What Is Mesothelioma Staging?
Mesothelioma staging describes how much cancer is in the body and whether it has spread to nearby tissues or organs. Doctors use this information to better understand how mesothelioma is progressing in your body and create a treatment plan that fits your needs.
There are four stages of mesothelioma cancer:
- 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.
Only pleural mesothelioma (which forms in the lining of the lungs) has an official staging system. For the other types of mesothelioma — peritoneal, pericardial, and testicular — doctors use other methods to measure how much the cancer has grown.
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 detailed information on stages, symptoms, and top specialists who can help improve your prognosis.
Pleural Mesothelioma Stages
Pleural mesothelioma is the most common type of this cancer. Doctors use the tumor-node-metastasis (TNM) system to stage pleural mesothelioma.
This system looks at three things:
- Tumor (T): Size and location of the main tumor
- Node (N): Whether the cancer has spread to nearby lymph nodes
- Metastasis (M): If the cancer has spread to other areas of the body
Doctors combine this information to assign a stage from 1 to 4. In some cases, stage 1 may be broken into stage 1A or 1B, depending on how far the tumor has spread.
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
Peritoneal Mesothelioma Stages
Unlike pleural mesothelioma, peritoneal mesothelioma (which affects the abdominal lining) doesn’t have an official staging system.
However, some doctors use a tool called the Peritoneal Cancer Index (PCI) to measure how widespread the cancer is. The PCI divides the abdomen into 13 sections, giving each section a score of 0-3. A score of 0 means there’s no cancer, and a score of 3 means there is extensive tumor growth.
- 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
By breaking mesothelioma down into four stages, doctors can get a better sense of how the cancer is progressing. This helps them choose the most effective treatment options and gives you a clearer idea of what to expect moving forward.
Symptoms by Mesothelioma Stage
Mesothelioma takes a long time to develop. This means there’s usually a big gap between being exposed to asbestos — the only known cause of this cancer — and noticing any symptoms. In fact, symptoms may not appear until 10 to 50 years after exposure.
On top of that, the early signs of mesothelioma can be vague and mistaken for common illnesses. Because of this, it’s unusual to get an early diagnosis. Below are some of the symptoms people may experience in the beginning and later stages of mesothelioma.
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
Because many asbestos cancer stages overlap with symptoms of other illnesses, patients are often not diagnosed until stage 3 or 4, when signs are more severe and persistent.
Late-stage symptoms may include:
- Abdominal pain
- Anemia
- Chronic fatigue
- Coughing up blood
- Difficulty breathing
- Fever
- Muscle atrophy
- Night sweats
- Weight loss
- Worsened chest pain
If you’re experiencing any of these symptoms, contact us for help making an appointment with a mesothelioma specialist.
Registered Nurse Amy Fair discusses the 4 stages of mesothelioma and why it's important to talk to your doctor about mesothelioma staging. Call (866) 608-8933 connect with Amy for personalized medical guidance. 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
Mesothelioma stages play a significant role in treatment planning. Medical teams need to know 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
In the first stage of mesothelioma, the cancer has just started to form. It’s rare to be diagnosed with stage 1 mesothelioma because the symptoms are usually very mild or may not appear at all.
Stage 1 mesothelioma can usually be treated with:
- Chemotherapy
- Radiation
- Surgery
- Other treatment options, such as immunotherapy
Stage 1 patients are usually good candidates for surgery, depending on their mesothelioma cell type. Early detection at this stage often provides the best chance for long-term survival since the cancer is still localized and more responsive to aggressive treatments.
Stage 2 Mesothelioma Treatment
For people with stage 2 mesothelioma, treatment often involves more than one approach. In the past, surgery was recommended more often, but updated guidelines now suggest it should only be considered for patients with epithelioid tumors that are still in the early stages.
When surgery is an option, procedures like pleurectomy with decortication (P/D) may help by removing as much of the cancer as possible. However, these operations should only be done at a specialized cancer center.
The main treatment for most stage 2 patients continues to be chemotherapy, usually with a combination of pemetrexed and a platinum drug like cisplatin or carboplatin. Immunotherapy is also now an important option — sometimes used on its own, and sometimes combined with chemotherapy.
Stage 3 Mesothelioma Treatment
Stage 3 mesothelioma is harder to treat, but there are still effective options. Most patients receive chemotherapy and/or immunotherapy to help slow the cancer and manage symptoms.
Surgery is less common at this stage, though there are rare exceptions. For example, Cleveland musician John Panza was diagnosed with stage 3 mesothelioma and underwent surgery followed by chemotherapy. More than a decade later, he’s still living life to the fullest.
A newer treatment called Tumor Treating Fields (TTFields) can also be used with chemotherapy to disrupt cancer cell growth and improve survival.
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.
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 Cancer 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 where it has spread.
- 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.
“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.”
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 |
Source: Frontiers in Oncology
Patients with early-stage mesothelioma have higher survival rates than those in the later stages. However, there are long-term mesothelioma survivors who are still alive today after being diagnosed with stage 3 and stage 4 mesothelioma.
“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.”
Get Help for Your Stage of Mesothelioma
Mesothelioma cancer 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.
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 Cancer 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 stage of mesothelioma is death?
Mesothelioma is described in stages from 1 to 4, with stage 4 being the most advanced. In the earlier stages, treatment may focus on surgery or other therapies to slow the cancer and ease symptoms. As the cancer spreads further, treatment usually shifts toward controlling symptoms and maintaining quality of life.
Most deaths from mesothelioma happen when the disease reaches stage 4, but the timing can be very different for each person. Factors like overall health, treatment, and how quickly the cancer grows all play a role. At this stage, care often focuses on comfort, relief from pain, and helping patients make the most of their time with loved ones.
How does mesothelioma spread?
Mesothelioma can travel to distant organs like the liver or brain through various means.
It 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.
How many stages of mesothelioma are there?
There are 4 malignant mesothelioma stages :
- Stage 1: 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 2: 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 3: 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 4: 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 because it’s rarer and develops differently from pleural mesothelioma. However, doctors can assess cancer spread at the time of diagnosis and recommend the most appropriate treatments.
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