What is Stage 4 Mesothelioma?

stage 4 mesotheliomaStage 4 mesothelioma is late-stage cancer that has spread from where it started to distant parts of the body. Mesothelioma, a rare disease linked to asbestos exposure, often appears in the lining of the lungs, abdominal cavity, or heart before spreading to distant organs and lymph nodes.

Treatment for stage 4 mesothelioma most often consists of methods to reduce symptoms and improve quality of life. Patients with late-stage mesothelioma typically undergo palliative therapies, mental health counseling, or complementary treatments to help with pain and symptom management.

Stage 4 Mesothelioma Symptoms

The onset of symptoms of mesothelioma often occurs in later stages. Common symptoms of stage 4 mesothelioma include shortness of breath (dyspnea) and coughing. Symptoms can vary depending on the site where mesothelioma first occurs. Other signs you may have stage 4 mesothelioma:

  • Abdominal pain
  • Coughing up blood (hemoptysis)
  • Difficulty swallowing (dysphagia)
  • Fatigue
  • Fluid buildup in the chest or abdomen
  • General discomfort (malaise)
  • Muscle weakness
  • Night sweats and fever
  • Chest pain or tightness
  • Severe weight loss or anorexia (lack of appetite)

Symptoms of mesothelioma mirror those of other diseases, such as lung cancer. The expertise of a mesothelioma specialist is often needed to confirm a diagnosis.

How is Stage 4 Meso Diagnosed? 

There are several steps involved in the diagnosis process of stage 4 mesothelioma. Some patients receive a stage 4 mesothelioma diagnosis as a result of undergoing an unrelated surgery. Others may begin the diagnosis process after experiencing symptoms of mesothelioma.

Imaging scans, biopsies, and blood tests are commonly used to diagnose mesothelioma. An essential step of the diagnosis process involves sharing a detailed history of potential asbestos exposure with your doctors. Coming into contact with asbestos puts people at risk of developing mesothelioma.

Pleural Mesothelioma

Pleural mesothelioma begins in the lining of the lungs and chest cavity, called the pleura. Patients experiencing pain in the chest or difficulty breathing often undergo one or more imaging tests, including X-rays, CAT scans, or PET scans to reveal fluid buildup, tumors, or other irregularities. Blood tests like MesoMark® identify mesothelioma cells, while tissue or tumor biopsies confirm them.

Peritoneal Mesothelioma

Peritoneal mesothelioma is a form of cancer originating in the tissue of the abdomen as a result of ingesting asbestos fibers. The diagnostic process follows the same series of imaging tests as pleural mesothelioma but instead looks for fluids present in the abdomen. A fluid and tissue biopsy confirms the presence of mesothelioma cells.

*Note: Under TNM staging system guidance, doctors diagnose peritoneal mesothelioma using phases instead of stages (early-stage, mid-stage, late-stage).

Pericardial Mesothelioma

Pericardial mesothelioma forms in the tissues that line the heart, called the pericardium. Before diagnosing mesothelioma, doctors must rule out common issues that present similar issues, such as heart disease. The combination of imaging tests and biopsies still applies in the diagnosis process. However, pericardial mesothelioma patients may undergo additional tests, such as an echocardiogram that uses ultrasound to visualize heart function.

Testicular Mesothelioma

Less than 1% of mesothelioma starts in the lining of the testes. The similarities between testicular cancers and other medical issues are hard to detect, commonly leading to a misdiagnosis. A medical ultrasound can detect tumors and other fluid-like sacs that indicate an underlying disease. Doctors ultimately diagnose testicular mesothelioma after examining tissue from a biopsy.

How Long Do You Live With Stage 4 Mesothelioma?

The average life expectancy for stage 4 mesothelioma is between 12-24 months with treatment. Patients and their doctors determine whether the treatment will prioritize extending survival, improving quality of life, or both. Patients who choose not to undergo treatment often live less than one year after initial diagnosis.

Extensive asbestos exposure could impact your risk of developing mesothelioma, but not how long you live. The life expectancy for stage 4 mesothelioma depends instead on other factors, including where it develops, the patient’s age, overall health, and the treatment plan.

Stage 4 Mesothelioma Survival Rate by Age

The survival rate does not determine the outcome for each patient, mainly if there are individual factors involved. Patients under 64 years of age often live months past the survival rates. There are various reasons why age may impact survival rates. For example, younger patients are typically in better health than other patients and are eligible for more aggressive mesothelioma treatments.

Stage 4 Life Expectancy by Type

The life expectancy for mesothelioma varies on where it develops. Pleural mesothelioma, the most common type, has an average life expectancy of one year. Patients with testicular or peritoneal mesothelioma tend to have higher life expectancies.

Site Life Expectancy With Treatment
Pleural Mesothelioma 12-15 months
Peritoneal Mesothelioma (Late-Stage) 12-26 months
Pericardial Mesothelioma 6-12 months
Testicular Mesothelioma 20+ months

Stage 4 Mesothelioma Life Expectancy Without Treatment

Without treatment, patients with advanced mesothelioma live an average of six months. No matter what stage of mesothelioma you have, your life expectancy could increase considerably when treated.

Related: Stage 4 Lung Cancer Life Expectancy

Stage 4 Treatment Types

Primary treatment methods used for stage 4 mesothelioma include chemotherapy and palliative care. Chemotherapy can alleviate symptoms and extend survival. Palliative care helps patients cope with pain and other symptoms, improving their quality of life.

Pleural Stage 4 Treatment Types

Stage 4 pleural mesothelioma cannot be cured, but chemotherapy may help reduce the size of tumors and make breathing less painful. Palliative therapies such as respiratory therapy and pain medication further reduce painful symptoms of pleural mesothelioma.

Pericardial Stage 4 Treatment Types

There are not many treatment options for stage 4 pericardial mesothelioma. Patients may be eligible for a pericardiectomy, which is a surgery to reduce fluid buildup and improve heart function. Researchers across the world constantly study life-extending chemotherapy treatments for pericardial mesothelioma, including clinically-tested drugs cisplatin and pemetrexed.

Peritoneal Stage 4 Treatment Types

Advanced stages of peritoneal mesothelioma cannot be cured but instead treated with surgery to improve quality of life and reduce symptoms. One surgery, called HIPEC, involves removing as much of the tumor and affected tissues as possible followed by the direct application of heated chemotherapy. Another surgery involving draining fluid from the abdomen, called abdominal paracentesis, can also improve comfort.

Testicular Stage 4 Treatment Types

Treatment of late-stage testicular mesothelioma involves multiple rounds of chemotherapy, typically etoposide and cisplatin or bleomycin, etoposide, and cisplatin. Some mesothelioma doctors may recommend a high dose of chemotherapy followed by a stem cell transplant.

Is Stage 4 Mesothelioma Curable?

Late-stage mesothelioma cannot be cured. Without treatment, patients may only live months in comparison to those undergoing treatment.

Site 5-Year Survival Rates With Treatment
Pleural Mesothelioma 12%
Peritoneal Mesothelioma 65%
Pericardial Mesothelioma 9%
Testicular Mesothelioma 50%

Related: Is Stage 4 Lung Cancer Curable?

Is Stage 4 Always Terminal?

All mesothelioma cases are terminal with the exception of testicular mesothelioma. There is no way of knowing how long each patient has, and each prognosis is dependent on the area of tumor growth and response to treatment. Get in-depth information about mesothelioma treatment options with the Lung Cancer Center guide.