Stage 4 Pleural Mesothelioma

Quick Summary

Stage 4 mesothelioma is the most advanced stage of mesothelioma. Treatment options for this stage can help reduce pain and symptoms like difficulty breathing. The goal of treatment for stage 4 patients is to make them as comfortable as possible and to improve mesothelioma survival as much as possible.

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What Is Stage 4 Pleural Mesothelioma?

How far a cancer has spread determines how advanced it is. In stage 4 mesothelioma, the cancer has distant metastasis, meaning it has spread to distant parts of the body.

Common areas stage 4 mesothelioma may spread to include:

  • Lining of the heart (pericardium)
  • Diaphragm
  • Distant and nearby lymph nodes
  • Distant organs, including abdominal organs
  • Opposite side of chest

Stage 4 mesothelioma is the final stage in the Tumor Node Metastasis (TNM) staging system. Only pleural mesothelioma (the most common type of mesothelioma) is staged using the TNM system at this time. Other recognized mesothelioma staging systems include the Brigham and Butchart systems, however, these are rarely used today in the United States.

Symptoms of Stage 4 Mesothelioma

As the last stage of pleural mesothelioma, patients have the most advanced symptoms. Growing tumors and metastasis cause the symptoms of stage 4 mesothelioma, including discomfort and difficulty breathing. As the disease metastasizes to other parts of the body, new symptoms may emerge.

Common symptoms of stage 4 mesothelioma include:

  • Shortness of breath
  • Difficulty breathing
  • Chest pain
  • Coughing up blood
  • Lack of appetite
  • Loss of mobility
  • Overall declining health
  • Pain when breathing
  • Significant weight loss
  • Night sweats

There are treatments to help ease your symptoms in stage 4. This is called palliative treatment. Common palliative treatments for cancer include medication for nausea and fatigue.

For mesothelioma symptoms, your doctor might drain fluid from your chest or use radiation to shrink tumors. Less fluid and smaller tumors reduce chest pain, making it easier to breathe.

Stage 4 Mesothelioma Diagnosis

30% of all mesothelioma patients are diagnosed in stage 4. Tumors have spread throughout the lymph system, the blood, and, in some cases, to the bone.

CT, MRI, and PET scans can show areas where mesothelioma has spread. PET scans use radioactive glucose to identify areas of high glucose metabolism. Cancer cells absorb these substances faster than healthy cells. This shows up as areas highlighted on the PET scan.

Stage 4 Mesothelioma Treatment

Some people choose not to undergo surgery at this stage. There may be too much cancer in places where surgery can’t be done. Palliative surgery is still an option at this stage.

Common palliative treatments include:

  • Draining Chest Fluid: Fluid buildup in the lining of the lungs (pleura) and chest are called pleural effusions. Your doctor may insert a needle to draw out the fluid in your chest. This allows your lungs to expand more freely. It reduces pain when breathing and makes it easier to get deep breaths.
  • Pleurodesis: This procedure helps prevent the recurrence of pleural effusions. Doctors inject a talc substance between the inner and outer linings of your affected lung. The talc fills the space where fluid would gather.
  • Radiation and Chemotherapy: These are the most traditional treatments for mesothelioma. At stage 4, radiation and chemotherapy help ease symptoms. Your doctor probably won’t use an aggressive dose. This helps minimize symptoms from treatment. Instead, your doctor wants to shrink tumors and prevent them from spreading. This helps patients stay comfortable longer.
  • Medications: There are medications for all the typical symptoms of cancer. They could treat nausea, pain or fatigue. They aren’t specific to mesothelioma but can help nonetheless.
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Is Curative Surgery an Option at Stage 4 Mesothelioma?

Most treatments for stage 4 pleural mesothelioma are considered palliative care. But doctors are pushing for more radical approaches in clinical trials, including surgery for stage 4 patients. Some stage 4 pleural mesothelioma patients have surprised doctors by living months or years past their initial prognosis.

Did you know?

An emerging treatment for late-stage patients called SMART uses high doses of radiation before surgery. Some stage 4 mesothelioma patients who had this treatment lived longer than 3 years.

SMART stands for “Surgery for Mesothelioma After Radiation Therapy.”

The goal is to radically attack and diminish mesothelioma tumors before surgery. SMART relies on extrapleural pneumonectomy (EPP) surgery to completely remove the diseased lung. Specialists used higher than normal doses of intense radiation targeted at the tumors.

Before the radiation can endanger the patient, surgeons remove the irradiated tumors and cancerous lung. Between 2008 and 2012, 24 stage 3 and 4 patients had this procedure. One patient was in an earlier stage. There were 13 patients with stage 4 mesothelioma. All patients completed the treatment with minor symptoms like fatigue.

The overall 3-year survival rate was 84%. This means 21 of the original patients lived at least 3 years. The stage 4 patients in this study effectively tripled their survival times.

The patients chosen for the SMART study were carefully chosen. Patients chosen for the study had to meet strict requirements to be eligible. Factors included location and size of tumors and overall health.

The SMART study highlights the benefits of considering clinical trials. Learn More about the different types of options that are available in our free Mesothelioma Veterans Packet.

“This study demonstrates for the first time that EPP after a short accelerated course of high-dose hemithoracic radiation is feasible,” said the authors of the SMART study.

Stage 4 Mesothelioma Prognosis

Patients with stage 4 mesothelioma have the worst prognosis because aggressive surgery is usually not an option. This leaves just chemotherapy and radiation as options to stunt the cancer’s growth.

The median survival rate for stage 4 mesothelioma is less than 12 months. This means that half of all patients will live less than a year and half of all patients will survive longer than one year.

Next Steps for Stage 4 Patients

Now that you know more about your situation, the next step is taking action. Whether you were diagnosed at stage 4 or your disease has recently progressed to this stage, you have options.

Common palliative treatments include:

  • Draining Chest Fluid: Fluid buildup in the lining of the lungs and chest are called pleural effusions. Your doctor may insert a needle to draw out the fluid in your chest. This allows your lungs to expand more freely, reducing breathing pains and making it easier to draw a deep breath.
  • Pleurodesis: This procedure helps prevent the recurrence of pleural effusions. Doctors inject a talc substance in the chest cavity, between the inner and outer linings of your affected lung. The talc fills the space where fluid would gather.
  • Radiation and Chemotherapy: These are the most traditional treatments for mesothelioma. At stage 4, radiation and chemotherapy help ease symptoms. Your doctor probably won’t use an aggressive dose. This helps minimize symptoms from treatment. Instead, your doctor wants to shrink tumors and prevent them from spreading. This helps patients stay comfortable longer. The most common chemotherapy drug combination for mesothelioma is cisplatin and pemetrexed.
  • Medications: There are medications for all the typical symptoms of cancer. They could treat nausea, pain, or fatigue. They aren’t specific to mesothelioma but can help nonetheless.

Stage 4 patients may face a choice with their diagnosis. You may choose to search for clinical trials for which you may be eligible. Clinical trials have helped many mesothelioma patients live years past their prognosis.

You may also choose to seek out treatment designed to improve your quality of life and make you comfortable. No matter your decision, we are here to help. If you are looking for financial help, there are trust funds that we can help you access.

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: https://www.cancer.org/content/dam/CRC/PDF/Public/8735.00.pdf. Accessed on August 23rd, 2017.

Cho MD, John. “A Feasibility Study Evaluating Surgery for Mesothelioma After Radiation Therapy: The “SMART” Approach for Resectable Malignant Pleural Mesothelioma.” Retrieved from: http://www.sciencedirect.com/science/article/pii/S1556086415302239. Accessed on August 23rd, 2017.

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