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Mesothelioma Stages

Doctors use four mesothelioma stages to define how far this cancer has spread through the body. Mesothelioma staging helps doctors design the most effective treatment plan to improve each patient’s prognosis and quality of life. Learn more about each stage of mesothelioma and how Mesothelioma Hope can help you or a family member find personalized treatment.

Medically reviewed by: Mark Levin, MD

Last updated:

What Are Mesothelioma Stages?

Mesothelioma stages are used to categorize the spread and location of this cancer throughout the body. A doctor will determine the stage of a patient’s malignant mesothelioma when they are first diagnosed and identify appropriate treatment.

Stages of Mesothelioma Video Thumbnail

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.

Pleural mesothelioma is the only type of malignant mesothelioma with an official staging system.

The four mesothelioma stages are based on the tumor-node-metastasis (TNM) staging system. The TNM system is the global standard for classifying cancer spread.

  • Stage 1: The cancer is small and hasn’t spread past one area.
  • Stage 2: Tumors have spread to nearby lymph nodes, possibly affecting neighboring organs.
  • Stage 3: The cancer has spread extensively and may affect adjacent organs and lymph nodes.
  • Stage 4: Tumors have spread widely throughout the body, reaching distant organs.

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Why Is Mesothelioma Staging Important?

Mesothelioma staging helps doctors determine what type of treatment to use and how aggressive they need to be. Some treatments are used for early-stage cancer, while others are primarily used for advanced mesothelioma stages when a patient may no longer qualify for invasive surgeries.

“Mesothelioma staging is important in mesothelioma as it is with any cancer. It drives your prognosis. It drives your treatment modalities.”

- Quote from Amy Fair, RN, Mesothelioma Patient Advocate

Knowing their cancer stage gives mesothelioma patients an idea of what to expect in terms of their health and life expectancy. This information can help them make more informed choices and actively participate in their care plan.

Mesothelioma staging also helps doctors and researchers work together to study new and emerging treatments.

What Are the 4 Mesothelioma Stages?

Pleural mesothelioma forms in the lining of the lung (pleura) and is the only type of this cancer that is officially staged using the TNM system. Although peritoneal mesothelioma doesn’t have an official mesothelioma staging system, doctors can let patients know how advanced the cancer is to help them better understand their prognosis.

Nearly 50% of pleural mesothelioma patients are diagnosed in stage 4, according to a 2022 review of the National Cancer Database (NCDB).

Learn more about the four mesothelioma stages below.

*Located in lining of the lungs

Stage 1 Mesothelioma

  • This is the earliest stage of mesothelioma and means the cancer has not spread beyond one part of the chest wall lining.
  • The average life expectancy for stage 1 malignant pleural mesothelioma is 21 months.

Patients have a range of treatment options that may improve their life expectancy by several months or years.

Learn More About Stage 1

*Located in lining of the lungs

Stage 2 Mesothelioma

  • The cancer has metastasized (spread) slightly outside one side of the chest wall and possibly into nearby lymph nodes.
  • The average life expectancy for stage 2 mesothelioma is 19 months.

Patients still have many treatment options (notably surgery) to increase life expectancy.

Learn More About Stage 2

*Located in lining of the lungs

Stage 3 Mesothelioma

  • Mesothelioma has spread considerably beyond one side of the chest wall into nearby tissues, organs, or lymph nodes.
  • The average life expectancy for stage mesothelioma is 16 months.

Most stage 3 mesothelioma patients are no longer eligible for surgery but can still get treatment to help slow disease spread and manage symptoms.

Learn More About Stage 3

*Located in lining of the lungs

Stage 4 Mesothelioma

  • This is the most advanced of all four pleural mesothelioma stages.
  • The average life expectancy for stage 4 mesothelioma is 12 months.

By stage 4, the cancer has moved far beyond the chest wall into the bones, brain, liver, or other distant parts of the body. Treatment during this stage is focused on relieving symptoms and giving the patient the best quality of life.

Learn More About Stage 4

Use our Free Doctor Match to find a top specialist near you who can develop a personalized treatment plan based on your mesothelioma stage.

Staging Information for Other Types of Mesothelioma

There isn’t an official staging system for other forms of mesothelioma because they are much rarer.

Doctors don’t have enough data from case studies to accurately assign a TNM stage to these other types of mesothelioma:

  • Peritoneal mesothelioma affects the lining of the abdomen (peritoneum) and only makes up 10% of mesothelioma cases, compared to 80% of cases for pleural mesothelioma. Instead of using the TNM framework, doctors can sometimes stage peritoneal mesothelioma using the peritoneal cancer index (PCI).
  • Pericardial mesothelioma forms in the heart lining and is most often diagnosed after death through an autopsy.
  • With just 52 cases diagnosed between 1973 and 2013, testicular mesothelioma is the rarest of all types, according to a report in BMC Cancer journal.

Despite the lack of an official staging system, doctors can still use diagnostic tools such as MRI (magnetic resonance imaging) scans, CT (computed tomography) scans, and tumor marker tests to see if and how these cancers have spread.

