Mesothelioma Stages

Quick Summary

Doctors can break most mesothelioma cases into 1 of 4 stages. The higher the mesothelioma stage, the further the cancer has spread through the body. Pleural mesothelioma is the only type of this cancer with an official staging system. However, doctors can still see how far tumors have spread for patients with other types.

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What Are the 4 Stages of Mesothelioma?

Mesothelioma tumors first appear in the linings of either the lungs, heart, abdomen, or testicles decades after asbestos exposure. As the cancer worsens, the tumors can spread to different parts of the body.

When making a mesothelioma diagnosis, doctors can often see how far the tumors have spread and determine the stage of the cancer.

Mesothelioma Diagnosis Video Thumbnail

Video Summary: Registered Nurse Amy Fair discusses the emotional stages that a patient may go through after getting a mesothelioma diagnosis. View Transcript.

I’ve been diagnosed with mesothelioma, now what?

When someone’s first diagnosed with mesothelioma, it’s not uncommon for them to go through the same stages that one goes through with a cancer diagnosis, because mesothelioma is a cancer.

Fear, anxiety, at one point they’ll go through acceptance, but all the stages are very important to go to just to get through to the acceptance point. All those other unfortunate feelings such as fear and anxiety are part of the process.

The 4 mesothelioma stages are:

  • Stage 1: A mesothelioma tumor is confined to a single location and has not spread.
  • Stage 2: The tumor has grown, causing the spread of mesothelioma cells to nearby organs and lymph nodes.
  • Stage 3: The cancer spreads further into nearby organs but is still contained to one side of the body. Symptoms become noticeable for many patients in this stage.
  • Stage 4: The tumor growth is significant and the cancer spread is impossible to control. The cancer has spread into distant organs.

U.S. veterans are at a higher risk of mesothelioma since the military heavily relied on asbestos between the 1930s and early 1980s. Thankfully, there are treatments and benefits available for veterans at any stage.

Get a free veterans packet to learn how you can access medical care and financial aid no matter which stage of mesothelioma you have.

Mesothelioma Veterans GuideGet a FREE Veterans Packet

Get information on:

  • Top Treatment
  • Best Doctors
  • Improving Prognosis

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Pleural Mesothelioma Stages

Malignant pleural mesothelioma develops in the lining of the lung (pleura).

It is the only type of mesothelioma to have an official cancer staging system. There is not enough information available about the other types so doctors cannot break them down into cancer stages.

Stage 1 Pleural Mesothelioma

Patients diagnosed with stage 1 mesothelioma have the best overall prognosis and highest chance of long-term survival.

A stage 1 mesothelioma tumor is contained to the chest wall. It is only present on one side of the body and has not spread to nearby lymph nodes or distant organs.

21 MonthsLife Expectancy

Some patients with stage 1 mesothelioma experience mild flu-like symptoms that are typically overlooked. In fact, mesothelioma is rarely diagnosed in this stage due to lack of symptoms.

Doctors can also misdiagnose early mesothelioma symptoms as more common illnesses like pneumonia.

For these reasons, it is important to ask your doctor about mesothelioma as a potential cause of your symptoms, especially if you were ever exposed to asbestos. An early diagnosis can help catch the cancer before it spreads.

Prognosis & Overall Survival
Stage 1 pleural mesothelioma patients can often live for around 2 years or more provided they get properly treated. Patients who received life-extending surgery lived for 21 months on average, according to a report from the medical journal Frontiers in Oncology.

Stage 2 Pleural Mesothelioma

In cases of stage 2 mesothelioma, the cancer is contained to one side of the chest but has started to spread. The American Cancer Society (ACS) notes that tumors may have reached several nearby organs in this stage.

By stage 2, the cancer may have reached the:

  • Diaphragm
  • Lung
  • Nearby lymph nodes

19 MonthsLife Expectancy

Since cases of stage 2 mesothelioma have not spread very far, symptoms will not be severe. Patients may not even notice them.

Patients diagnosed with this mesothelioma stage often have fluid buildup in the lung lining (pleural effusions) and discomfort.

Prognosis & Overall Survival
Patients diagnosed with stage 2 mesothelioma are typically still candidates for life-extending surgeries and have similar overall survival rates to stage 1 patients. Stage 2 patients who undergo surgery live for 19 months (over a year and a half) on average.

Our patient advocates are standing by to help you. Call (877) 450-8973 now to find the best treatments depending on your mesothelioma stage.

Stage 3 Pleural Mesothelioma

In stage 3 mesothelioma, the cancer cells have started to spread beyond the original site of the tumor in the pleura.

The cancer may have spread to the lymph nodes, as well as other tissues and organs, but only one side of the chest is usually affected.

Patients diagnosed with stage 3 mesothelioma have fewer available treatment options but may still qualify for surgery and other therapies that aim to slow tumor growth.

