Stage 3 Pleural Mesothelioma

Quick Summary

Stage 3 is an advanced stage of mesothelioma. Tumors have begun spreading farther and faster in stage 3. Initial treatments include chemotherapy and radiation, but many stage 3 patients are still eligible for surgery.

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What Is Stage 3 Pleural Mesothelioma

In stage 3, mesothelioma tumors are still on one side of the chest. Tumors may also be in the pleural lining, diaphragm, and lining of the heart.

The difference between stage 2 and stage 3 is lymph node involvement. Like all cancers, mesothelioma spreads through the lymph system, so it is common to have nodes involved at this stage.

Stage 3 Mesothelioma Symptoms

As mesothelioma progresses into later stages, symptoms begin to worsen. Some patients hardly notice their symptoms in the first two stages. But stage 3 patients are likely to start noticing new symptoms. These symptoms become worse as tumors and cancer cells spread. Tumors can create pressure in the chest, making it harder to breathe. Mesothelioma cells spreading to lymph nodes creates more work for the immune system. Your body may not process nutrients as easily. This can cause tiredness or a lack of appetite.

Some symptoms you may feel at this stage include:

  • Chest pain
  • Fatigue
  • Loss of appetite
  • Pain when breathing
  • Pleural effusions (fluid buildup)
  • Weakness
  • Weight loss

Your doctor can treat many of these symptoms. Palliative care (symptom management) is common for all stages of mesothelioma. Medications are commonly prescribed for each stage.

In stage 3, your doctor might recommend draining fluid in your chest, which can help you breathe easier. Doctors place a needle or small tube in the pleural space to remove the fluid; you’ll be under anesthetic during this kind of procedure. Another procedure for pleural effusions is pleurodesis. This seals the area between the pleural linings to prevent fluid buildup.

Diagnosing Stage 3 Mesothelioma

Imaging tests are the first step of diagnosis. An X-ray may show thickening of the pleural lining or fluid within the pleural space. Many patients will have a CT or MRI scan to look for lymph node involvement. PET scans of the chest and abdomen can show areas of increased radioactive uptake in areas where cancer cells are located.

Sometimes doctors find cancer in the lymph nodes without evidence elsewhere in the body. This still classifies as stage 3 disease. The cancer may have spread to nearby organs, including muscle, cartilage and the lining of the chest wall. There may be tumors in the fatty areas between the lobes of the lung and the pericardial sac.

Veterans may be diagnosed at stage 3 because they didn’t notice their early symptoms. At first, some veterans with mesothelioma don’t attribute their symptoms to anything serious. Statistics historically show that vets smoke more than civilians. These veterans might think their shortness of breath is from smoking, even if they quit years ago. And non-smoking vets could think their symptoms are signs of aging rather than a rare cancer.

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The TNM Staging System for Stage 3 Mesothelioma

There are different staging systems for Pleural Mesothelioma. Most doctors agree on the TNM system for staging mesothelioma. TNM is short for “tumor, node, and metastasis.” This system is a detailed way to describe how far, and to what degree, your disease has spread.

Here’s how to define each group of the TNM staging system:

  • (T) Tumor: Doctors consider how far the original tumor has grown and spread into nearby tissue. A rating of T1 indicates the tumor is on one side of the chest in the pleural lining. T4 describes tumors that have spread throughout the chest.
  • (N) Node: Mesothelioma can spread through the lymph system. Looking at lymph nodes is a good way to track the disease. An N1 rating means doctors found cancer in nodes within the lung on the same side of the body as the tumor. N3 is the highest rating for this group. Cancer found on the opposite side of the body equals an N3 rating.
  • (M) Metastasis: This group has either M0 or M1. Doctors either found mesothelioma in distant organs (M1) or they didn’t (M0).

After a doctor rates each group, they can determine your disease stage.

Patients with stage 3 mesothelioma can have the following ratings for each group:

  • T1 to T3
  • N0 to N2
  • M0

Each combination of these groups indicates stage 3 mesothelioma. But each combination is unique in telling the story of how your cancer has spread.

