Stage 4 Pleural Mesothelioma

Stage 4 pleural mesothelioma is the most advanced stage of this disease. At stage 4, cancer cells have spread, resulting in malignant tumor growth throughout the body. Treatments at stage 4 are focused on reducing pain and alleviating symptoms, such as difficulty breathing.

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What Is Stage 4 Mesothelioma?

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

Stage 4 mesothelioma cancer may spread to the:

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

Only malignant pleural mesothelioma (which forms in the lining of the lungs) is broken down into four stages. Peritoneal mesothelioma and other types of this cancer do not have formal staging systems at this time, but they can generally be classified as local or advanced based on tumor spread.

An older male patient reviews his stage 4 mesothelioma diagnosis with a doctor

Life-extending treatment options may be limited during mesothelioma’s final stage because of how invasive the cancer has become, affecting bodily functions in different spots.

Most doctors will not perform any major surgeries to remove tumors when a patient has reached stage 4, according to the American Cancer Society (ACS).

While major surgeries are usually not an option, there are still other treatments that may help patients manage the pain and, in some cases, extend their lives.

See what treatments may be available for you or your loved one.
Contact our team of trusted Patient Advocates.

Veterans and Stage 4 Mesothelioma

Veterans comprise 33% of all mesothelioma patients since the military relied on asbestos from the 1930s to the 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, as noticeable symptoms (such as coughing up blood or shortness of breath) do not appear until these stages.

Veterans experiencing these symptoms may not initially think these symptoms stem from mesothelioma, since this cancer shares symptoms with much more common illnesses like the flu.

Despite this, veterans with mesothelioma stage 4 can still get certain treatments and financial compensation from the U.S. Department of Veterans Affairs (VA). More compensation might also be available from the makers of asbestos-based products through legal action.

Get a Free Veterans Packet to learn about all the benefits available to veterans with mesothelioma.

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Stage 4 Mesothelioma Symptoms

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

Common symptoms of stage 4 pleural mesothelioma include:

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

If you suffer from any of these symptoms and were exposed to asbestos decades ago, see a doctor immediately. The sooner you are diagnosed, the sooner you can start treatment to ease symptoms and possibly live longer.

Stage 4 Mesothelioma Types

Only pleural mesothelioma (the most common type of this cancer) has a staging system. Oncologists (cancer doctors) see how far a patient’s cancer has spread if they have another type of mesothelioma when making a diagnosis.

Stage 4 Pleural Mesothelioma

Pleural mesothelioma tumors first form in the lining of the lungs (pleura). By stage 4, the cancer may have invaded the brain, kidneys, liver, and lungs.

Stage 4 mesothelioma is very aggressive, but veterans can get treatments from top doctors to ease symptoms and possibly live longer through the VA.

Learn more about treatment and clinical trials.
Connect with our Patient Advocates at (877) 450-8973.

Stage 4 Peritoneal Mesothelioma

Peritoneal mesothelioma forms in the abdominal cavity (peritoneum) and does not have a staging system at this time. Instead, doctors will use different diagnostic techniques to see how far the cancer has spread.

Though peritoneal mesothelioma rarely spreads outside of the abdomen, it’s still often deadly as tumor spread can shut down vital organs.

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

Stage 4 Pericardial Mesothelioma

Pericardial mesothelioma, which forms in the heart lining, does not yet have a formal staging system. Instead, doctors will use the diagnostic process to determine the spread of tumors.

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

Stage 4 Testicular Mesothelioma

Doctors do not use an official staging system for testicular mesothelioma either. 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 use several diagnostic tests to confirm a patient has mesothelioma and note the cancer’s stage.

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 allow doctors to see inside the body, where they can then check for possibly cancerous tumors.

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

Once a stage 4 mesothelioma diagnosis has been confirmed, doctors can develop a cancer treatment plan to help the patient live in less pain, destroy tumors, and possibly improve the patient’s life expectancy.

Get a Free Veterans Packet to learn how you can find diagnosis and treatment options for stage 4 mesothelioma.

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Diagnosis and Staging Systems

Doctors classify cases of pleural mesothelioma into stages using the Tumor Node Metastasis (TNM) cancer staging system.

The TNM staging system looks at the size of tumors, if they have spread to lymph nodes, and if the cancer has spread through the body. Stage 4 mesothelioma is the final and most advanced stage, and by this point, the cancer is widespread.

Other mesothelioma staging systems include the Brigham and Butchart systems. However, these are rarely used today to make a mesothelioma stage 4 diagnosis.

Stage 4 Mesothelioma Prognosis

A prognosis is a patient’s overall health outlook after being diagnosed with a disease. Patients with stage 4 mesothelioma may live for only one year.

That said, treatments for stage 4 mesothelioma can help patients live with less pain or even improve their survival time in some cases.

Stage 4 Mesothelioma Life Expectancy

The average stage 4 mesothelioma life expectancy is 12 months.

However, it’s important to know that some patients may defy the odds and live longer if they work with top doctors and get proper medical care.

Stage 4 Mesothelioma Survivors

Those who live much longer than originally expected are considered mesothelioma survivors. While it’s rare for those diagnosed with stage 4 to become mesothelioma survivors, it may be possible if treatment begins promptly.

Doctors diagnosed comedian Quincy Jones with stage 4 mesothelioma in 2015 and gave him 12 months to live. However, after receiving medical care, Jones is still alive today.

