Mesothelioma Stages

Pleural mesothelioma has four stages. However, doctors can also determine how far tumors have spread with other types of mesothelioma. The more advanced the mesothelioma stage, the further the cancer has spread. But treatment options may be available at each stage.

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What Are the 4 Stages of Mesothelioma?

Mesothelioma stages allow doctors to note how far the cancer has spread.

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

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.
  • Stage 2: The tumor has grown and mesothelioma cells start to spread to nearby tissues, organs, and/or 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 cancer has spread into distant organs.

After examining how far the tumors have spread with imaging scans, doctors can determine the stage of the cancer.

U.S. veterans are at a higher risk of mesothelioma since the military heavily relied on asbestos (the only known cause of mesothelioma) between the 1930s and early 1980s. Veterans are often diagnosed in the later stages. Thankfully, veterans can get treatments and benefits regardless of their cancer stage.

Get a free veterans packet to learn how you can access medical care and financial aid.

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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 of mesothelioma to have an official cancer staging system.

There are four stages of pleural mesothelioma.

Stage 1 Pleural Mesothelioma

Stage 1 mesothelioma patients have the best overall prognosis (health outlook) and the highest chance of long-term survival.

In this stage, the cancer 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.

  • Symptoms: Mild flu-like symptoms (cough, shortness of breath) and fluid buildup in the lung lining (pleural effusion). Symptoms are usually mistaken for more common illnesses at first. Some may have no symptoms.
  • Treatments: Usually treated with surgeries to remove cancer tumors from the chest cavity. Chemotherapy, radiation therapy, and other cancer treatments may also be used.
  • Prognosis: 21 months on average with surgery, according to 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 reach the diaphragm or lung in this stage.

  • Symptoms: Like in stage 1, patients may have mild symptoms or be asymptomatic.
  • Treatments: Though the cancer has started to spread, patients can often undergo chemotherapy, radiation, surgery, or other treatments to live longer.
  • Prognosis: 19 months on average with surgery.

Stage 3 Pleural Mesothelioma

In stage 3 mesothelioma, the cancer may have spread to the lymph nodes, the mediastinum (space between lungs), and other tissues and organs. It has not spread to the other side of your chest.

  • Symptoms: Chest pain, difficulty breathing, and fever, along with symptoms from earlier stages. Patients are often diagnosed at this stage due to the symptoms.
  • Treatments: Surgery may still be an option depending on cancer spread, patient health, and other factors. Other treatments like chemotherapy can also be used to reduce tumor size.
  • Prognosis: 16 months on average with surgery.

Stage 4 Pleural Mesothelioma

Stage 4 mesothelioma is the most advanced stage. Cancer cells may spread to the other side of the chest and distant parts of the body like the spine or liver.

  • Symptoms: Severe symptoms (coughing up blood, difficulty swallowing, night sweats, weight loss, and chest tightness) due to widespread cancer.
  • Treatments: Patients can’t get life-extending surgeries in most cases. Treatments focus on relieving symptoms (palliative care).
  • Prognosis: 12 months or less on average.

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

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Peritoneal Mesothelioma Stages

Peritoneal mesothelioma develops in the lining of the abdominal cavity (peritoneum). There is currently no staging system for this type. Oncologists (cancer doctors) may informally classify patients as either early-stage or late-stage based on cancer spread.

Early-stage patients can undergo cytoreductive surgery with HIPEC (heated chemotherapy) since the cancer hasn’t spread far. Patients who get this treatment live for 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 patients can get palliative care to ease symptoms and improve their quality of life.

Stages of Other Mesothelioma Types

Some may develop mesothelioma in the lining of the heart (pericardium) or testicles (tunica vaginalis) in very rare cases. Neither type is classified into formal stages, but doctors can determine cancer spread during a diagnosis.

  • Pericardial mesothelioma: Diagnosis in early stages is rare. 80-90% of pericardial mesothelioma patients are diagnosed only after they have died. Early-stage treatment includes surgery to remove the lining of the heart (pericardiectomy) and all visible cancer tumors.
  • Testicular mesothelioma: Cancer forms in testicular lining in its early stages before spreading. Early-stage patients can get a surgery called an orchidectomy to remove cancer tumors and affected tissue. Combining surgery, chemotherapy, and/or radiation can also help late-stage patients.

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. 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. 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 nodes
  • 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. The pathological stage is a patient’s stage after surgery.

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

Butchart Staging System

The Butchart system is the oldest mesothelioma staging system. It was 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 as cancer imaging scans improved and is no longer in use.

Brigham System

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

With this system, doctors determine stages based on whether the cancer 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

Mesothelioma stage greatly affects the cancer treatments a patient can access. Patients diagnosed in the early stages often qualify for more aggressive treatments that can help them live longer.

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

Stage 1 Mesothelioma Treatment Options

Stage 1 mesothelioma patients can get surgeries to remove cancer tumors. Surgery options include an extrapleural pneumonectomy (EPP) or a 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.

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.

Either surgery can greatly improve life expectancy. Doctors can also use chemotherapy and radiation with surgeries to kill unseen cancer cells.

Stage 2 Mesothelioma Treatment Options

Stage 2 mesothelioma patients can often still get life-extending surgeries like an EPP or P/D even though the cancer has started to spread.

Doctors can also use chemotherapy, radiation, and other treatments to destroy mesothelioma cells that weren’t removed in surgery.

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

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  • Best Doctors
  • Improving Prognosis

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Stage 3 Mesothelioma Treatment Options

Stage 3 mesothelioma patients may be able to undergo surgery, depending on how far the cancer has spread, their overall health, and other factors.

If surgery isn’t possible, patients can be treated with chemotherapy and/or radiation to shrink tumors. Palliative care may also be used to ease symptoms. Doctors can see which treatments are best for you at this stage.

Stage 4 Mesothelioma Treatment Options

Life-extending treatments are not usually an option for stage 4 mesothelioma patients, as the cancer has already spread through the body. Palliative treatments like low doses of chemotherapy and radiation may be used to shrink tumors and ease symptoms.

Hospice care can also help patients manage painful symptoms at the end of their life.

Further, some stage 4 patients can join clinical trials that test new treatments to improve life expectancy or ease pain. Late-stage patients may achieve long-term survival in some cases depending on how their body responds to treatments.

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 cancer doctors within the VA health care system. In fact, many of the nation’s top mesothelioma specialists work with the VA to treat veterans.

Free Mesothelioma Doctor Match for Veterans
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  • File for VA health care to cover costs
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Two 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.

FAQs on Mesothelioma Stages

Which stages of mesothelioma are fatal?

While patients with late-stage mesothelioma may have lower life expectancies and survival rates, long-term survival may be possible with treatment. The key is to get medical care from a mesothelioma specialist.

Chat with our team now to find treatments for all stages of mesothelioma.

What is the death process for mesothelioma?

In the final stages of mesothelioma, the cancer has spread throughout the body. It may have reached the bones, liver, lymph nodes, or other major organs. You may experience more severe symptoms during the cancer’s final stages due to the spread of the tumors.

However, treatment options are available to ease painful symptoms and improve your life expectancy.

Learn more about treatments for all mesothelioma stages by calling (877) 450-8973.

Can stage 4 mesothelioma be cured?

There’s no cure for any mesothelioma, but treatments are available to help patients live longer. Stage 4 mesothelioma patients can sometimes live much longer than average with proper medical care.

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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