Stage 3 Mesothelioma

During stage 3 mesothelioma, cancer has spread deeper into surrounding tissues and organs and to nearby lymph nodes. Many mesothelioma patients are more commonly diagnosed during stage 3. At this stage, most patients are no longer able to get life-extending surgeries, but they can still undergo treatments like chemotherapy to help slow the disease and manage symptoms. Treatments for stage 3 mesothelioma can also reduce pain, manage symptoms, and improve quality of life.

What Is Stage 3 Mesothelioma?

As the second to last stage of mesothelioma, Stage 3 mesothelioma generally refers to mesothelioma that has spread deeper into the tissues surrounding the tumor’s original location and has usually reached the lymph nodes.

Depending on the type, mesothelioma may begin in the:

  • Pleura: The lining of the lungs and chest
  • Peritoneum: The lining of the abdomen
  • Pericardium: The lining of the heart
  • Tunica vaginalis: The membrane lining the testes

Stage 3 may also reveal that the cancer has spread to the nearby lymph nodes. But mesothelioma that spreads to more distant sites, like the collarbone or lymph nodes on the other side of the chest, is considered stage 4.

Because stage 3 mesothelioma hasn’t yet spread to the other side of the chest, it is still considered somewhat local even though it has metastasized.

Pleural mesothelioma is the only type of mesothelioma with an official staging system, but peritoneal mesothelioma is sometimes referred to in stages as well.

Not enough is known about pericardial and testicular mesothelioma to properly stage them. Instead, doctors may refer to their progression as early or advanced.

Quick Facts About Stage 3 Mesothelioma
  • Surveillance, Epidemiology, and End Results (SEER) data indicate that roughly 16% of mesothelioma cases are diagnosed during the regional stage, which includes stage 3.
  • According to the American Cancer Society, roughly 12% of pleural mesothelioma patients diagnosed during the regional stage (which includes stage 3) will live 5 years or longer.
  • During stage 3, mesothelioma has spread too far for most patients to undergo surgery.
  • Stage 3 mesothelioma patients are usually excellent candidates for clinical trials, which test new and promising therapies.

How Stage 3 Mesothelioma Develops

The Centers for Disease Control and Prevention (CDC) state that mesothelioma may take anywhere from 20-50 years to develop. However, the disease progresses rapidly once symptoms appear.

As cancer cells multiply, they cause tumors to grow and spread. Eventually, these cells may travel through the lymph nodes and form new tumors in distant parts of the body. This process is called metastasis, and doctors try to prevent or control it through treatment.

While stage 3 mesothelioma has not metastasized, it has spread deeper into nearby tissues and reached the lymph nodes.

The TNM system divides stage 3 mesothelioma into two sub-sections depending on severity: 3A and 3B.

Stage 3 Mesothelioma TNM System Subtypes

SubtypeTumorLymph NodeMetastasis
3AThe tumor is in the pleura on one side of the chest, the diaphragm, and the space between the lungs. It has also grown into other areas such as at least one layer of the chest wall.The cancer has spread to nearby lymph nodes on the same side of the body as the main tumor.The cancer has not spread to distant parts of the body yet.
3BThe cancer may have grown into nearby parts of the body. It has also grown into at least one more distant area, such as deeper layers of the chest wall, the lining of the abdomen, or the spine.The cancer may have spread to lymph nodes on the other side of the body.The cancer has not spread to distant parts of the body.

As mesothelioma progresses from stage 2 to stage 3, most patients experience common mesothelioma symptoms.

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Stage 3 Mesothelioma Symptoms

While early-stage mesothelioma is typically asymptomatic (showing no signs or symptoms), as the cancer spreads and tumors grow, stage 3 mesothelioma patients usually notice significant symptoms.

Common stage 3 mesothelioma symptoms include:

  • Difficulty breathing
  • Worsened chest pain
  • Noticeable weight loss
  • Abdominal pain
  • Chronic fatigue
  • Fever
  • Fatigue
  • Sweating

This is when most mesothelioma victims go to their doctors and begin the process of identifying the source of their symptoms.