For best results, work with a mesothelioma specialist and get cancer treatments scheduled as soon as a diagnosis is confirmed. Getting quickly treated is key to preventing the cancer from spreading and becoming a survivor.

Amy Fair, RN
Amy Fair, RNPatient Advocate
20+ years helping mesothelioma victims

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

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 that can help early-stage patients live longer. By this point, the cancer is so widespread that the risks of major surgery may outweigh the benefits.

However, minor mesothelioma surgeries may be used to ease symptoms and improve quality of life. These are known as palliative surgeries.

“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 part of the lining of the lungs and cancer tumors in patients with stage 4 pleural mesothelioma to help them breathe easier. This is known as a partial pleurectomy.

Stage 4 Chemotherapy

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

Doctors generally don’t use an aggressive dose of chemotherapy, meaning patients avoid serious side effects from the treatment.

Instead, doctors use chemotherapy drugs to shrink tumors and prevent them from spreading. This low-dose treatment will keep patients comfortable for a longer amount of time.

Stage 4 Mesothelioma Radiation Therapy

Texas Oncology, a cancer treatment group located throughout Texas, notes that radiation therapy is sometimes used to help stage 4 mesothelioma patients relieve symptoms like chest pain.

Radiation therapy can shrink tumors without the need for surgery. The ACS also notes that radiation can help clear cancer buildups in a patient’s breathing tube.

Speak with our Patient Advocates to find a mesothelioma specialist who can help. Call (877) 450-8973 to get started.

Other Palliative Care Options

Doctors can use other palliative treatments besides chemotherapy, surgery, and radiation therapy to help those with mesothelioma stage 4 live with less pain.

Other palliative mesothelioma treatments include:

  • Thoracentesis:  Fluid buildup in the lining of the lungs is called a pleural effusion. Doctors can insert a needle to drain out the fluid in the lungs. This is known as a thoracentesis. Draining the fluid also reduces pain when breathing and makes it easier to get deep breaths.
  • Medications: Medications can help ease 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.
  • Pleurodesis: This procedure helps prevent pleural effusions that keep coming back. Doctors inject talc between the inner and outer linings of the affected lung. The talc fills the space where fluid would gather.

Clinical Trials

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

Scientist looking through microscope in research laboratory

Some stage 4 pleural mesothelioma patients lived for months or years past their initial prognosis because of 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.

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 essentially tripled their survival times.

Use our Doctor Match program to find a doctor who can use the best treatment for your diagnosis.

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End-of-Life Planning and Next Steps for 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 can get treatments from doctors or hospice services and access financial aid for medical expenses.

Mesothelioma stage 4 patients can:

  • Access treatments

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

  • File for VA benefits & compensation

    Veterans with mesothelioma may qualify for monthly financial payouts from the VA and legal compensation from the makers of asbestos-based products. The average mesothelioma legal claim awards $1 to $1.4 million, which can be used to help patients and their families after they pass away.

  • Find end-of-life support options

    End-stage cancer support options like hospice care can be very helpful. Hospice allows patients to live out their remaining time with dignity. It’s typically recommended for patients who cannot get treatments to live longer. On-staff caregivers at hospice facilities focus on easing pain and making the patient feel comfortable.

Request our Free Veterans Packet now or contact us at (877) 450-8973 to learn more about your options after a stage 4 mesothelioma diagnosis.

Common Questions About Stage 4 Mesothelioma

Is curative surgery an option during stage 4 mesothelioma?

The phrase "curative surgery" is somewhat misleading, 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 that surgeries are too risky.

Most treatments for mesothelioma stage 4 are considered palliative care. However, some stage 4 mesothelioma patients may undergo surgeries through clinical trials.

How long do people live with stage 4 mesothelioma?

Many wonder how long the final stages of mesothelioma last. Stage 4 mesothelioma patients live for 12 months on average. Depending on how their body responds to cancer treatment, some patients may live longer than this.

Your mesothelioma specialist can give you a more accurate idea of your prognosis following a confirmed diagnosis.

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

The VA considers mesothelioma a disability, and veterans with mesothelioma usually qualify for full (100%) disability. By applying for mesothelioma VA benefits in 2024, married veterans may receive nearly $4,000 monthly.

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 against manufacturers of asbestos-containing products have awarded millions of dollars in past cases. No legal action is taken against the military if a claim is filed.

Contact 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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  4. Gong, W., Ye, X., Shi, K., & Zhao, Q. (2014, December 10). Primary malignant pericardial mesothelioma-a rare cause of superior vena cava thrombosis and constrictive pericarditis. Retrieved from Accessed on March 22, 2024.
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  6. Raeside, M. C., Gormly, K., Neuhaus, S. J., Kotasek, D., & James, C. (2016). Primary pericardial mesothelioma presenting as multiple pericardial masses on CT. BJR case reports, 2(1), 20150295. Retrieved March 22, 2024, from
  7. Rusch, V. W., Giroux, D., Kennedy, C., et al. Initial analysis of the international association for the study of lung cancer mesothelioma database. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 7(11), 1631–1639. Retrieved March 22, 2024, from
  8. Texas Oncology. "STAGE IV/RECURRENT MALIGNANT PLEURAL MESOTHELIOMA." Retrieved from: Accessed on March 22, 2024.