What Is Stage 4 Mesothelioma?
Stage 4 mesothelioma is the final stage under the tumor-node-metastasis (TNM) staging system, which is what most doctors use to measure how far cancer has progressed.
As mesothelioma cancer cells multiply, they cause tumors to grow and spread. Eventually, these cancer cells may travel through the lymph nodes or blood vessels, creating new tumors far from where they formed. Stage 4 mesothelioma marks the point when the cancer has metastasized, or spread to distant parts of the body.
Here’s how the TNM staging system describes stage 4 mesothelioma cancer:
- Cancer may have grown into nearby tissues and other body parts.
- Cancer may have spread to nearby lymph nodes or those on the other side of the body.
- Cancer has spread to distant organs, such as the kidneys, liver, or lungs.
The TNM system is used specifically for staging pleural mesothelioma. Doctors use other methods to determine if and how far peritoneal mesothelioma has spread.
Quick Facts About Mesothelioma Stage 4
- Mesothelioma is often diagnosed in later stages because early-stage symptoms are non-specific and may not be severe.
- The most common sites of stage 4 mesothelioma tumor spread are the lungs, diaphragm, liver, kidneys, and adrenal glands.
- Stage 4 patients who aren’t eligible for surgery may benefit from chemotherapy or immunotherapy.
Get help with an advanced-stage mesothelioma diagnosis by meeting with a specialist. Use our Free Doctor Match to connect with a specialist near you today.
Stage 4 Mesothelioma Cancer Types
Mesothelioma is caused by asbestos exposure. Asbestos is a toxic mineral used in many products until the early 1980s.
Depending on the type of cancer, mesothelioma may first appear in the:
- Pleura: Lining of the lungs and chest wall (pleural mesothelioma)
- Peritoneum: Lining of the abdominal cavity (peritoneal mesothelioma)
- Pericardium: Lining of the heart (pericardial mesothelioma)
- Tunica vaginalis: Membrane lining the testes (testicular mesothelioma)
Learn more about mesothelioma’s final stages for each type of cancer below.
Stage 4 Pleural Mesothelioma
Stage 4 pleural mesothelioma has spread through tissue, lymph nodes, or blood vessels to distant parts of the body, forming new tumors.
At this advanced stage, not all patients may be eligible for life-extending surgeries, which can be aggressive and difficult to recover from. However, many mesothelioma survivors have far outlived their prognosis with other treatments.
John Stahl, a retired construction worker from Nevada, was diagnosed with stage 4 malignant pleural mesothelioma in 2019. Despite this unexpected diagnosis, John remained optimistic throughout his chemotherapy sessions, focusing on living out his dream retirement with his wife.

“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.”
Stage 4 Peritoneal Mesothelioma
Other types of mesothelioma don’t have an official staging system as they are rarer and spread differently than pleural mesothelioma. However, some oncologists (cancer doctors) have proposed stages for peritoneal mesothelioma.
In particular, some oncology doctors use the peritoneal cancer index (PCI) to informally stage peritoneal mesothelioma.
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
The further the spread of cancer, the higher the stage. Stage 4 peritoneal mesothelioma describes the largest amount of cancer present throughout the abdomen.
These stages can be a helpful tool for understanding cancer spread even though they haven’t yet been approved by the American Joint Committee on Cancer (AJCC).
Mesothelioma Stage 4 Symptoms
As mesothelioma progresses and spreads to other parts of the body, symptoms may worsen or extend to other areas.
Common stage 4 mesothelioma symptoms include:
- Abdominal pain
- Anemia
- Chest pain
- Chronic fatigue
- Coughing up blood
- Difficulty swallowing
- Fever
- Muscle atrophy
- Night sweats
- Shortness of breath
- Weight loss
If you’re experiencing symptoms of stage 4 mesothelioma, our team is here to help. Contact us any time for information, support, and recommendations for mesothelioma specialists in your area.
Mesothelioma Stage 4 Treatment
Stage 4 malignant mesothelioma treatment may involve chemotherapy, radiation, immunotherapy, or participation in clinical trials.
