Stage 4 Mesothelioma

Quick Summary

Stage 4 mesothelioma cancer is the most advanced stage. Cancer tumors have spread throughout the body in this stage. Treatments can help reduce pain and symptoms, such as difficulty breathing. Veterans with stage 4 mesothelioma may qualify for free or low-cost treatments and financial payouts from the U.S. Department of Veterans Affairs (VA).

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What Is Stage 4 Mesothelioma?

In stage 4 mesothelioma, the cancer has spread beyond its origin and reached distant parts of the body. This spread is also known as metastasis.

Common areas stage 4 mesothelioma may spread to include:

  • Bones
  • Diaphragm
  • Distant organs (such as kidneys or liver)
  • Lymph nodes
  • Opposite side of chest wall

Life-extending treatment options may be limited at this stage because of how far the cancer has spread. Most stage 4 patients cannot undergo major surgery to remove cancerous tumors, according to the American Cancer Society (ACS).

That said, treatments to help patients manage their pain or even live longer may still be available.

Amy Fair
Amy FairRegistered Nurse
20+ years helping mesothelioma victims

“We don’t like to look at stage 4 as a death sentence.”

Chat now with our trusted advocates to learn more about what treatment may be available for you or your loved one.

Veterans and Stage 4 Mesothelioma Risks

Veterans make up 33% of all mesothelioma patients due to widespread military asbestos use between the 1930s and early 1980s. Asbestos exposure is the only known cause of mesothelioma.

A graphic of a Navy veteran with text that reads "Veterans account for 1 out of 3 mesothelioma cases each year"

Sadly, most veterans with mesothelioma are not diagnosed until stage 3 or stage 4. This is because noticeable symptoms of mesothelioma (like coughing up blood or shortness of breath) might not appear until these stages.

Veterans may not think these symptoms stem from mesothelioma since this cancer is so rare and it takes 20-50 years for symptoms to appear after asbestos exposure.

Thankfully, veterans with stage 4 mesothelioma can still pursue treatment and financial compensation through the VA. Additional compensation might also be available from the makers of asbestos-containing products through a lawsuit or trust fund claim.

Get a free veterans packet to learn about all the benefits available to veterans with mesothelioma.

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  • Top Treatment
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Mesothelioma Stage 4 Symptoms

Patients have the most advanced symptoms during the final stage of malignant pleural mesothelioma.

Common symptoms of stage 4 pleural mesothelioma include:

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

Patients may have suffered some of these symptoms in the cancer’s earlier stages. When mesothelioma reaches its fourth stage, existing symptoms will have worsened.

If you are suffering from any of these symptoms and were exposed to asbestos years ago, see a cancer specialist immediately. Mesothelioma is highly aggressive at any stage. The sooner you are formally diagnosed, the sooner you can start treatment to potentially improve life expectancy and/or ease symptoms.

Stage 4 Mesothelioma Types

Only pleural mesothelioma has its own formal staging system and is broken up into four stages. All other types do not officially have staging systems. Doctors can look to see how far a patient’s cancer has spread if they have one of these other types.

Stage 4 Pleural Mesothelioma

Pleural mesothelioma tumors first form in the lining of the lungs. By stage 4, the cancer may have invaded the lungs, lymph nodes, and other major organs like the liver.

While stage 4 pleural mesothelioma often has a poor outlook, there is hope. Veterans can get low-cost or free treatment from pleural mesothelioma specialists with decades of experience through the VA.

Specialists can offer treatments to ease symptoms of mesothelioma and potentially help patients live longer in some cases.

Chat now with our trusted patient advocates to learn more about treatment and clinical trials.

Staging Systems for Pleural Mesothelioma

Doctors classify cases of pleural mesothelioma into different stages using the Tumor Node Metastasis (TNM) staging system. The TNM staging system looks at how big a tumor is, if it has spread to lymph nodes, and if it has metastasized throughout the body.

Other mesothelioma staging systems include the Brigham and Butchart systems. However, these are rarely used today in the United States.

Stage 4 Peritoneal Mesothelioma

Peritoneal mesothelioma, which forms in the abdominal cavity, is not usually classified in stages. Instead, doctors will see if cancerous tumors have spread throughout the abdomen to determine the extent of the disease. Though it rarely spreads outside of the abdomen, peritoneal mesothelioma can still be fatal.

In cases of advanced peritoneal mesothelioma, patients often suffer from symptoms like swelling in the abdomen, fever, and weight loss.

