Resources for Patients and their Families

Stage 4 Mesothelioma

Stage 4 mesothelioma is the last of the stages of this deadly cancer, often considered terminal. At this end stage of mesothelioma, cancer cells have spread throughout the chest, abdomen, and other parts of the body (metastasized).

Surgical removal of tumors is no longer an available treatment, and the primary focus of therapy is palliative care to reduce pain and improve quality of life. The life expectancy of stage 4 mesothelioma patients is about a year.

Stage 4 Mesothelioma Illustration Lungs Icon
Stage 4 Mesothelioma

Stage 4 Mesothelioma by Type

The most recent version of the American Joint Committee on Cancer (AJCC) Staging System (8th Edition), published in 2017, only provides staging information for pleural mesothelioma. For peritoneal mesothelioma and pericardial mesothelioma, doctors have to rely on more general staging guidelines to determine the cancer’s stage and progression.

Stage 4 Pleural Mesothelioma

As the most common form, pleural mesothelioma is the only type that has its own staging system. In fact, over the years at least three types of staging systems have been developed for pleural mesothelioma, with the Butchart System being the most commonly used system today.

Descriptions of Stage 4 Mesothelioma by Staging System

Butchart System
TNM System
Brigham System

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 Peritoneal Mesothelioma

There is no dedicated staging system for peritoneal mesothelioma because there are not enough cases of this type to document the details necessary to create a formal staging system. However, doctors can still determine what stage peritoneal mesothelioma looks like at stage four by using the general cancer staging guidelines published in the AJCC Cancer Staging Manual.

As such, stage 4 peritoneal mesothelioma is characterized by spreading of tumors outside the immediate area of the peritoneum. This includes spreading to the lymph nodes, throughout the abdominal cavity, and into the chest and other areas of the body.

Stage 4 Pericardial Mesothelioma

Like peritoneal mesothelioma, there is no formal staging system for pericardial mesothelioma. Because it is so rare, the disease is almost never caught before it enters mesothelioma final stages, and this particular form of the cancer often is diagnosed during an autopsy after the patient has passed away.

Doctors can use general staging guidelines in the AJCC Cancer Staging Manual to determine the stage at diagnosis. Stage 4 pericardial mesothelioma typically consists of the spreading of tumors outside the pericardium and throughout the chest, possibly into other parts of the body such as the abdomen or esophagus.

Stage 4 Mesothelioma Prognosis: What to Expect

As the last stage of mesothelioma, stage 4 has the poorest overall prognosis of all mesothelioma stages. The median life expectancy at stage 4 is only 12 months, while diagnosis at an earlier stage often results in a longer life expectancy.

Statistics compiled by the National Cancer Institute indicate that only 6.9% of people who have late-stage mesothelioma with a spread of the disease to distant areas of the body – a common feature of stage 4 cancers – live beyond 5 years. However, as newer treatments begin to emerge, there is hope and expectation that more people diagnosed with stage 4 mesothelioma will live longer.

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Symptoms of Stage 4 Mesothelioma

As the disease progresses through the four stages, mesothelioma symptoms tend to get more severe. Also, some new symptoms may appear during the final stages of mesothelioma that were either nonexistent or extremely mild earlier on.

Common Symptoms of Stage 4 Mesothelioma
  • 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

Treating Stage 4 Mesothelioma

At the end stage, mesothelioma treatment tends to focus on improving the patient’s overall comfort and quality of life. While individuals diagnosed at stage 4 have the same primary types of treatment available to them – surgery, chemotherapy, and radiation – as those at earlier stages, these therapies are typically only used to manage pain and suffering rather than as an attempt to cure the disease. This is known as palliative care.


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 addition to conventional therapies, 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 near you to see whether 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.


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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

Richards, WG. Malignant pleural mesothelioma: predictors and staging. Annals of Translational Medicine. June 2017;5(11):243. doi: 10.21037/atm.2017.06.26

Rusch V. Update on the Mesothelioma Staging System. Journal of Thoracic Oncology. January 2017;12(15):S30-S31. doi: 10.1016/j.jtho.2016.11.031

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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