16 MonthsLife Expectancy

Patients with stage 3 mesothelioma often experience more severe symptoms, including chest pain, difficulty breathing, and fever. Patients are often diagnosed at this stage as the symptoms have become more noticeable when compared to stage 1 or stage 2.

Prognosis & Overall Survival
Stage 3 pleural mesothelioma patients are likely to survive for just over 1 year on average. Stage 3 patients who undergo surgery have a median survival time of 16 months.

Stage 4 Pleural Mesothelioma

Stage 4 is the most advanced stage of mesothelioma. Cancer cells may spread to affect distant parts of the body like the spine, liver, or brain.

Patients with stage 4 mesothelioma cannot usually undergo life-extending surgeries. That said, treatments may still be available to improve quality of life and reduce symptoms.

12 MonthsLife Expectancy

Extensive tumor growth causes severe symptoms such as coughing up blood and difficulty swallowing.

Other symptoms include night sweats, extreme weight loss, abdominal pain, and chest tightness.

Prognosis & Overall Survival
Stage 4 pleural mesothelioma patients have the worst prognosis of all stages, with most only living for 12 months or less after a diagnosis. That said, new treatments are being tested all the time. New treatments tested in clinical trials may help late-stage patients live longer.

Veterans can access free or low-cost treatments for any stage of mesothelioma through the U.S. Department of Veterans Affairs (VA). Apply for VA benefits now to get financial assistance.

Peritoneal Mesothelioma Stages

Peritoneal mesothelioma develops in the lining of the abdominal cavity (peritoneum). If left untreated, the cancer can spread beyond the lining of the abdomen and into the vital organs nearby.

There is currently no official peritoneal mesothelioma staging system, so doctors generally classify this type of cancer as either early-stage or late-stage.

Early-Stage Peritoneal Mesothelioma

In early-stage peritoneal mesothelioma, tumors have not spread past the abdominal lining. The most common symptoms of early-stage peritoneal mesothelioma are bloating (abdominal distension) and pain.

Patients diagnosed with early-stage peritoneal mesothelioma have a good chance of long-term survival through the common procedure of cytoreductive surgery with HIPEC.

With this treatment, doctors surgically remove all visible tumors and then apply HIPEC (heated chemotherapy) directly to the abdominal cavity to kill unseen cancer cells. Patients who undergo this treatment have a median survival time of 50 months on average.

Graphic showing abdominal cytoreduction with HIPEC. Step 1 is cytoreductive surgery to remove cancer tumors from the abdomen. Step 2 is HIPEC (heated chemotherapy) inserted into the abdomen.Graphic showing abdominal cytoreduction with HIPEC. Step 1 is cytoreductive surgery to remove cancer tumors from the abdomen. Step 2 is HIPEC (heated chemotherapy) inserted into the abdomen.

Late-Stage Peritoneal Mesothelioma

In cases of late-stage peritoneal mesothelioma, the cancer has spread to distant sites in the body. Signs of late-stage peritoneal mesothelioma include vomiting blood, blood in stool, and pain in the ribs or upper back.

The goal of treatment for these patients is often to improve patient quality of life through palliative care options. Patients may be in too poor health to safely undergo aggressive surgeries that require long recovery periods.

Pericardial Mesothelioma Stages

Malignant pericardial mesothelioma develops in the lining of the heart (pericardium). Doctors can’t break pericardial mesothelioma into stages as it’s so rare, with only a few hundred cases ever reported.

If the patient’s cancer remains localized (contained to one area), surgery to remove the lining of the heart (pericardiectomy) may control the spread of the disease and reduce symptoms.

In advanced cases, pericardial mesothelioma typically spreads into the liver, kidney, or lungs.

Sadly, 80-90% of pericardial mesothelioma cases are diagnosed only after a patient has died.

Testicular Mesothelioma Stages

Malignant testicular mesothelioma affects the lining of the testicles (tunica vaginalis). It is very uncommon, with less than 300 reported cases in total. Due to its rarity, doctors cannot break this type into stages.

Like many other types of mesothelioma, patients may not experience symptoms at first. Patients may suffer from pain and buildups of fluid or masses in the scrotum as the cancer spreads.

Patients can undergo a surgery called an orchidectomy to remove cancerous tumors and affected tissue if the cancer has not spread throughout the body. Chemotherapy and radiation may also be used.

Help is available for veterans diagnosed with mesothelioma. Call (877) 450-8973 to access medical care and financial aid.

Malignant Mesothelioma Staging Systems

Three systems were created to help doctors classify a patient’s mesothelioma stage. However, the Tumor Node Metastasis (TNM) system is the only one in use today.

TNM Staging System

The American Joint Committee on Cancer (AJCC) developed the TNM system for staging pleural mesothelioma. Mesothelioma doctors use this system to create personalized treatment plans for their patients.