While each case is different, the most commonly used stage 4 mesothelioma treatment is chemotherapy. Learn more about the types of mesothelioma stage 4 treatment below.
Stage 4 Mesothelioma Surgery
Stage 4 mesothelioma cancer patients are not typically candidates for surgery. At this stage, it may not be possible to remove all the cancer as it has usually spread to different parts of the chest wall or grown through the diaphragm, pleura, or thoracic organs.
In some cases, doctors may recommend surgery to debulk or reduce the size of tumors, which could help make chemotherapy and other treatments more effective.
Palliative mesothelioma surgery may also help ease discomfort caused by tumors pushing against various organs. For example, reducing tumors around the pleura to improve breathing.
Stage 4 Mesothelioma Chemotherapy
Chemotherapy is the standard treatment option for stage 4 mesothelioma patients. Chemotherapy uses powerful drugs to destroy cancer cells.
The preferred method for stage 4 mesothelioma is a combination of two chemotherapy medications called cisplatin and pemetrexed (Alimta®).
Adding targeted therapy to standard chemotherapy has also shown promise as an effective mesothelioma treatment option, specifically the cancer drug bevacizumab. According to the American Cancer Society (ACS), these targeted medications sometimes work when standard chemotherapy drugs don’t — often with less severe side effects.
Seattle-based comedian Quincy Jones (born Quami Wallen) was diagnosed with late-stage peritoneal mesothelioma in 2016. Over 8 years later, he continues to undergo chemotherapy to keep his cancer at bay and is living his life to the fullest.
Immunotherapy for Stage 4 Mesothelioma
Immunotherapy is a newer type of mesothelioma treatment that works by supporting the immune system’s ability to target and destroy cancer cells.
Immunotherapy may be an option for stage 4 patients because it is often less aggressive than surgery and may have fewer side effects than other treatments. However, every patient’s experience will be different.
Approved immunotherapy drugs for mesothelioma include:
- Opdivo® (nivolumab)
- Yervoy® (ipilimumab)
- Keytruda® (pembrolizumab)
Learn more about this treatment by downloading our Free Guide to Immunotherapy for Mesothelioma.
Stage 4 Mesothelioma Radiation Therapy
During mesothelioma radiation therapy, doctors use high-energy rays to destroy the DNA of cancer cells.
For stage 4 mesothelioma patients, radiation therapy is most commonly used to help shrink painful tumors that are pressing on nearby nerves or organs.
Radiation may also be used alongside chemotherapy to destroy as much of the cancer as possible.
Stage 4 Mesothelioma Without Treatment
Some patients choose not to pursue treatment for their stage 4 mesothelioma cancer diagnosis. They may not want to experience treatment side effects or may be unable to pay for their medical costs.
However, the average life expectancy for stage 4 pleural mesothelioma patients without treatment is around 6 months.
In most cases, stage 4 mesothelioma patients are encouraged to pursue medical care. Even if doctors don’t know if they can stop or slow the progression of the disease, treatment can help address symptoms and improve quality of life for patients with advanced cancer.
Stage 4 Mesothelioma Palliative Care
Palliative care describes treatment that relieves pain and increases comfort and well-being.
If stage 4 mesothelioma cancer patients won’t benefit from more aggressive treatment, doctors can focus on reducing symptoms and giving them the best quality of life possible.
Palliative care options for stage 4 mesothelioma include:
- Fluid removal: Doctors may perform a thoracentesis to drain fluid buildup in the chest cavity and around the lungs to make breathing easier.
- Low-risk surgeries: Palliative surgery for mesothelioma may include resection, or partially removing tumors to alleviate pain or pressure.
- Medication: Doctors may prescribe medication such as morphine to help with pain management.
Get connected with a mesothelioma doctor who can help design a treatment plan for your situation. Use our Free Doctor Match to get started.
Mesothelioma Life Expectancy Stage 4
The average amount of time doctors expect a patient to live after their diagnosis is known as mesothelioma life expectancy. Life expectancy is usually measured in months.