For example, a patient with T2, N2, M0 typically has mesothelioma in both linings of the lung. The cancer is also found in the diaphragm and chest lymph nodes. A patient with T3, N0, M0 has tumors deeper in the layers of the chest but no lymph node involvement.

The details of your diagnosis are important for determining the best treatment for you. It can help doctors decide whether surgery will help or hurt you.

There is one thing in common for each combination of the TNM system for stage 3 mesothelioma. Aggressive treatment is still possible because mesothelioma cells still haven’t spread too far yet.

Stage 3 Mesothelioma Treatment

Patients with stage 3 disease may or may not have surgery, as a cure may not be not possible at this stage. If they have surgery, they can have an extrapleural pneumonectomy procedure or a pleurectomy with decortication procedure. These surgeries will remove much of the cancer, but radiation therapy and chemotherapy are required to kill off mesothelioma cells that weren’t taken in surgery.

Aggressive treatments like surgery are your best chance of living a longer life. If your doctor doesn’t feel like surgery is right for you, you can get a second opinion. Good doctors will be okay with you seeking a second opinion. Your doctor may even recommend a colleague who can run independent diagnostics.

In the past, doctors found surgery too risky for stage 3 patients, but it has become much more common today.

The lung-sparing P/D surgery is often favored by specialists. “The role for lung-sparing surgery is unclear but this [study] demonstrates that it is an option, even for advanced cases,” said the authors of a study evaluating aggressive treatment in stage 3 and 4 mesothelioma patients.

Stage 3 Mesothelioma Prognosis

The median life expectancy for people with stage 3 disease is about 16 months. This means that half of all patients will live more than 16 months and half of all patients will live less than 16 months.

Did you know?

A study published in 2016 reported on P/D surgery with photodynamic therapy in late-stage mesothelioma patients. Stage 3 patients without mesothelioma in their lymph nodes had a median survival of 7.3 years. The group of patients were evaluated from 2005 to 2013.

Improving a Stage 3 Prognosis

Many patients have had amazing turnarounds after being diagnosed with stage 3 mesothelioma. Treatments for patients at this stage are getting better all the time. Some stage 3 patients are living years beyond their prognosis thanks to improvements in surgery.

Things to keep in mind about your disease stage:

  • Surgery is the best treatment option.
  • If surgery isn’t possible, consider clinical trials.
  • Many stage 3 patients outlive their prognosis.

With the help of a mesothelioma specialist, you can send your mesothelioma into remission. Take control of your mesothelioma prognosis by asking your doctor about aggressive treatments or clinical trials. Get more information about improving your prognosis in your free Mesothelioma Veteran’s Guide.

Veterans Support Team
Todd Gersten, MD PhotoReviewed by:Todd Gersten, MD

Double Board-Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Todd Gersten, MD is a double board-certified medical oncologist and hematologist specializing in general adult oncology and hematologic disease. He is a physician partner with the Florida Cancer Specialists and practices in Wellington, Florida.

Dr. Todd Gersten is an independently paid medical reviewer.

Christopher Dryfoos PhotoWritten by:

Contributing Author

Christopher Dryfoos is a journalist and member of the American Medical Writers Association (AMWA). As the grandson of the U.S. Navy’s first forensic pathologist, he aims to help veterans with mesothelioma access needed care.

View Sources

American Cancer Society. “Early Detection, Diagnosis, and Staging.” Retrieved from: Accessed on August 23rd, 2017.

Healthline. “Fluid in the Chest (Pleural Effusions).” Retrieved from: Accessed on August 23rd, 2017.

Centers for Disease Control. “Burden of Tobacco in the U.S.” Retrieved from: Accessed on August 23rd, 2017.

Friedberg MD, Joseph. The Annals of Thoracic Surgery. “Extended Pleurectomy-Decortication–Based Treatment for Advanced Stage Epithelial Mesothelioma Yielding a Median Survival of Nearly Three Years.” 2016. Retrieved from: Accessed on August 23rd, 2017.

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