Mesothelioma Stage 4

Stage 4 mesothelioma is the last stage of asbestos-caused cancer. Tumors that first developed in the mesothelium (organ linings) have metastasized to distant sites—organs like the heart or brain or tissues in the rib cage. Stage 4 mesothelioma also involves lymph nodes. Treatments for stage 4 mesothelioma are focused on finding the most effective ways to improve the patient’s quality of life.

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Overview of Stage 4 Mesothelioma

  • Most advanced stage of the 4 mesothelioma stages
  • Pleural mesothelioma is the only disease with an official staging system, but doctors still use certain criteria to help stage peritoneal and pericardial mesothelioma
  • Many mesothelioma cases aren’t diagnosed until stage 4
  • By stage 4, mesothelioma cells have metastasized so significantly that cancer can no longer be resected (removed)
  • Stage 4 mesothelioma symptoms can be painful and uncomfortable
  • Stage 4 mesothelioma has the poorest prognosis for long-term survival but life expectancy may be extended with the right treatments
  • Doctors treat stage 4 mesothelioma with palliative care approaches such as non-invasive surgeries to relieve chest or abdominal pressure
  • New and novel therapies in clinical trials may also help improve the quality of life in stage 4 mesothelioma patients

What is Stage 4 Mesothelioma?

Stage 4 mesothelioma is the most advanced stage of 4 mesothelioma stages. It refers to the last level of disease progression whereby the tumors have metastasized well beyond the primary location. In stage 4, it’s possible for tumors to have spread to the other side of the chest and into the spine, rib cage, diaphragm, and heart. With lymph node involvement, mesothelioma cells may even have spread to the brain or liver.

It’s important for patients diagnosed at stage 4 mesothelioma to cope with their diagnosis by understanding how the disease formed and spread. The area where the tumor first develops inside the mesothelium (the protective organ linings) is called the primary location. A tumor in the mesothelium is composed of mesothelioma cancer cells, which grow and divide at abnormal rates. As mesothelioma cells increases, they cause the tumor to spread and invade surrounding areas (metastasis).

Doctors try to prevent further metastasis in some patients with earlier stage mesothelioma. However, in most stage 4 patients the metastasis is so extensive that doctors are unable to stop it. As mesothelioma invades other parts of the body, it compromises organs like the lungs and heart, which is what eventually becomes fatal. During this process, the patient can experience severe pain and discomfort, so doctors treat stage 4 patients using palliative treatments to improve quality of life.

Stage 4 Mesothelioma Prognosis and Life Expectancy

Mesothelioma has a poor prognosis (disease outlook) and by stage 4, the outlook is bleak. On average, a mesothelioma patient’s life expectancy ranges from 12-21 months. Stage 4 life expectancy is at the lowest end of this range.

The average life expectancy for stage 4 mesothelioma is 12 months. Though survival is likely not possible, patients do have important treatment options that can potentially extend life by a few months.

Mesothelioma Justice Network Brief

Getting a second opinion from a mesothelioma specialist is important at any stage. But a stage 4 mesothelioma diagnosis should be reviewed by a doctor who specializes in treating your exact form of mesothelioma. There have been cases where patients were diagnosed with stage 4 mesothelioma and told they had limited treatment options. However, upon seeing a different doctor, the patients were given other, more aggressive treatments.


Stage 4 Mesothelioma Symptoms

Not having been diagnosed with mesothelioma at an earlier stage is usually the result of a misdiagnosis stemming from confusing symptoms. The symptoms that patients typically first report can be mistaken for symptoms of emphysema or pneumonia—especially in patients who are already in poor health. Because mesothelioma is so rare, it’s not often considered by general practitioners. But when mesothelioma is misdiagnosed it can waste precious time, as the disease continues to advance.

