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Stage 4 Mesothelioma

Stage 4 mesothelioma is the most advanced stage where tumors have spread beyond the lungs or abdomen. Life expectancy is around 12 months, and while surgery may not be viable for every patient, chemotherapy and other treatments can extend survival and improve quality of life. Learn more about this stage and discover how Mesothelioma Hope can help you access life-changing support and treatment.

Medically reviewed by: Mark Levin, MD

Last updated:

What Is Stage 4 Mesothelioma?

Stage 4 mesothelioma generally refers to malignant (cancerous) mesothelioma that has spread from the location where it first appeared to distant parts of the body.

Depending on the type, mesothelioma may first appear in the:

  • Pleura: Lining of the lungs and chest wall
  • Peritoneum: Lining of the abdominal cavity
  • Pericardium: Lining of the heart
  • Tunica vaginalis: Membrane lining the testes

Stage 4 mesothelioma is the final stage of mesothelioma under the tumor-node-metastasis (TNM) staging system. In the United States and many other countries, the TNM system is the most widely used framework for measuring how far cancer has progressed.

Doctors use the TNM system to help malignant pleural mesothelioma patients understand the extent of their cancer, how long they can expect to live, and what treatment options may help.

Stage 4 Pleural Mesothelioma

The only mesothelioma type with a generally accepted staging system is pleural mesothelioma. Stage 4 pleural mesothelioma is described as cancer that has spread through tissue, lymph nodes, or blood vessels to distant parts of the body, forming new tumors.

At this advanced stage, life-extending treatments may be extremely limited or unavailable. However, there are mesothelioma survivors who have been able to outlive their prognosis by months and years.

John Stahl, a retired construction worker from Nevada, was diagnosed with stage 4 pleural mesothelioma in 2019 after experiencing breathing difficulties. Despite the life-threatening diagnosis, John remained optimistic throughout his chemotherapy treatment, focusing on living his dream retirement with his wife.

“It’s going to end my life eventually, but I’m going to live it as well as I can.”
– John Stahl, stage 4 mesothelioma survivor

Learn more about mesothelioma types, stages, and symptoms in our Free Mesothelioma Guide.

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Stage 4 Peritoneal Mesothelioma

Peritoneal mesothelioma has no official staging system. However, some oncologists (cancer doctors) have proposed stages for peritoneal mesothelioma that have yet to be approved by the TNM staging system’s creators, the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC).

Under the most commonly used unofficial staging system, stage 4 peritoneal mesothelioma involves tumor spreading.

Quick Facts About Stage 4 Mesothelioma
  • This type of the cancer accounts for roughly 20% of all mesothelioma cases.
  • The most common sites of stage 4 mesothelioma tumor spread are the lungs, diaphragm, liver, kidneys, and adrenal glands.
  • According to the American Cancer Society (ACS), 8% of mesothelioma patients with distant or stage 4 mesothelioma survive 5 years after diagnosis.
  • Chemotherapy and treatment through clinical trials may help patients with stage 4 mesothelioma.

How Late-Stage Mesothelioma Develops

According to the Centers for Disease Control and Prevention (CDC), mesothelioma can take 10-50 years to develop after a patient has been exposed to asbestos — the only known cause of the cancer. However, once symptoms appear, the disease progresses rapidly.

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, forming new tumors far from where they originated — a process called metastasis.

Stage 4 mesothelioma marks the point when the cancer has metastasized (spread to distant parts of the body).

The TNM system describes stage 4 mesothelioma as follows:

  • Tumor: Cancer may have grown into nearby tissues and other body parts.
  • Node: Cancer may have spread to the lymph nodes — either nearby or on the other side of the body.
  • Metastasis: Cancer has spread to distant organs, such as the bones, the liver, lungs, etc.

As mesothelioma progresses from stage 3 to stage 4, the increased size and spread of tumors cause patients to experience the most severe mesothelioma symptoms.