However, even though by stage 3 the symptoms have worsened, they can still be confused with symptoms of pulmonary infections such as pneumonia or bronchitis.

Discuss any history of asbestos exposure as soon as possible with your doctor to prevent a misdiagnosis. This can help you to receive life-saving treatment.

How to Identify Stage 3 Mesothelioma

At stage 3, mesothelioma is easier to identify. However, doctors may still initially confuse stage 3 mesothelioma symptoms for other conditions like viral pneumonia.

By reading the results of a chest X-ray or other imaging tests, doctors can identify abnormalities such as tumors, fluid buildup, and thickening of the lining of the lungs.

While these symptoms are strong indicators of mesothelioma, they may also be signs of other cancers and conditions. Asbestos is the main cause of mesothelioma, so it is critical for patients to tell their doctors about any history of asbestos exposure.

Stage 3 Mesothelioma Diagnosis

Because symptoms are far more noticeable during stage 3 mesothelioma, more patients are diagnosed during this stage.

When diagnosing mesothelioma, doctors may initially take images of the patient’s chest from multiple angles to identify the location of any tumors. However, a mesothelioma diagnosis cannot be confirmed without a biopsy.

During a biopsy, a tissue sample is removed from the tumor or surrounding fluid. By examining this sample under a microscope, a doctor can see if any of its cells are cancer cells.

Stage 3 Diagnosis and Staging Systems

Upon diagnosis, doctors use a staging system to find out how far a patient’s mesothelioma has advanced and what the outlook for their disease is.

The TNM staging system is the most widely accepted staging system for pleural mesothelioma, although other systems exist.

Pleural mesothelioma is the only type officially staged under any of these systems, which all have their own way of describing stage 3.

Stage 3 Pleural Mesothelioma By Staging System

  • Butchart System: The cancer has spread past the pleura and the chest wall, to the diaphragm, the lining of the abdomen, or both.
  • Brigham System: Cancer has spread to the chest wall, heart, diaphragm, or abdominal cavity. The cancer may have reached the lymph nodes. Stage 3 tumors are not surgically removable.
  • TNM System: The cancer has spread past the pleura into the deeper tissues and may have reached areas such as the abdominal lining or spine. Cancer may have spread to both sides of the body. It has spread to the lymph nodes but has not reached distant parts of the body.

Many medical communities worldwide use the TNM staging system for its practicality in terms of understanding a patient’s prognosis.

Stage 3 Mesothelioma Prognosis

Because treatment options in stage 3 are limited, the prognosis is considered poor. The survival rates in stage 3 mesothelioma range between 12 and 24 months, although life expectancy can be improved with treatments. Other factors like age, gender, and overall health also influence life expectancy at this stage.

In stage 3, it’s important to consider getting a second opinion from a mesothelioma specialist. A specialist can confirm your diagnosis or provide you with new information about your disease that other doctors may have missed. Oftentimes, a second opinion can present you with other treatment options that you otherwise wouldn’t have known about.

Doctors determine a patient’s mesothelioma prognosis using the stage of the patient’s disease at diagnosis along with other factors such as mesothelioma cell type and the patient’s overall health. A prognosis describes how a disease is expected to progress.

Mesothelioma has a generally poor prognosis, and patients diagnosed at stage 3 have a relatively poor outlook. However, some stage 3 patients may still be able to receive life-extending surgery.

Stage 3 Mesothelioma Life Expectancy

Mesothelioma life expectancy is the average amount of time doctors expect a patient to live after diagnosis. For mesothelioma, life expectancy is often measured in months.

According to a mesothelioma review published in the West Virginia Medical Journal, the average survival time for malignant mesothelioma of all types is 6-13 months overall and 6-18 months with treatment.

Stage 3 patients can expect to live somewhere in the middle of this range, with stage 3A patients expected to live longer than stage 3B patients.

Stage 3 Mesothelioma Survival Rate

The percentage of people with mesothelioma who survive for a certain amount of time (often measured in 1-, 3-, and 5-year increments after diagnosis) is known as the mesothelioma survival rate.

