Mesothelioma has four stages, with higher stages indicating that the cancer has spread. Treatment options are available for all mesothelioma stages to ease symptoms and potentially improve survival time. We can help veterans with any mesothelioma stage access the medical care they need.
What Are the 4 Stages of Mesothelioma?
Mesothelioma stages allow doctors to determine how far the cancer has spread.
The 4 malignant mesothelioma stages are:
- Stage 1: A mesothelioma tumor is confined to a single location.
- Stage 2: Cancer cells start to spread to nearby tissues, organs, and lymph nodes.
- Stage 3: The cancer spreads deeper and further into organs and lymph nodes.
- Stage 4: The cancer has spread into distant organs and is very hard to treat.
U.S. veterans are at a higher risk of mesothelioma due to military asbestos exposure, and many are only diagnosed in the later stages of this cancer.
Video Summary: Registered Nurse Amy Fair discusses the four stages of mesothelioma and what patients can expect. View Transcript
There are four stages of mesothelioma, just as there are in most cancers. Stage one, the mesothelioma is contained within the pleura.
Stage two, the diseases come outside the pleura and invaded into the fatty tissue of the lung, or the diaphragm.
Stage three, it's where it's metastasized into local organs. And stage four is where it's metastasized into distant organs, lymph node, and tissue.
Staging is important in mesothelioma as is in any cancer. It drives your prognosis, it drives your treatment modalities. It's important to know if you're a surgical candidate. The staging of your disease drives that decision.
It's important to discuss staging after you've had your CT or PET scan with your surgeon or oncologist.
However, treatments can help patients at any stage of mesothelioma find relief from symptoms and possibly live longer. Your mesothelioma stage will affect which treatments you can receive to improve your prognosis (health outlook).
Get a Free Veterans Packet to learn how you can access medical care and pursue compensation after a mesothelioma diagnosis.
Pleural Mesothelioma Stages
Malignant pleural mesothelioma develops in the lining of the lung (pleura) and makes up 80% of all mesothelioma cases. It is the only type to have an official cancer staging system. There are four stages of pleural mesothelioma.
Stage 1 Mesothelioma
Stage 1 mesothelioma patients have the best overall prognosis. In this stage, the cancer is contained to the chest wall on one side of the body and has not spread to nearby lymph nodes or organs.
- Symptoms: Flu-like symptoms such as a mild cough, shortness of breath, and fluid buildup in the lung lining (pleural effusion)
- Treatments: Surgery, chemotherapy, radiation, and immunotherapy
- Prognosis: 21 months
Stage 1 mesothelioma patients may have little to no symptoms, so not many are diagnosed in this stage. Surgery to remove visible tumors around the lungs, and sometimes the lung itself, is often the most effective treatment.
Stage 2 Mesothelioma
In mesothelioma stage 2, the cancer is contained to one side of the chest but has started to spread. The American Cancer Society (ACS) notes that tumors may reach the diaphragm (space between chest cavity), lung, or lymph nodes in this stage.
- Symptoms: Worsening chest pain, breathing issues, and pleural effusion
- Treatments: Surgery, chemotherapy, radiation, and immunotherapy
- Prognosis: 19 months
Like in stage 1, patients with stage 2 mesothelioma may have mild or even no symptoms. However, though the cancer has spread, patients may still qualify for major treatments like surgery to help them live longer.
Stage 3 Mesothelioma
In stage 3 mesothelioma, the cancer may have reached more lymph nodes, the mediastinum (space between lungs), and nearby organs. It has not spread to the other side of the chest.
- Symptoms: Chest pain, difficulty breathing, and fever
- Treatments: Chemotherapy, radiation, immunotherapy, and sometimes surgery
- Prognosis: 16 months
“With mesothelioma, they save stage 4 for if it spreads to different organs. However, it can still ravage the body before it does that. So, even though my husband is being torn up by this, it’s only considered stage 3.”
— Connie Bonnin, wife of U.S. Army mesothelioma veteran Alan Bonnin
Mesothelioma stage 3 marks the point where many patients start to experience concerning symptoms. Major surgeries may not be available due to cancer spread, but other treatments could help ease pain and improve survival.
Stage 4 Mesothelioma
Stage 4 is the final stage of mesothelioma. In this stage, distant metastasis (cancer spread) has occurred, limiting treatment options. For example, surgery isn’t possible.
