What Are the Mesothelioma Stages?
Mesothelioma stages are used to categorize the location and spread of this cancer through the body. Determining the stage of a patient’s malignant mesothelioma is part of the diagnosis process. Mesothelioma staging helps doctors identify appropriate treatment.
Pleural mesothelioma is the only type of this cancer with an official staging system. It has four stages under the tumor-node-metastasis (TNM) staging system, the global standard for classifying cancer spread.
The TNM stages of mesothelioma cancer are:
- 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 nearby organs and lymph nodes.
- Stage 4: Mesothelioma tumors have spread throughout the body, reaching distant organs.
Oncologists (cancer doctors) use other methods for determining prognosis and treatments for patients diagnosed with the other types of mesothelioma: peritoneal, pericardial, and testicular.
Get our Free Mesothelioma Guide today for essential 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. Because it is the most common type of this cancer, pleural mesothelioma is the only type of malignant mesothelioma with an official staging system (TNM).
Learn more about the four malignant mesothelioma stages below.
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.
Unfortunately, it’s rare to be diagnosed in stage 1 because of the long latency period and mild symptoms. Patients diagnosed in stage 1 are more likely to have multiple treatment options available to them.
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.
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 3 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.
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.
Nearly 50% of pleural mesothelioma patients are diagnosed in stage 4. By this stage, the cancer has moved far beyond the chest wall into the bones, brain, liver, or other distant parts of the body. Treatment during stage 4 is focused on relieving symptoms and giving the patient the best quality of life.
Why Mesothelioma Staging Is Important
Mesothelioma staging helps doctors determine what type of treatments to use and how aggressive they need to be.
Some treatments (notably surgery) are used for early-stage cancer, while others are primarily used in advanced mesothelioma stages when a patient may no longer qualify for invasive surgeries.
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.
If you’ve been diagnosed with mesothelioma, knowing your cancer stage can help you make more informed health care decisions and actively participate in your treatment.
Mesothelioma staging also helps doctors and researchers work together to study new and emerging treatments.
Staging for Peritoneal Mesothelioma and Other Types
There isn’t an official staging system for other types of mesothelioma because they are rarer, have less data available, and don’t spread the same way 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
“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 or not. From there, our team considers the goals of the patient and presents a recommended plan forward.”
Despite the lack of an official staging system for the less common 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.
Treatment for the 4 Stages of Mesothelioma
The stages of mesothelioma cancer can play a large role in helping doctors determine the right treatment approach. The mesothelioma stage may determine if the cancer is resectable (can be removed by surgery) and if a patient is likely to respond well to 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
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 be able to undergo surgery to fully remove all visible signs of cancer — which may be harder to achieve in later 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 very 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 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. Chemotherapy and radiation therapy are often used as the main treatment options for patients who cannot have surgery.
Although it’s less common, some stage 3 patients are still candidates for surgery. For example, 12+ 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 or the cancer has spread. 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 often 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, 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 relieve pain
- Pleurodesis to decrease fluid buildup by sealing the space between the chest cavity and the outer lung lining
- Radiation to help shrink tumors and relieve pain or pressure
- Thoracentesis to drain excess fluid using a small needle inserted into the patient’s 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.
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 was created by the American Joint Committee on Cancer (AJCC) to assess cancer spread and determine 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. 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.
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 may be helpful when determining if pleural mesothelioma has spread to the diaphragm.
- PET 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 at the same time 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.”
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.
Get our Free Mesothelioma Guide to learn more about the diagnosis and staging process and how we can support you during this journey.
Prognosis of Mesothelioma Stages
The staging 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 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.
| 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 an important role in determining your overall health outlook and treatment plan. The Mesothelioma Hope team is here to support you at every step — regardless of your diagnosis.
“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:
- Find a specialist with experience treating your type & stage of mesothelioma
- Review your pathology report and better understand your diagnosis
- Determine options 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 spread fast?
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, 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 is the end stage of mesothelioma?
The terminal or end stage of mesothelioma typically refers to stage 4 of the disease. In this final stage, 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.
What are the stages of mesothelioma?
Pleural mesothelioma has four distinct stages under the TNM staging system:
- 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, but it becomes more challenging.
- Stage 3: The cancer 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.
- 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 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.
What is the life expectancy of someone with mesothelioma?
The average life expectancy of mesothelioma is 12-21 months, but your outcome may be very different. Your life expectancy will depend on multiple factors specific to you — and many survivors have far outlived their initial prognosis.
Our Patient Advocates are standing by to provide more information on treatment options and support you no matter your mesothelioma stage. Contact us now for personalized medical guidance.
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