Stage 3 mesothelioma patients experience 1-year survival rates around 33-40% for pleural mesothelioma and roughly 41-55% for peritoneal mesothelioma. Survival rates are better for stage 3 patients who can still have their tumors surgically removed.

A 2017 study published in Lung Cancer International collected data from over 11,000 pleural and peritoneal mesothelioma patients between 1973–2011 to show how a person’s stage at diagnosis affects survival rates.

The study used language from the older LRD staging system to describe pleural and peritoneal mesothelioma stages:

  • Localized: Stage 1 mesothelioma contained in one area
  • Regional: Stage 2, 3, and 4 mesothelioma that has not spread to distant body parts
  • Distant: Stage 4 mesothelioma that has spread to parts of the body far from where it originated

The tables below show the percentage of mesothelioma patients out of the entire study who lived for at least 1 year or 5 years, respectively, after diagnosis.

Survival Rates for Pleural Mesothelioma by Stage

Mesothelioma Stage1-Year Survival Rate5-Year Survival Rate
Localized41%6%
Regional40%4%
Distant32%3%

Survival Rates for Peritoneal Mesothelioma by Stage

Mesothelioma Stage1-Year Survival Rate5-Year Survival Rate
Localized74%26%
Regional55%19%
Distant40%11%

A patient’s remaining life expectancy may be greatly influenced by the stage of their mesothelioma after diagnosis. Stage 3 mesothelioma tumors are usually not resectable (surgically removable), preventing patients from undergoing the most effective treatment options for increasing their life expectancy.

However, even stage 3 patients who cannot receive surgery may benefit from chemotherapy and other treatments.

Stage 3 Mesothelioma Treatment

Though stage 3 mesothelioma is considered an advanced stage, there are still treatment options for patients. Typically, the goal with stage 3 treatments is to improve quality of life. This is done through palliative therapies that relieve pain.

Stage 3 malignant mesothelioma treatment may involve surgery, chemotherapy, radiation, or new treatments through clinical trials. The optimal treatment approach for stage 3 patients whose mesothelioma has not spread too far to be surgically removed is a combination of surgery, chemotherapy, and radiation therapy.

Patients who cannot undergo surgery often receive chemotherapy alone.

Surgery

Depending on the patient’s overall health, surgery may still be an option. A surgical procedure called extrapleural pneumonectomy (EPP) can remove tumors and prevent the mesothelioma from spreading further.

With an EPP, surgeons remove the lung linings, the lung, the nearby lymph nodes, and part of the diaphragm. This can help extend life expectancy by preventing the mesothelioma from advancing into the last stage of mesothelioma.

If you are eligible, surgeries in stage 3 can also be supported with chemotherapy or radiation to shrink tumors and kill remaining cancer cells. This multimodal treatment plan can improve your life expectancy by several months or even years in some cases.

Stage 3 mesothelioma is often not able to be operated on because the tumor has spread too far for surgeons to effectively remove it. However, some stage 3 tumors may be able to be surgically removed so that no visible parts of the tumors remain.

By undergoing mesothelioma surgery, especially when paired with chemotherapy and/or radiation, patients may live for several more months or even years.

However, even stage 3 patients whose cancer is still fairly contained may not be good candidates for surgery.

Doctors may consider the following factors to decide if a patient can undergo surgery:

  • Stage: Small, localized tumors are easier to surgically remove.
  • Cell type: Only epithelioid and mixed/biphasic cell tumors are resectable.
  • Location: If a tumor is too close to a vital organ, it may be too dangerous to surgically remove it.
  • Patient health: Mesothelioma surgery can be risky and taxing on a patient’s body. Doctors will carefully consider a patient’s health to decide how likely they are to survive or properly recover from an operation.

If a patient is a good surgery candidate, they have a few options depending on their type of mesothelioma and their doctor’s recommendations.