- Symptoms: Night sweats, coughing up blood, difficulty swallowing, and chest tightness
- Treatments: Palliative (pain-relieving) care, chemotherapy, radiation, and immunotherapy
- Prognosis: 12 months
Even though stage 4 mesothelioma cancer is often terminal, some patients have lived for many years with treatment. John Stahl is “pretty well back to normal” and living happily today thanks to chemotherapy. He was diagnosed with stage 4 mesothelioma in 2019.
While mesothelioma stages near death can be scary, there is hope. Call (877) 450-8973 now for help finding doctors and treatments that may allow you to live longer.
Peritoneal Mesothelioma Stages
Peritoneal mesothelioma develops in the lining of the abdominal cavity (peritoneum). There’s no official staging system, but some health care professionals use the peritoneal cancer index (PCI) to assess cancer spread.
With the PCI, doctors assign a “score” based on cancer spread within the abdomen. Higher scores mean patients have a later stage.
Peritoneal cancers are assigned 4 stages under the PCI:
- Stage 1: PCI score from 1-10
- Stage 2: PCI score from 11-20
- Stage 3: PCI score from 21-30
- Stage 4: PCI score from 31-39
Early-stage peritoneal mesothelioma patients often qualify for cytoreduction with HIPEC, which combines surgery and heated chemotherapy to treat the cancer. This can allow patients to live for over 4 years on average.
Late-stage patients are typically treated with chemotherapy and pain-relieving options.
Stages of Other Mesothelioma Types
Pericardial mesothelioma (which forms in the heart lining) and testicular mesothelioma (which develops in the testicle lining) are two very rare types of this cancer. Neither has formal stages, but doctors can assess cancer spread during a diagnosis.
Here’s what to know about staging for:
- Pericardial mesothelioma: Between 80% and 90% of patients are diagnosed only after they have died from advanced cancer. Early-stage treatment includes surgery to remove the lining of the heart (pericardiectomy) and cancer tumors.
- Testicular mesothelioma: Early-stage patients can get a surgery called an orchidectomy to remove cancer tumors. Surgery, chemotherapy, and radiation can also help late-stage patients.
Skilled cancer doctors can recommend treatments for veterans with mesothelioma, no matter the type or stage.
Get a Free Veterans Packet now to explore your options after a diagnosis.
Malignant Mesothelioma Staging Systems
Three systems were created to help mesothelioma doctors classify cancer stage. The Tumor Node Metastasis (TNM) system is the only one used today.
TNM Staging System
The American Joint Committee on Cancer (AJCC) developed the TNM system for staging pleural mesothelioma.
Doctors use the TNM system to look at:
- Tumor: Whether the original tumors have spread
- Node: Whether tumors have spread through the lymph nodes
- Metastasis: Whether cancer has spread to distant areas in the body
Mesothelioma doctors use this system to create personalized treatment plans for their patients. It is continuously updated for accuracy, with the latest version being released in January 2025.
Other Staging Systems
Doctors once used these systems to stage pleural mesothelioma, but the TNM system is considered more accurate today.
Older mesothelioma staging systems include:
- Butchart Staging System: This is the oldest system. It was developed in 1976 and classified pleural mesothelioma into 4 stages.
- Brigham System: This was proposed by the late Dr. David Sugarbaker and staged the cancer based on lymph node involvement and if surgery was possible.
Contact us if you’ve been diagnosed with any stage of mesothelioma for help finding top doctors, treatments, and compensation to cover medical costs.
How Mesothelioma Stage Impacts Treatment
Stage greatly affects the mesothelioma treatments a patient can access. Patients diagnosed in the early stages often qualify for more aggressive cancer treatments. Learn about treatments by stage below.
Stage 1 Mesothelioma Treatment Options
Stage 1 patients are typically treated with different mesothelioma surgeries to remove any visible cancer tumors within the body.
Key surgeries for stage 1 mesothelioma include:
- Extrapleural pneumonectomy (EPP): Pleural mesothelioma surgery to remove tumors, the lung closest to them, and the lung lining
- Pleurectomy with decortication (P/D): This pleural mesothelioma surgery extracts tumors and the lung lining but leaves the lungs intact
- Cytoreduction with HIPEC: Treats peritoneal mesothelioma by taking out tumors in the abdomen and then flushing it with hot chemotherapy
Doctors can also combine surgery with other treatments like chemotherapy, radiation therapy, and immunotherapy for best results.