Stage 4 Mesothelioma Symptoms

During stage 4, the symptoms commonly experienced by mesothelioma patients worsen. As the cancer spreads to other parts of the body, new symptoms may arise or extend to other areas.

Common stage 4 mesothelioma cancer symptoms include:

  • Abdominal pain
  • Anemia
  • Chest pain
  • Chronic fatigue
  • Coughing up blood
  • Difficulty swallowing
  • Extreme weight loss
  • Fever
  • Muscle atrophy
  • Night sweats
  • Shortness of breath

At this advanced stage, symptoms are typically severe enough for patients to notify their doctors, who can then run tests to determine a diagnosis.

If you’re experiencing symptoms of stage 4 mesothelioma, use our Free Mesothelioma Doctor Match to connect with top specialists who can accurately diagnose you.

Stage 4 Mesothelioma Diagnosis

Sadly, many patients do not receive a mesothelioma diagnosis until stage 4, since this is when symptoms are most prominent. Because mesothelioma is so rare, doctors may not immediately consider the possibility that a patient has it unless they are aware of the patient’s asbestos exposure.

Further, some cases of mesothelioma are initially misdiagnosed as other diseases, which means it may not be caught until stage 4.

Doctors can use the following to help diagnose stage 4 mesothelioma:

  • Biopsy
  • Blood tests
  • Imaging tests
  • Physical exam
  • The patient’s history of asbestos exposure
  • The type and severity of the patient’s symptoms

Ultimately, a biopsy is the most accurate way to diagnose mesothelioma. This involves removing a tissue sample from a patient’s tumor, thickened organ lining, or fluid around the cancer site. By examining this tissue under a microscope, a doctor can determine if any of its cells are cancerous.

Stage 4 Diagnosis and Mesothelioma Staging Systems

Once mesothelioma has been diagnosed, doctors use a staging system to find out how far the patient’s cancer has advanced and how they can expect it to progress.

While other systems exist (for pleural mesothelioma only), the TNM staging system is the most widely accepted. Each system focuses on different aspects of mesothelioma, describing stage 4 in its own way.

Stage 4 Pleural Mesothelioma By Staging System

  • Butchart system: The cancer has metastasized, spreading to distant parts of the body.
  • Brigham system: There are distant metastases. Tumors are not surgically removable.
  • TNM system: Mesothelioma may or may not have grown into nearby tissues and may or may not have spread to nearby lymph nodes. However, it has spread to distant organs.

Medical professionals around the world rely on the TNM for its simplicity, applicability, and practicality in explaining a patient’s mesothelioma prognosis.

Stage 4 Mesothelioma Prognosis

A prognosis describes how a disease is expected to progress. The stage of a patient’s cancer at diagnosis is a major factor in determining their mesothelioma prognosis.

Mesothelioma has a poor prognosis in general, and patients diagnosed at stage 4 have the poorest outlook. However, some stage 4 patients may extend their lives with chemotherapy and other treatments. Palliative treatment may also relieve symptoms and improve quality of life.

Learn more about mesothelioma stages, prognosis, and treatment in our Free Mesothelioma Guide.

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Stage 4 Mesothelioma Life Expectancy

The average amount of time doctors expect a mesothelioma patient to live after diagnosis is known as mesothelioma life expectancy. Life expectancy is usually measured in months.

Stage 4 patients have an average life expectancy of 12 months because they are often unable to undergo the most invasive life-extending treatments. Still, it’s important to note that some patients have lived longer than this.

Stage 4 Mesothelioma Treatment

Stage 4 malignant mesothelioma treatment may involve surgery, chemotherapy, radiation, or participation in clinical trials.

However, chemotherapy is the primary recommended treatment for patients with stage 4 mesothelioma since it is less invasive and has a shorter recovery period.

Stage 4 Mesothelioma Surgery

Stage 4 mesothelioma is usually not able to be operated on because cancer cells have spread to distant parts of the body. At this stage, the cancer is too widespread for surgeons to effectively remove all of it, and patients may be too sick to undergo such aggressive surgery.