Treatment and Staging

A doctor speaks with a patient about mesothelioma staging

The stage of mesothelioma plays a large role when doctors consider treatment options. The mesothelioma stage may determine if the cancer is resectable (can be removed by surgery) and if a patient is healthy enough to undergo major surgery or other invasive cancer treatments.

Doctors may decide to focus mesothelioma treatment on life-extending or palliative (symptom-relieving) options depending on the extent of the cancer, the patient’s personal wishes, and other factors.

Stage 1 Mesothelioma Treatment

This is the earliest point in mesothelioma’s development. During this stage, the cancer is still contained to the chest lining and may not be causing symptoms. Stage 1 mesothelioma patients have the best prognosis and are usually good candidates for various types of treatment.

Stage 1 mesothelioma can usually be treated with:

Unfortunately, it’s very rare to be diagnosed in stage 1. According to the NCDB, the vast majority (72%) of patients don’t receive a diagnosis until their cancer has reached mesothelioma stages 3 and 4.

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 a pleurectomy with decortication (P/D) may be beneficial for patients with early-stage mesothelioma. According to the American Cancer Society (ACS), surgery is more likely to show long-term benefits in early-stage cancers because there is a greater chance that most of the 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.

While the ACS reports that mesothelioma doctors often disagree on the effectiveness of chemotherapy and radiation therapy for mesothelioma, these methods are often used as the main treatment for patients who cannot have surgery.

Although it’s less common, some stage 3 patients are still candidates for surgery. The ACS states that surgery may be helpful for late-stage patients, but the benefits are more likely to last only a short time.

Immunotherapy can also be considered as a treatment option for advanced-stage mesothelioma when surgery may not be feasible or the cancer has spread to distant organs. It can be used alone or alongside other therapies to help slow down mesothelioma progression, manage symptoms, and improve overall quality of life.

Other non-invasive therapies like Tumor Treating Fields (TTFields) can also be explored to disrupt cancer cell growth and increase survival time.

Stage 4 Mesothelioma Treatment

Stage 4 mesothelioma cannot be removed completely with surgery because the cancer is no longer contained in one area. Chemotherapy is usually the main treatment for stage 4 mesothelioma.

Additionally, 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.

“We don’t like to look at stage 4 as a death sentence. We have a stage 4 patient who’s still with us and doing very well on the immunotherapy drug Keytruda®.”

- Quote from Amy Fair RN, Mesothelioma Patient Advocate

Palliative Treatment for Stage 4 Mesothelioma

Mesothelioma stage 4 patients can also seek palliative treatment to reduce pain and discomfort caused by mesothelioma rather than extend life expectancy.

Palliative stage 4 mesothelioma treatments and procedures may include:

  • Medication to help relieve pain
  • Pleurodesis to decrease fluid buildup by sealing the space between the chest cavity and outer lung lining
  • Radiation to help shrink tumors and relieve pain
  • Thoracentesis to drain excess fluid using a small needle inserted into the patient’s chest wall

Use our Free Doctor Match to find specialists who can develop a personalized treatment plan for you or a loved one.

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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 of this cancer that has been researched enough to be officially staged using the tumor-node-metastasis (TNM) staging system. This staging system helps mesothelioma patients understand the expected outlook of their disease.

TNM Mesothelioma Staging System

The TNM system is a way to stage cancer that helps doctors understand how far the cancer has spread in the body. It has three main parts.

Tumor (T)Node (N)Metastasis (M)
Describes the size and spread of the main tumorIndicates whether the cancer has spread to nearby lymph nodesShows if the cancer has spread to other parts of the body

Doctors assign a numbered stage to the cancer from early to advanced. The stage helps them decide on the best treatments to use and predict how the cancer might respond.

The TNM system is regularly updated to include new information and research. In addition to guiding treatment decisions, TNM mesothelioma staging helps doctors communicate with each other when discussing a patient’s cancer.

Diagnosing the Stages of Mesothelioma Cancer

Doctors use imaging tests and biopsy results to make a mesothelioma diagnosis.

Imaging tests such as X-rays, MRI scans, and CT scans can help doctors see the location and spread of a patient’s mesothelioma.

  • CT scans are detailed images of the body used to diagnose mesothelioma. These scans also help doctors 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 may be helpful when determining if pleural mesothelioma has spread to the diaphragm.
  • PET (positron emission tomography) scans use a camera to detect radioactivity in a patient’s body. Before the scan, patients are injected with a low-dose radioactive sugar that is absorbed more quickly by cancer cells. The PET scan image can help doctors see if mesothelioma has spread to the lymph nodes or other areas.

Mesothelioma doctors often take PET and CT scans simultaneously to compare areas where the cancer appears to be concentrated (PET scan) with a more detailed image (CT scan).

“It’s important to discuss mesothelioma staging after you’ve had your CT or PET scan with your surgeon or oncologist.”

- Quote from Amy Fair, RN, Mesothelioma Patient Advocate

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.