“I think patients who have disease that can be surgically resected, especially those with earlier stage disease, can achieve long-term survival in conjunction with chemotherapy.”
— Dr. Taylor Ripley, mesothelioma specialist
Stage 2 Mesothelioma Treatment Options
Stage 2 mesothelioma treatments are similar to those in stage 1, with surgeries being preferred since the cancer hasn’t spread very far. Doctors will also recommend other treatments like chemotherapy to help improve life expectancy.
Stage 3 Mesothelioma Treatment Options
In stage 3, doctors need to assess how far the cancer has spread to determine which treatments are most appropriate.
Surgery may or may not be used at this stage. If surgery is not an option, chemotherapy, immunotherapy, and radiation may all be considered.
Stage 4 Mesothelioma Treatment Options
By stage 4 mesothelioma, surgery can’t be used anymore. This is because doctors won’t be able to remove all of the cancer since it’s spread through the body.
Systemic treatments like chemotherapy may allow you or a loved one to live longer with final-stage mesothelioma. Palliative treatment or hospice care may also be recommended to improve quality of life.
Get Help for Any Stage of Mesothelioma
While mesothelioma is very aggressive and life-threatening at any stage, medical care can help improve your survival time.
In some cases, veterans and civilians with mesothelioma have gone on to live for many years thanks to treatments like surgery, chemotherapy, and more.
The Mesothelioma Veterans Center stands ready to assist veterans with any stage of this cancer get the medical care they deserve.
Our team can connect you with:
- The best treatments for your diagnosis
- Experienced mesothelioma doctors and cancer centers
- Financial compensation options to afford treatment
Get a Free Veterans Packet or call (877) 450-8973 now to get started with our team’s help.
Mesothelioma Stages FAQs
What are the mesothelioma end stages?
Mesothelioma end stages are stages 3 and 4. By this point, treatment options may be limited since the cancer has metastasized (spread) to other areas of the body.
However, veterans and civilians with advanced-stage cancer can still access care that may allow them to live longer. Pain-relieving options can also boost quality of life in the last stages of mesothelioma cancer.
What are the symptoms of the final stages of mesothelioma?
In the final stages of mesothelioma, symptoms include coughing up blood, severe fatigue, difficulty breathing, and night sweats.
Doctors can recommend palliative care to help patients suffering from mesothelioma symptoms in later stages feel better and have a higher quality of life.
Contact us now for help finding treatments to relieve mesothelioma symptoms and potentially improve survival.
How long are the final stages of mesothelioma?
The final stages of mesothelioma are different for everybody. Factors like overall health, type of mesothelioma, and response to treatment all impact survival time.
Some patients have lived for years with final-stage mesothelioma, while others have had only weeks.
The best way to work toward long-term survival is to get treatment from top doctors. Both civilian cancer specialists and those affiliated with the U.S. Department of Veterans Affairs (VA) offer treatments that may allow you to live longer.
Does mesothelioma progress quickly?
Mesothelioma progresses quickly from early stages to late stages, particularly without treatment.
However, depending on how the cancer responds to treatments, its progression may slow or completely stop for an extended period of time. This is known as mesothelioma remission.
What is the death process for mesothelioma?
In the last stages of mesothelioma, death can occur as the cancer overruns the functions of vital organs.
Doctors may recommend hospice care or pain-relieving measures to make mesothelioma death stages as painless as possible for your loved one.
Can stage 4 mesothelioma be cured?
There’s no cure for stage 4 mesothelioma (or any stage of this cancer) currently, but in rare cases, patients have survived for much longer than expected following treatment.
John Stahl has lived for over 5 years after his stage 4 mesothelioma cancer diagnosis, thanks to multiple rounds of chemotherapy, and has since returned to an active lifestyle.
Is mesothelioma 100% fatal?
No, mesothelioma isn’t 100% fatal. Some veterans and civilians have lived for many years — even if diagnosed with late-stage cancer.
For example, after his 2018 mesothelioma diagnosis, U.S. Army and Air Force veteran Art Putt was given between 6 months and 1 year to live. Art fought the cancer with different treatments, although it continued to advance to later stages.
Art started an alternative treatment recommended by his wife and daughter, both nurses, and he credits this as the reason he’s still alive today.