Less invasive mesothelioma surgery may still help relieve discomfort and treat complications caused by tumor growth by removing the tumors that are causing symptoms.

Stage 4 Mesothelioma Chemotherapy

Chemotherapy, a procedure that treats a patient with cancer-destroying drugs, is the standard treatment option for stage 4 mesothelioma patients.

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 ACS, these targeted medications sometimes work when standard chemotherapy drugs don’t, and often with less severe side effects.

Did You Know?

A 2021 clinical trial found that treatment with atezolizumab (Tecentriq®) and bevacizumab (Avastin®) was well-tolerated and resulted in a 40% objective response rate in patients with advanced malignant peritoneal mesothelioma.

Stage 4 Mesothelioma Radiation Therapy

During mesothelioma radiation therapy, doctors use high-energy rays to destroy the DNA of mesothelioma cancer cells.

For stage 4 mesothelioma patients, radiation therapy is most commonly used to help shrink tumors that can be directly targeted, relieving pain or obstruction.

Many advanced-stage mesothelioma patients do not respond effectively to typical cancer treatments like surgery, chemotherapy, and radiation. However, other treatment options are available.

Other Treatment Options for Stage 4 Mesothelioma

Most stage 4 mesothelioma patients are not ideal candidates for invasive treatments like surgery. However, some late-stage patients may be able to improve their mesothelioma prognosis by participating in a clinical trial.

Mesothelioma clinical trials test emerging therapies that may be more effective than the treatment options that are currently available.

For example, immunotherapy therapy showed promise as a more effective mesothelioma treatment option in clinical trials. As a result, two immunotherapy drugs — Opdivo (nivolumab) in combination with Yervoy (ipilimumab) — were approved in October 2020 as the first-line treatment of adults with malignant pleural mesothelioma that cannot be removed by surgery.

Other novel approaches like biological and targeted therapies are being studied in clinical trials.

Emerging mesothelioma treatments include:

Many trials restrict patients by cancer stage, so patients should confirm with their doctor whether they’re eligible to enroll in a clinical trial.

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Stage 4 Mesothelioma Palliative Care

Palliative care describes treatment that focuses on relieving pain and increasing comfort and well-being rather than improving life expectancy.

Many stage 4 mesothelioma patients do not receive much benefit from chemotherapy and cannot undergo surgery to extend their lives. Therefore, doctors focus on reducing their symptoms and giving them the best quality of life possible.

Palliative care options for stage 4 mesothelioma include:

  • Chemotherapy: Chemotherapy helps reduce the size of tumors, easing symptoms.
  • Low-risk surgeries: Palliative surgery for mesothelioma may reduce fluid buildup or partially remove tumors.
  • Medication: Doctors may prescribe medication such as morphine to help patients manage their pain.
  • Radiation: Like chemotherapy, radiation may shrink cancerous tumors and ease symptoms.

For those who have reached the final stage of mesothelioma, palliative care is central to optimal treatment.

Mesothelioma Hope can connect you with resources to help make this difficult time easier on you and your family. Contact us today at (866) 608-8933 to get started.

End-of-Life Planning for Stage 4 Mesothelioma

A doctor holds the hand of a patient with stage 4 mesothelioma

Stage 4 mesothelioma is the final stage of this aggressive cancer, and many patients live fewer than 6 months after diagnosis.

While such a diagnosis can be devastating, patients may ease anxiety and improve their general well-being by managing their treatment and making an end-of-life plan.

Learn more about end-of-life planning below.

Care Setting

Patients should speak with their loved ones about where they wish to receive end-of-life care (hospital, hospice, at home, etc.) and whether they would like to designate someone as their caregiver.

Care of Dependents

Patients with dependent children or grandchildren, pets, or anyone else reliant on their care should make arrangements to make sure those who survive them are taken care of.

Funeral Arrangements

Patients should let loved ones know how they want their body to be handled (cremation, burial, etc.), any details about a funeral service, and any special religious requests.