The average stage 4 mesothelioma life expectancy is 12 months. Stage 4 has the lowest life expectancy due to the cancer’s spread, which can limit patients from undergoing more aggressive, life-extending treatments.
However, stage 4 mesothelioma survival rates are just an average — they aren’t set in stone and don’t dictate your future. Many patients have outlived their initial life expectancy and led fulfilling lives after a diagnosis.

“Patients can have hope by saying, ‘I may not get cured of this cancer, but I can live with this cancer — and I’m going to do everything I can to have the best quality of life and get the most enjoyment out of my life with whatever time I have.'”
Stage 4 Mesothelioma Prognosis
Prognosis describes how a patient’s disease is expected to progress. Patients diagnosed at stage 4 may have a poorer mesothelioma prognosis due to fewer available treatment options.
However, chemotherapy and immunotherapy can help some patients live longer. Palliative treatment may also relieve symptoms and improve quality of life.
Learn more about mesothelioma stages, prognosis, and treatment in our Free Mesothelioma Guide.
End-of-Life Planning for Stage 4 Mesothelioma
In addition to palliative and life-extending treatments, stage 4 mesothelioma cancer patients may want to consider end-of-life planning. Knowing what to expect can ease your anxiety and improve your overall well-being.
Considerations for end-of-life planning may include:
- Care setting: Decide where to receive care (hospital, hospice, at home, etc.) and designate a primary caregiver if needed.
- Dependent care: Arrange for the care of children, grandchildren, pets, or other dependents.
- Funeral arrangements: Plan for cremation or burial, funeral service details, and any religious preferences, and share these wishes with your loved ones.
- Medical preferences: Specify treatment choices, such as whether to pursue life-sustaining therapies like CPR, ventilation, or artificial nutrition and hydration.
- Personal records: Ensure your loved ones have access to important documents, including social security numbers, banking information, and passwords.
- Will and financial planning: Draft or review a will, ensuring you account for income, assets, investments, and personal possessions.
While these conversations can be challenging, discussing your plans with loved ones and your doctor in advance will ensure your wishes are respected.
Get Support for Stage 4 Mesothelioma
If you or a loved one has been diagnosed with stage 4 mesothelioma cancer, you are not alone. Our team is standing by to provide support and guidance as you face this diagnosis.
We can help you:
- Find a doctor to pursue life-extending or palliative care
- Connect with support groups and peer mentors
- Answer questions about what to expect during treatment
- Pursue financial compensation for your family
Contact us or call us at (866) 608-8933 for support right now.
Stage 4 Mesothelioma FAQs
How long can you live with stage 4 mesothelioma?
The average mesothelioma stage 4 life expectancy is 12 months. However, each patient is unique. Depending on which treatments you qualify for and how your cancer responds, you could live much longer.
A mesothelioma doctor can give you a better idea of your prognosis after you’ve been accurately diagnosed.
How long are the final stages of mesothelioma?
The mesothelioma final stages can last months, weeks, or days depending on the individual. Advanced symptoms of mesothelioma will be different for each patient but may include difficulty breathing, severe pain, coughing, or abdominal swelling.
Patients may benefit from hospice care during the final stages of mesothelioma to address symptoms, live more comfortably, and receive support from caregivers and family members.
How bad is stage 4 mesothelioma?
Stage 4 mesothelioma is usually considered terminal. In this final stage, the cancer has spread to other areas of the body through blood, tissue, and lymph nodes.
Late-stage mesothelioma patients are generally not eligible for tumor-removing surgeries and usually receive chemotherapy and palliative care to reduce their pain and make them more comfortable.
However, stage 4 mesothelioma cancer is not a guaranteed death sentence. Some survivors have outlived their initial prognosis by several years.
What are stage 4 mesothelioma survival rates?
Stage 4 mesothelioma survival rates describe the percentage of mesothelioma patients who are still alive a specific number of years after being diagnosed.
Late-stage mesothelioma has a 5-year survival rate of 8%, according to the ACS.