannot be treated with surgery as the cancer is no longer contained to one area. Chemotherapy is usually the main treatment for stage 4 mesothelioma, though other treatments are starting to gain more traction.
For example, stage 4 patients can be good candidates for immunotherapy depending on their age and overall health. These patients may also benefit from newer or experimental treatments being tested in mesothelioma clinical trials.
Regardless of what mesothelioma stage you’re in, there is always hope — many survivors have beaten the odds, even with an advanced-stage diagnosis.
“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.”
Palliative Care for Advanced Stages of Mesothelioma Cancer
Patients with any stage of mesothelioma can receive palliative care to reduce pain and discomfort. Palliative care may be used as the main treatment to improve quality of life, particularly for patients who aren’t eligible for surgery or chemotherapy.
Palliative care may include:
- Medication to help with pain management
- Pleurodesis to decrease fluid buildup by sealing the space between the chest cavity and the lung lining
- Radiation to shrink mesothelioma tumors and relieve pain or pressure
- Thoracentesis to drain excess fluid using a small needle inserted into the chest wall
Whether you’re looking for life-extending treatments or palliative care, use our Free Doctor Match service to connect with specialists who can develop a personalized treatment plan for you or a loved one.
Tests for Mesothelioma Staging
Doctors use imaging tests — such as X-rays, MRI scans, and CT scans — and biopsy results to confirm cancer stage as part of a mesothelioma diagnosis.
- CT scans are detailed images of the body used to find the exact cancer location and spread to determine the mesothelioma stage.
- MRI scans use powerful magnets to look deep into the body’s tissues. According to the ACS, MRI scans can help determine if pleural mesothelioma has spread to the diaphragm.
- PET scans allow doctors to see if the cancer has spread to lymph nodes or other areas. Before the scan, patients are injected with a low-dose radioactive sugar that is absorbed more quickly by cancer cells. The PET scan detects where the sugar has spread to.
Mesothelioma doctors often take PET and CT scans at the same time to compare areas where the cancer appears to be concentrated (PET scan) with a more detailed image (CT scan).
These imaging tests are a critical part of a mesothelioma diagnosis since they help doctors decide the most effective treatments for each patient’s mesothelioma stage.
“It’s important to discuss mesothelioma staging with your surgeon or oncologist after you’ve had your CT or PET scan.”
Prognosis by Mesothelioma Stage
The progression of mesothelioma plays a large role in determining mesothelioma prognosis. Although every patient’s situation is different, being diagnosed in the earlier stages can lead to better survival outcomes.
Patients with early-stage mesothelioma are more likely to qualify for more aggressive life-extending surgeries.
Mesothelioma life expectancy describes how long doctors think a patient will live after being diagnosed. Life expectancy is influenced by the type, stage, and cell type of your mesothelioma, as well as your age and overall health at the time of diagnosis.
| Stage | Life Expectancy |
|---|---|
| Stage 1 | 21 months |
| Stage 2 | 19 months |
| Stage 3 | 16 months |
| Stage 4 | 12 months |
Patients with early-stage mesothelioma have higher survival rates than those in the later stages. However, there are survivors who are still alive today after being diagnosed with stage 3 and stage 4 mesothelioma.
Get Help for Your Stage of Mesothelioma
Malignant mesothelioma staging plays a major role in determining your overall health outlook and treatment plan. The Mesothelioma Hope team is here to support you at every step.
“We want everyone to be armed with the resources necessary to overcome challenges related to a cancer diagnosis. You have options even if you feel like you don’t.”
Our team can help you:
- Review your pathology report and better understand your diagnosis
- Find a specialist with experience treating your type & stage of mesothelioma
- Learn more about mesothelioma progression and what to expect
- Pursue compensation to pay for palliative or life-extending treatments
Get our Free Mesothelioma Guide shipped overnight to get help for any stage of this cancer or call (866) 608-8933 to speak to a Patient Advocate right now.
Mesothelioma Stages FAQs
Does mesothelioma progress quickly?
Mesothelioma has a long latency period, so you may not experience any symptoms for years after asbestos exposure. However, once symptoms start to manifest, mesothelioma can progress quickly.
If you’re concerned about mesothelioma or think you may have been exposed to asbestos, you should see a specialist for a proper exam and diagnosis. The earlier you start treatment, the better chance you’ll have at stopping the progression of mesothelioma.
Call us today at (866) 608-8933 to find top mesothelioma doctors near you.
What are the final stages of mesothelioma?
The terminal or end stage of mesothelioma typically refers to stage 4 of the disease. In mesothelioma’s final stages, the cancer has spread to distant organs, and treatment options may be limited.
It’s essential for patients and their families to have open and honest discussions with their doctor about the prognosis and treatment options for stage 4 mesothelioma.
At this point, palliative care can play a crucial role in providing comfort, pain relief, and emotional support. However, some end-stage patients have become long-term survivors in rare cases.
How does mesothelioma spread?
Mesothelioma can travel to distant organs like the liver or brain through various means.
Pleural mesothelioma spreads mainly through:
- Blood: Cancer can spread through the cardiovascular system and travel throughout the body.
- Lymph vessels: Mesothelioma cells can spread through the lymph vessels to the lymph nodes in the armpits, neck, or groin.
- Tissue: Cancer tumors may spread from the pleura to the tissue of nearby areas, such as the chest wall or lungs.
Pleural mesothelioma is the only type that has been researched enough to be officially staged using the tumor-node-metastasis (TNM) staging system, which measures cancer spread.
What are the stages of mesothelioma?
Pleural mesothelioma has four distinct stages under the TNM staging system:
- Stage I: The cancer is confined to one area and hasn’t spread to nearby lymph nodes or organs. Surgery to remove the tumor is usually an option.
- Stage II: The cancer has started to spread to nearby structures or lymph nodes on the same side of the body. Tumor-removing surgery may still be considered.
- Stage III: The cancer has spread to nearby structures, lymph nodes, and possibly the chest wall, peritoneum, abdominal cavity, pericardium, heart, or diaphragm. Treatment options may include surgery, chemotherapy, radiation and/or immunotherapy.
- Stage IV: The cancer has spread extensively to distant organs and lymph nodes. The primary treatment at this stage is chemotherapy.
These four mesothelioma stages help doctors determine the most appropriate cancer treatment plan for each patient.
Peritoneal mesothelioma doesn’t have a formal staging system yet because it’s rarer and develops differently than pleural mesothelioma. However, doctors can assess cancer spread at time of diagnosis and recommend the most appropriate treatments.
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