Stage 4 is the most advanced stage of pleural mesothelioma. Treatments at this stage are more limited, but can greatly help reduce pain and symptoms like difficulty breathing. Since cancer has progressed through the body, the goal of treatment for stage 4 patients is providing patients comfort (palliative care)as they fight the disease, improving their quality of life.
What is Stage 4 Pleural Mesothelioma
How far a cancer has spread determines how advanced it is. In stage 4 mesothelioma, the cancer has spread to distant parts of the body.
Common areas stage 4 mesothelioma may spread to include:
- Lining of the heart
- Diaphragm
- Abdominal organs
- Opposite side of chest
- Distant lymph nodes
Stage 4 Symptoms
As the last stage of pleural mesothelioma, patients have the most advanced symptoms. Growing tumors and metastasis cause the symptoms of stage 4 mesothelioma. Growing tumors in the chest cause discomfort and difficulty breathing. As the disease metastasized to other parts of the body, new symptoms may emerge.
Common symptoms of stage 4 mesothelioma include:
- Pain when breathing
- Chest pain
- Coughing up blood
- Significant weight loss
- Lack of appetite
- Overall declining health
- Loss of mobility
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.
Diagnosis
Thirty percent of all mesothelioma patients are diagnosed in stage 4. Tumors spread through the lymph system and through the blood. In some cases, mesothelioma can spread 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.
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 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.
Is Curative Surgery an Option at Stage 4 Mesothelioma?
Most treatments for stage 4 pleural mesothelioma are palliative. But doctors are pushing for more radical approaches. Some surgeons may consider stage 4 patients for radical surgery as part of clinical trials. Some stage 4 patients have surprised doctors by living months or years past their initial prognosis.
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 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 percent. 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 locations 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 Guide.
“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 Pleural Mesothelioma Prognosis
Patients with stage 4 mesothelioma have the worst prognosis of all the stages. This is because aggressive surgery is usually not an option. The cancer continues to spread with only chemotherapy or radiation to try and control the cancer 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. 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.
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 make your life comfortable and peaceful. No matter your decision, we are here help. If you are looking for financial help, there are trust funds that we can help you access.