Learn more about the pocess and how we can help you after a diagnosis in our Free Mesothelioma Guide.

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Prognosis of Mesothelioma Stages

The staging of mesothelioma plays a large role in determining mesothelioma prognosis. As the cancer spreads to other areas, there is less of a chance that the body will respond well to treatment. As a result, late-stage mesothelioma patients are less likely to achieve long-term survival.

Additionally, patients with late-stage mesothelioma may not qualify for more aggressive life-extending surgeries such as an extrapleural pneumonectomy (EPP).

Mesothelioma life expectancy describes how long doctors think you will live after being diagnosed. Life expectancy is influenced by your age, the type and stage of your mesothelioma, and your overall health at the time of diagnosis.

StageLife Expectancy
Stage 121 months
Stage 219 months
Stage 316 months
Stage 412 months
Source: Frontiers in Oncology, 2018

Patients with early-stage mesothelioma have higher survival rates than those with advanced mesothelioma. However, there are survivors who are still alive today after being diagnosed with stage 3 and stage 4 mesothelioma.

Get Treatment for Your Stage of Mesothelioma

Mesothelioma staging plays an important role in determining your overall health outlook and treatment plan.

Even if you or a family member has been diagnosed in one of the later stages, Mesothelioma Hope can help you explore treatment options like surgery, chemotherapy, and immunotherapy that may  improve your prognosis.

Get our Free Mesothelioma Guide shipped overnight or call (866) 608-8933 to speak to a Patient Advocate right now.

Mesothelioma Stages FAQs

How quickly does mesothelioma develop?

The time it takes for mesothelioma to develop differs for each person. Generally, however, there is a delay of 10-50 years between being exposed to asbestos and experiencing mesothelioma symptoms or receiving a diagnosis.

If you’re concerned about mesothelioma or think that you may have been exposed to asbestos, it’s important to consult with a health care professional for a proper exam and diagnosis.

Call us today at (866) 608-8933 to get help finding a mesothelioma doctor near you.

What are the levels of mesothelioma?

There are four levels, or stages, of mesothelioma.

  • In 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.
  • In mesothelioma 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, but it becomes more challenging.
  • By the time the cancer has reached stage 3, it has spread to nearby structures, lymph nodes, and possibly the chest wall, heart, or diaphragm. Treatment options may include a combination of surgery, chemotherapy, radiation and/or immunotherapy.
  • In the fourth stage, the cancer has spread extensively to distant organs and lymph nodes. The primary treatment at this stage is chemotherapy.

These four mesothelioma stages help guide doctors in determining the most appropriate treatment plan for patients.

How quickly does mesothelioma progress?

Mesothelioma can progress relatively quickly over several months or years, depending on factors like the type and stage of the cancer, overall patient health, and the effectiveness of treatment.

Detecting mesothelioma early and receiving timely medical care can greatly impact your prognosis and available treatment options.

What is the terminal stage of mesothelioma?

The terminal stage of mesothelioma typically refers to stage 4 of the disease. In this final stage, the cancer has spread significantly 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.

Can mesothelioma go into remission?

Yes, in rare cases. Remission refers to a period when the signs and symptoms of mesothelioma are absent or significantly reduced. Early diagnosis and treatment are the best ways to achieve mesothelioma remission.

As mesothelioma progresses into the later stages, it can become more difficult to reach remission.

Dr. Mark LevinReviewed by:Mark Levin, MD

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD, has over 30 years of experience in academic and community hematology and oncology. In addition to serving as Chief or Director at four different teaching institutions throughout his life, he is still a practicing clinician, has taught and designed formal education programs, and has authored numerous publications in various fields related to hematology and oncology.

Dr. Mark Levin is an independently paid medical reviewer.

  • Board Certified Oncologist
  • 30+ Years Experience
  • Published Medical Author
Jenna TozziWritten by:

Director of Patient Advocacy

Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

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References
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  3. American Cancer Society. (2019, May 28). Treatment of mesothelioma based on the extent of the cancer. Retrieved February 5, 2024, from https://www.cancer.org/cancer/malignant-mesothelioma/treating/by-extent.html
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  13. Watson, S. (2018, March 23). Pleurodesis: Complications, side effects, and recovery. Retrieved February 5, 2024, from https://www.healthline.com/health/pleurodesis
  14. Yan, T. D., et al. (2010). A novel tumor-node-metastasis (TNM) staging system of DIFFUSE malignant peritoneal Mesothelioma USING OUTCOME analysis of A multi-institutional database*. Cancer, 117(9), 1855-1863. Retrieved February 5, 2024, from https://pubmed.ncbi.nlm.nih.gov/21509762/
  15. Ye Z, Yu P, et al. (January 2022). Prediction of Peritoneal Cancer Index and Prognosis in Peritoneal Metastasis of Gastric Cancer Using NLR-PLR-DDI Score: A Retrospective Study. Cancer Manag Res. 14:177-187. Retrieved February 5, 2024, from https://pubmed.ncbi.nlm.nih.gov/35046725/
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