Stage 3 mesothelioma surgery options may include:

  • Extrapleural pneumonectomy (EPP) for pleural mesothelioma
  • Pleurectomy with decortication (P/D) for pleural mesothelioma
  • Cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal mesothelioma

After surgery, some cancer cells remain. For this reason, doctors usually treat patients with chemotherapy and/or radiation to destroy remaining cells.

Chemotherapy

Chemotherapy involves the intravenous administration of drugs that destroy cancer cells. It is a popular standalone treatment option for stage 3 mesothelioma patients since most cannot undergo surgery.

Doctors may use chemotherapy on stage 3 mesothelioma patients to:

  • Treat patients who cannot undergo surgery
  • Stop cancer cells from spreading before, during, or after surgery
  • Destroy cancer cells doctors cannot surgically remove

While mesothelioma chemotherapy and surgery may be an effective treatment combination for some stage 3 mesothelioma patients, a three-treatment approach of surgery, chemotherapy, and radiation may lead to the best results for both pleural and peritoneal mesothelioma patients.

Radiation Therapy

During radiation therapy, doctors use high-energy rays to target the DNA of cancer cells, destroying them. For stage 3 mesothelioma patients able to undergo surgery, it may be used as part of a multi-treatment approach.

Radiation therapy may also be used with chemotherapy for many stage 3 patients. This combination may increase each therapy’s effectiveness at destroying cancer cells in the original tumor site and cells that may have spread to other parts of the body.

Radiation therapy may help treat stage 3 mesothelioma by:

  • Killing cells that remain after surgery
  • Making surgery easier by shrinking tumors beforehand
  • Slowing the return of cancer after surgery

While a three-treatment approach may be the most helpful option for stage 3 mesothelioma patients who can undergo surgery, other treatment options are available for the many who are not able to receive standard treatment.

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Other Treatment Options

Another option in stage 3 is clinical trials. Clinical trials provide emerging treatments that can improve your life expectancy. Talk to your health care team today about available clinical trials you may qualify for.

Emerging mesothelioma treatments may include:

  • Anti-angiogenesis
  • Gene therapy
  • Immunotherapy
  • Photodynamic therapy

Patients should keep the stage of their mesothelioma in mind when searching for clinical trials since many restrict patients by cancer stage.

Improving Your Stage 3 Mesothelioma Prognosis

Many factors that determine a patient’s stage 3 mesothelioma prognosis are out of the patient’s control. However, patients can still take action to improve their prognosis as much as possible.

The following actions may improve a stage 3 mesothelioma prognosis:

  • Seeking life-extending treatment: For many mesothelioma patients, life-extending treatments are simply not an option because their cancer is already too advanced. However, some stage 3 patients are still good candidates for such treatments.
  • Eating well: Nutrition is essential for a strong immune system and a quick and complete recovery after invasive treatments like surgery and chemotherapy.
  • Exercising: Exercise has several health benefits, including lowering stress, improving blood flow, and helping prevent secondary health issues like bedsores.
  • Managing stress: Stress can negatively affect health by increasing blood pressure, causing sleep problems, and other issues. This may slow treatment recovery and decrease quality of life.
  • Not smoking: Smoking negatively affects overall patient health and may even disqualify a patient from certain treatments. It may also increase the chance of another cancer diagnosis, such as lung cancer.

As new treatment methods continue to develop, mesothelioma patients at all stages can look forward to longer survival rates — and one day, perhaps, a cure.

Reviewed by:Dr. Assuntina Sacco

Board-Certified Oncologist

  • Fact-Checked
  • Editor

Assuntina Sacco, MD is an Associate Professor of Internal Medicine at the University of California, San Diego (UCSD) Moores Cancer Center, where she also serves as the Medical Director of Infusion Services. She is a board-certified medical oncologist trained to treat all solid tumor types, with the use of chemotherapy, immunotherapy, targeted therapy, and clinical trials.

Dr. Assuntina Sacco is an independently paid medical reviewer.

Mesothelioma Hope was founded by a team of advocates to educate people about this aggressive form of cancer. Mesothelioma affects thousands of people each year. We help give hope to those impacted by mesothelioma.

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