Possible stage 4 pleural mesothelioma symptoms include:

  • Shortness of breath
  • Painful breathing
  • Coughing up blood
  • Chest pain
  • Significant weight loss
  • Loss of appetite
  • Fever, night sweats, and fatigue
  • Pleural thickening and fluid buildup (pleural effusions)
  • Lumps of tissue forming under the skin around the chest

Most patients have developed pleural effusions by stage 4, which can be detected when doctors listen to the chest with a stethoscope. If doctors suspect malignancy due to a patient’s severe pain and weight loss, they will order x-rays, which can show them concerning abnormalities eventually leading to a mesothelioma diagnosis.

Stage 4 Mesothelioma Treatment Options

Unlike stage 1, 2 or even 3 mesothelioma patients, stage 4 patients are rarely good candidates for any significant surgical procedures. However, some specialists are known for treating late-stage patients with aggressive surgeries in some cases. For the most part though, doctors will recommend palliative treatments to help improve comfort.

Mesothelioma cases are all unique, so what works for some stage 4 patients may not be right for others. Some patients are too sick to undergo chemotherapy, which is known for difficult side effects. Others still have the option of chemo or radiation therapies to help reduce painful symptoms.

Palliative Surgery

Depending on your unique case, doctors may recommend palliative surgery. Instead of removing the mesothelioma, doctors instead use minimally invasive surgeries to treat a major source of discomfort: pleural effusions. Occurring in 90% of mesothelioma patients, pleural effusions occur when fluid builds up in the pleural cavity, causing chest pain and difficulty breathing.

Two possible palliative surgeries for stage 4 pleural mesothelioma are:

  • Pleurodesis: Using a needle, doctors drain fluid from the pleura and then seal it off to prevent further effusions.
  • Thoracentesis: Similar to a pleurodesis, surgeons use a needle to drain fluid from the pleural cavity, but they don’t seal it off during a thoracentesis.


Chemotherapy is a class of anti-cancer drugs administered either intravenously or by pill. The chemotherapy drugs circulate through the body, killing cancer cells in their path. Though chemotherapy alone cannot stop significant mesothelioma metastasis, it can help slow disease progression and alleviate pain.

The combination of two chemotherapy drugs called cisplatin and pemetrexed has shown to help slow metastasis and possibly extend life.

Radiation Therapy

Radiation therapy may be prescribed for certain stage 4 mesothelioma patients. Radiation therapy works by shrinking tumors in size, which may help to alleviate pressure. Radiation therapy might be an option for patients who cannot undergo chemotherapy.

Clinical Trials

New and novel therapies are being tested in clinical trials right now. Clinical trials produce the next wave of medical advancements, and stage 4 mesothelioma patients have access to these treatments before the general public does. Talk to your doctor about participating in clinical trials to receive potentially life-extending therapies.

Stage 4 Mesothelioma Specialists

It’s vital for stage 4 mesothelioma patients to seek the second opinion of a specialist. Though stage 4 patients have a poor prognosis, seeing another specialist can open up new treatment options you otherwise wouldn’t have known about.

Stage 4 mesothelioma patients may be eligible for legal compensation from negligent asbestos manufacturers. Successful claims can provide you and your family with the financial resources to pay for your end-stage mesothelioma treatments and other costs associated with your diagnoses, such as hospice care or home care.

Author:Stephanie Kidd

Editor-in-Chief of the Mesothelioma Justice Network

Stephanie Kidd

Stephanie Kidd works tirelessly as a dedicated advocate for the vulnerable and underrepresented. Stephanie worked as a copywriter for an agency whose focus was communicating safety procedures on construction work sites. With her extensive background in victim advocacy and a dedication to seeing justice done, Stephanie works hard to ensure that all online content is reliable, truthful and helpful.

Last modified: June 24, 2019

View 4 Sources
  1. American Cancer Society, “Malignant Mesothelioma Stages” Retrieved from: Accessed on January 2, 2018.
  2. Medscape, “Surgery for Malignant Pleural Mesothelioma.” Retrieved from: Accessed on January 2, 2018.
  3. University of New Mexico Comprehensive Cancer Center, “Stage IV/Recurrent Malignant Pleural Mesothelioma.” Retrieved from: Accessed on January 2, 2017.
  4. National Cancer Institute, “Malignant Mesothelioma Treatment.” Retrieved from: Accessed on January 2, 2017.
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