Stage 4 Pericardial Mesothelioma

Pericardial mesothelioma, which forms in the heart lining, cannot be broken down into different stages since it is so rare. Instead, doctors will use the diagnostic process to see how far the cancer has spread.

Cases of advanced or late-stage pericardial mesothelioma can spread into lymph nodes and organs like the kidneys or lungs. Sadly, 80-90% of all pericardial mesothelioma cases are diagnosed only after patients have died as the cancer advances rapidly in a short span of time.

Stage 4 Testicular Mesothelioma

Doctors do not use an official staging system for testicular mesothelioma. This cancer, which develops in the lining of the testicles, is extremely rare — there have only been a few hundred reported cases in total.

In advanced cases of testicular mesothelioma, tumors may appear in lymph nodes and organs like the lungs.

Stage 4 Mesothelioma Diagnosis

Doctors can see if a patient has mesothelioma — and if so, what stage the cancer is in — with several diagnostic tests.

Doctors typically start with imaging tests such as CT (computed tomography) scans, MRI (magnetic resonance imaging) scans, and PET (positron emission tomography) scans. These tests can locate possibly cancerous tumors based on how far they have spread throughout the body.

For example, PET scans use radioactive sugar to identify cancer tumors. Cancer cells absorb these substances faster than healthy cells and will show up as highlighted areas on the PET scan.

Amy Fair
Amy FairRegistered Nurse
20+ years helping mesothelioma victims

“…I can see what other parts and major organs this disease is in, I can really have an honest discussion with them. I can say, ‘Look, this is a stage four. It’s not operable, you’re not going to be a surgical candidate. So let’s talk about another therapy.”

Chat now with our trusted advocates to learn more about what therapies may be available for you or your loved one.

If doctors think a patient has mesothelioma after conducting imaging scans, they’ll perform a biopsy. A biopsy is the only way to confirm a patient has mesothelioma. Doctors take a sample of the possibly cancerous tumor and look at it under a microscope to see if cancerous cells are present.

Once a stage 4 mesothelioma diagnosis has been confirmed, doctors can develop a cancer treatment plan to help the patient live with less pain.

Get a free veterans packet to get more information on how stage 4 mesothelioma is diagnosed and treated.

Mesothelioma Veterans GuideGet a FREE Veterans Packet

Get information on:

  • Top Treatment
  • Best Doctors
  • Improving Prognosis

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Stage 4 Mesothelioma Prognosis

Patients with stage 4 mesothelioma often have the worst prognosis because the cancer has already spread throughout the body. The average life expectancy of stage 4 mesothelioma patients is just 12 months.

However, it’s important to know that some patients may defy the odds and live longer. The key to outliving an initially poor prognosis is by getting treatments from top doctors.

Mesothelioma Stage 4 Treatments

While stage 4 mesothelioma is highly advanced, treatments are still available to help patients. Most of these treatments are considered pain-relieving (palliative) and may help some patients live longer.

Stage 4 Mesothelioma Surgery

Patients with stage 4 mesothelioma may not be able to undergo major surgeries used to extend the life of early-stage patients. By this point, the cancer is so widespread that the risks of the surgery may outweigh the benefits.

However, minor palliative mesothelioma surgeries may still be an option.

“Palliative surgery may be an option if the tumor has already spread beyond where it started and would be hard to remove completely. It may also be used if you’re too ill for a more extensive operation. The goal of this surgery is to ease or prevent symptoms, not to cure the cancer.”

– American Cancer Society

For example, doctors can remove the lining of the lungs in patients with stage 4 pleural mesothelioma to help them breathe easier. Doctors can also use debulking surgeries to reduce the size of cancerous tumors, but not remove them altogether.

Chat with our patient advocates to find a mesothelioma specialist and get top treatments.

Stage 4 Chemotherapy

Chemotherapy (cancer-killing medication) is often the main treatment method used for stage 4 mesothelioma cases.

Your doctor probably won’t use an aggressive dose of chemotherapy, meaning you can avoid serious side effects from the treatment. Instead, your doctor will want to lessen the size of tumors and prevent them from spreading if possible. This will help you to stay comfortable for a longer amount of time.

Chemotherapy drugs can be used to treat stage 4 pleural mesothelioma and advanced cases of all other mesothelioma types.

Mesothelioma Stage 4 Radiation Therapy

The Texas Oncology health care system notes that radiation therapy is not frequently used to help stage IV mesothelioma patients, although it can relieve some symptoms like chest pain.

