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.
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.
Get your Free Mesothelioma Survivors Guide today to learn what other patients did to improve their prognosis and beat the odds.
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.”
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 2023 review of the National Cancer Database (NCDB).
Learn more about the four 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.
Patients have a range of treatment options that may improve their life expectancy by several months or years.
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 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.
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.
Use our Free Doctor Match to find a top mesothelioma 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
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:
- Chemotherapy
- Radiation
- Surgery
- Other treatment options such as immunotherapy
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®.”
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
Request your Free Mesothelioma Survivors Guide today to learn about the treatments that helped 7 patients battle this cancer.
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 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.
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.”
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.
Try our Free Doctor Match today to get an accurate mesothelioma diagnosis and start the next step of your care journey.
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.
| 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 with advanced mesothelioma. However, there are survivors who are still alive today after being diagnosed with stage 3 or 4 mesothelioma.
For example, retired construction worker John Stahl has achieved 4+ years of survivorhood with stage 4 mesothelioma. Learn more about John and other patients who’ve outlived their prognosis in our Free Mesothelioma Survivors Guide.
Get Treatment From a Mesothelioma Doctor Today
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 mesothelioma stages, treatment options such as surgery, chemotherapy, and immunotherapy may help you beat your prognosis.
Get your Free Mesothelioma Survivors Guide and learn how 7 mesothelioma patients beat their prognosis.
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 stages of mesothelioma?
Mesothelioma staging helps doctors understand how far the cancer has spread.
The following is an overview of the four mesothelioma stages:
- 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 progression can occur 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.
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.