Doctors use the TNM system to look at:

  • Tumor: Whether the original tumors have spread
  • Node: Whether tumors have spread through the lymph system
  • Metastasis: Whether cancer has spread to distant areas in the body

Within the TNM staging system, cases of pleural mesothelioma are assigned a clinical stage and/or pathological stage.

Did You Know?

The clinical stage describes a patient’s stage before treatment, whereas a pathological stage represents a patient’s stage after surgery.

Mesothelioma doctors use both clinical and pathological stages to determine a patient’s “best” stage.

Butchart Staging System

The Butchart system is the oldest mesothelioma staging system, developed by Dr. Eric Butchart in 1976. This system had 4 mesothelioma stages and was once useful for classifying the spread of a patient’s cancer.

However, the Butchart system became outdated with the development of modern imaging methods and is no longer in use.

Brigham System

The Brigham staging system was proposed by the late Dr. David Sugarbaker at Brigham & Women’s Hospital in Boston.

With this system, doctors stage mesothelioma based on whether it can be treated with surgery and if the lymph nodes are affected. However, it was not picked up by the mainstream medical community as it could only be used to stage patients who underwent surgery.

How Mesothelioma Stage Impacts Treatment

The 4 mesothelioma stages help doctors create customized treatment plans for each patient. Patients diagnosed in the early stages often qualify for more aggressive treatments that can help them live longer.

An older man discusses test results with a female doctor.

Cases of early-stage mesothelioma are easier to treat because the cancer hasn’t spread throughout the body. That said, treatments are still available in the later mesothelioma stages to ease painful symptoms and sometimes improve life expectancy.

Stage 1 Treatment Options

Stage 1 mesothelioma patients may qualify to undergo aggressive surgeries like an extrapleural pneumonectomy (EPP) or pleurectomy with decortication (P/D).

An extrapleural pneumonectomy removes the lung closest to the cancer, the lining of the lung, and all visible tumors.

Diagram showing the steps of an extrapleural pneumonectomy. Doctors remove the healthy lung closest to the cancer, along with the pericardium (heart lining), a part of the diaphragm, and all visible cancer tumors.Diagram showing the steps of an extrapleural pneumonectomy. Doctors remove the healthy lung closest to the cancer, along with the pericardium (heart lining), a part of the diaphragm, and all visible cancer tumors.

Pleurectomy with decortication removes the cancerous lung lining but spares both lungs.

Both surgical procedures can greatly improve a patient’s life expectancy. Doctors can also use other treatments like chemotherapy and radiation in tandem with these surgeries to kill unseen cancer cells.

Diagram showing a pleurectomy with decortication. Doctors remove the lung lining and all visible cancer tumors.Diagram showing a pleurectomy with decortication. Doctors remove the lung lining and all visible cancer tumors.

Stage 2 Treatment Options

While the cancer has started to spread in stage 2 mesothelioma, aggressive surgery is still possible. Doctors may recommend an EEP or a P/D to remove visible tumors and slow the disease spread.

As with cases of stage 1 mesothelioma, doctors can also use chemotherapy, radiation, and other treatments to kill cancerous tumors.

Get a free veterans packet to learn about mesothelioma treatments that can help you live longer.

Mesothelioma Veterans GuideGet a FREE Veterans Packet

Get information on:

  • Top Treatment
  • Best Doctors
  • Improving Prognosis

Get a Free Veterans Packet

Stage 3 Treatment Options

Stage 3 mesothelioma patients may or may not be able to undergo surgery depending on how far the cancer has spread.

If surgery isn’t possible, patients can be treated with chemotherapy and/or radiation to shrink tumors. Palliative therapies to help reduce symptoms and improve quality of life may be used during this stage as well.

Your doctor can see if surgery is a realistic treatment option for you during this mesothelioma stage.

Stage 4 Treatment Options

Surgery is not usually an option for stage 4 mesothelioma patients as the cancer has spread too far throughout the body.

Palliative treatment is often recommended for patients in this stage. Hospice care can help patients manage any painful symptoms at the end of their life.

Chemotherapy and radiation therapy can also be used to slow the growth of the cancer and reduce painful symptoms from tumors.

Further, some stage 4 patients may be eligible for clinical trials that test new treatments to improve life expectancy or reduce pain.

Get the Right Treatment for Your Mesothelioma Stage

No matter what mesothelioma stage you are diagnosed with, working with a specialist at a mesothelioma cancer center can help you receive the best possible results.

Veterans with mesothelioma can get treatment from mesothelioma specialists within the VA health care system. In fact, many of the nation’s top mesothelioma specialists work with the VA and veterans.

Top VA mesothelioma doctors include:


The Mesothelioma Veterans Center has no affiliation with and is not endorsed or sponsored by Dr. Robert B. Cameron. The contact information above is listed for informational purposes only. You have the right to contact Dr. Cameron directly.

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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