Resources for Patients and their Families

Stage 4 Mesothelioma

Stage 4 mesothelioma is the most advanced stage of the disease. In Stage 4, the cancer has spread beyond the initial area, and the prognosis is very poor. The life expectancy of patients diagnosed with Stage 4 mesothelioma is usually a year or less.

Defining Stage 4 Mesothelioma

The standard way of classifying the severity and progression of cancer is using a four-tiered staging system. In this system, Stage 4 mesothelioma is the latest stage, and is usually considered terminal.

Stage IV Mesothelioma Illustration Lungs Icon
Stage 4 Mesothelioma

The most notable feature of Stage 4 mesothelioma is that the cancer has spread beyond its point of origin. This circumstance, known as metastasis, means that cancerous cells can be found throughout the body, including in lymph nodes and organs far from where it started.

Different staging systems have a slightly different definition of Stage 4:

Butchart System

The disease has dispersed throughout the bloodstream to distant organs.

TNM System

The tumor has metastasized throughout the body. Other organs and lymph nodes are involved – both nearby and distant.

Brigham System

The spreading of the disease has made surgery no longer possible. There is a high likelihood for recurrence if tumors are indeed removed.

Stage 4 Mesothelioma Symptoms

The symptoms of Stage 4 mesothelioma are usually quite severe, and often they are spread through the body, not being limited to the area where the cancer first developed.

Common symptoms of Stage 4 mesothelioma include:

  • General feeling of unwellness or fatigue
  • Difficulty breathing and shortness of breath (dyspnea)
  • Dysphagia (difficulty swallowing)
  • Pain and tightness in the chest
  • Night sweats and fever
  • Abdominal pain and discomfort
  • Accumulation of fluid in the chest or abdomen
  • Hemoptysis (coughing up blood)
  • Unexplained loss of weight

Prognosis for Stage 4 Mesothelioma

The median survival period for patients diagnosed with Stage 4 mesothelioma is about 12 months. In most cases, the cancer will continue to spread, resulting in respiratory or heart failure.

A patient’s individual life expectancy will differ depending on their age, gender, and overall health, as well as the mesothelioma location, cell type, and other factors.

Stage 4 Mesothelioma Treatment Protocols

In most cases, Stage 4 mesothelioma cannot be successfully cured. Therefore, therapy is usually limited to palliative care, meaning that it focuses on reducing pain and discomfort and improving quality of life.

Conventional multimodal treatment plans that combine surgery, radiation, and chemotherapy are not typically used for Stage 4 mesothelioma patients. Individual therapies, however, are sometimes used to manage pain and discomfort.


Surgery can remove one or more tumors, which can help relieve symptoms. Other procedures, such as thoracentesis, can remove fluid to ease discomfort.


Chemotherapy may lessen pain for some patients, but it can also have considerable risks at Stage 4. In some cases, after removing the tumor(s), chemotherapy can slow metastasis.


Radiation is rarely recommended for Stage 4 mesothelioma; however, in some cases it can help reduce tumor size to relieve pressure on the chest or abdomen.

Experimental Treatments and Clinical Trials

In some cases, experimental treatments such as immunotherapy, gene therapy, and other emerging therapies may be available through clinical trials. If you or a loved one has been diagnosed with Stage 4 mesothelioma, you may want to connect with a cancer center to see if a clinical trial is available.

Financial Assistance for Stage 4 Mesothelioma

Medical treatment costs can be significant for individuals who are diagnosed with Stage 4 mesothelioma. Sometimes insurance companies may not cover the cost of diagnostic tests, clinical trials, or other experimental treatments.

If you or a loved one is diagnosed, you should strongly consider taking steps to help offset this potential financial burden. Learn more about the financial assistance that is available to you if you or a loved one has been diagnosed with mesothelioma and exposed to asbestos.


Cao C., et al. Staging of patients after extrapleural pneumonectomy for malignant pleural mesothelioma—institutional review and current update. Interactive Cardiovascular and Thoracic Surgery. 2011;12(5): 754-757. doi: 10.1510/icvts.2010.262972

Dodson R. and Hammar S. Asbestos: Risk Assessment, Epidemiology, and Health Effects. Boca Raton, FL: Taylor & Francis; 2006.

Galateau-Salle F. Pathology of Malignant Mesothelioma. London: Springer-Verlag London Limited; 2006.

Heelan RT, et al. Staging of malignant pleural mesothelioma: comparison of CT and MR imaging. American Journal of Roentgenology. 1999;172(4):1039-1047. doi: 10.2214/ajr.172.4.10587144

Rusch VW, Venkatraman E. The importance of surgical staging in the treatment of malignant pleural mesothelioma. Journal of Thoracic Cardiovascular Surgery. 1996;111(4): 815-825.

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