Personal Records

A trusted loved one should have access to any important information they may need to know, such as the patient’s social security number and banking passwords.

Treatment Management

A patient’s treatment team should know their priorities when it comes to treatment. Do they want to focus on extending survival time or easing symptoms? At some point, patients may wish to end all standard cancer treatments like chemotherapy and surgery.

Will and Other Financial Matters

Patients should review or draft a will and make sure to account for all income and assets, such as investments, personal possessions, and other forms of compensation.

An advance directive also gives you the opportunity to spell out your decisions regarding end-of-life care in advance. This includes whether or not you wish to receive life-sustaining therapies such as CPR, a breathing machine (ventilator), artificial nutrition, or hydration.

While these decisions may be difficult to discuss with your doctor or family, doing so ahead of time will help ensure your wishes are followed, minimizing any unwanted procedures or unnecessary suffering.

Patients can ask their medical team for recommended end-of-life care documents and where they may receive further assistance. By working with their care team and planning ahead, stage 4 mesothelioma patients may experience a greater sense of peace and satisfaction at the end of their lives.

Finding Support for Stage 4 Mesothelioma

If you or a loved one has been diagnosed with stage 4 mesothelioma, it’s important to look for support resources that can help ease the physical and mental toll of this cancer.

At this stage, patients and their families may find comfort in:

  • Connecting with mesothelioma survivors
  • Joining support groups with other patients and caregivers
  • Seeing if they’re eligible for financial assistance
  • Seeking out emotional or faith-based guidance

Hope for Stage 4 Mesothelioma Patients

We understand that a diagnosis of stage 4 mesothelioma can be overwhelming, but we believe in the power of hope and resilience. Medical advancements and treatment options are continually evolving, offering new possibilities for long-term survival.

By embracing hope, families can cherish the time they have together, making precious memories and celebrating the courage and resilience of their loved ones.

Don’t let mesothelioma define your storyrequest our Free Mesothelioma Guide and get the essential information you need to fight this cancer.

Stage 4 Mesothelioma FAQs

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 as well as palliative care to reduce their pain and make them more comfortable.

How long does someone live with stage 4 mesothelioma?

Mesothelioma stage 4 life expectancy is 12 months on average. However, some patients have lived longer than a year with mesothelioma chemotherapy.

A mesothelioma doctor can give you a better idea of your prognosis after they make a diagnosis.

What are stage 4 mesothelioma survival rates?

Stage 4 mesothelioma survival rates describe the percentage of mesothelioma patients who are still alive for a specific number of years after being diagnosed.

The 5-year survival rate is 8% for late-stage mesothelioma, according to the ACS.

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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  2. Amin, W., et al. (2018). Factors influencing malignant mesothelioma survival: a retrospective review of the National Mesothelioma Virtual Bank cohort. F1000Research, 7, 1184. Retrieved May 31, 2024, from
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  4. Cho, B. C., et al. (2014). A feasibility study evaluating Surgery for Mesothelioma After Radiation Therapy: the “SMART” approach for resectable malignant pleural mesothelioma. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 9(3), 397–402. Retrieved May 31, 2024, from
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  7. Mayo Clinic. (2019). Mesothelioma: Diagnosis & treatment. Retrieved May 31, 2024, from
  8. Mott, F. E. (2012). Mesothelioma: a review. The Ochsner journal, 12(1), 70–79. Retrieved May 31, 2024, from
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  10. National Organization of Rare Disorders. (2017). Mesothelioma. Retrieved May 31, 2024, from
  11. Shavelle, R., Vavra-Musser, K., Lee, J., & Brooks, J. (2017). Life Expectancy in Pleural and Peritoneal Mesothelioma. Lung cancer international, 2017, 2782590. Retrieved May 31, 2024, from
  12. University of Texas M. D. Anderson Cancer Center. (2021, July 14). Drug combination shows meaningful responses for malignant peritoneal mesothelioma patient: Study shows 40% objective response rate for rare cancer with few treatment options. ScienceDaily. Retrieved May 31, 2024, from
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