For example, radiation therapy can shrink larger cancerous tumors without the need for surgery. The ACS also notes that radiation treatment can help clear buildups in a patient’s breathing tube.

Other Palliative Care Options

Doctors can explore additional palliative treatment options besides chemotherapy, surgery, and radiation therapy to help stage 4 mesothelioma patients live with less pain.

Other palliative mesothelioma treatments include:

  • Chest fluid drainFluid buildup in the lining of the lungs are called pleural effusions. Doctors can insert a needle to draw out the fluid in the lungs to expand freely. It also reduces pain when breathing and makes it easier to get deep breaths.
  • MedicationsMedications can help patients suffer from less nausea, pain, fatigue, or other symptoms caused by their cancer. The ACS notes that mesothelioma patients can receive pain-relieving drugs like morphine without major side effects in many cases.
  • PleurodesisThis procedure helps prevent pleural effusions that keep coming back. Doctors inject talc between the inner and outer linings of your affected lung. The talc fills the space where fluid would gather.

Clinical Trials

Clinical trials allow doctors to test new and potentially effective treatments for mesothelioma with the hopes of improving patient lifespans or even finding a cure.

Some stage 4 pleural mesothelioma patients lived for months or years past their initial prognosis thanks to clinical trials.

For example, some stage 4 mesothelioma patients who had Surgery for Mesothelioma After Radiation Therapy (SMART) lived longer than 3 years in a recent clinical trial.

Clinical trials may offer hope for late-stage patients.

Clinical trials may offer hope for late-stage patients.

This trial combined radiation therapy with a lung-removal surgery called an extrapleural pneumonectomy (EPP), which is normally not available to stage 4 patients.

Over the course of the trial, 10 stage 3 patients and 13 stage 4 mesothelioma patients had this treatment combination. The overall 3-year survival rate of the patients was 84%. The stage 4 patients in this study effectively tripled their survival times.

Get a free veterans packet to learn how clinical trials and other mesothelioma treatments can help you.

Mesothelioma Veterans GuideGet a FREE Veterans Packet

Get information on:

  • Top Treatment
  • Best Doctors
  • Improving Prognosis

Get a Free Veterans Packet

Next Steps for Veterans With Stage 4 Mesothelioma

If you or a loved one has stage 4 mesothelioma, every second counts. Thankfully, whether you were diagnosed at stage 4 or your disease has recently progressed to this stage, you have options.

  • Get treatment

    Skilled mesothelioma doctors can ease your symptoms and possibly help you live longer with different treatments. Veterans with stage 4 mesothelioma can seek treatment from civilian doctors and those partnered with the VA.

  • Get VA benefits & compensation

    Veterans with mesothelioma may qualify for monthly financial payouts from the VA, as well as legal compensation from the makers of asbestos-based products. The average mesothelioma legal claim awards $1 million.

  • Receive end-of-life support

    End-stage cancer support options like hospice care can be very helpful. On-staff caregivers at hospice facilities focus on relieving pain and making the patient feel as comfortable as possible.

Get a free veterans packet now to learn more about your options after a stage 4 mesothelioma diagnosis.

Common Questions About Mesothelioma Stage 4

Is curative surgery an option at stage 4 mesothelioma?

Curative surgery is not usually an option for stage 4 mesothelioma patients. Most treatments for stage 4 pleural mesothelioma are considered palliative care.

Curative surgery is something of a misnomer as mesothelioma cannot be cured. Life-extending surgeries are possible for many early stage patients, but by stage 4 the cancer has spread so far throughout the body that these surgeries won’t be effective or safe.

However, doctors are pushing for more radical surgery options for stage 4 mesothelioma patients through clinical trials.

How long can you live with stage 4 mesothelioma?

Stage 4 mesothelioma patients live for 12 months on average. Some patients may live for longer than this depending on how their body responds to cancer treatment.

Your mesothelioma specialist can give you a better idea of your expected prognosis after they make a diagnosis.

How can veterans get help after a stage 4 mesothelioma diagnosis?

Veterans with stage 4 mesothelioma have several options after a diagnosis. By applying for mesothelioma VA benefits, they may get $3,000 or more every month.

Veterans can also pursue mesothelioma treatments through the VA Health Care System or get medical care from civilian doctors.

Finally, veterans may qualify for even more compensation through legal action. Legal claims filed against manufacturers of asbestos-containing products and trust funds have awarded millions of dollars in past cases. No legal action is taken against the military if a claim is filed.

Connect with a mesothelioma lawyer to see if you can file a claim now.

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.

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