Stage 4 Mesothelioma Prognosis

The TNM staging system can be used to diagnose mesothelioma staging. Stage 4 is the most advanced diagnosis of mesothelioma. Each of these stages corresponds to a different treatment and prognosis. A stage 4 diagnosis involves a cancer that has progressed beyond just local tumor(s), deep into local organs or spread throughout the body. Each stage diagnosis of mesothelioma is based upon the prior diagnosis of cancer within the T, N, M staging system, and involves a different prognosis.

Stage 4 Mesothelioma

By stage IV, pleural mesothelioma has greatly advanced. It can indicate either a T4 diagnosis of significant local involvement into local tissue and organs around the primary tumor, a N3 diagnosis involving significant involvement into the lymphatic system, and may also include a M1 diagnosis of cancerous tumors in distant tissues and organs.

Stage 4 Mesothelioma Treatment

At stage 4, the highest diagnosis level for mesothelioma cancer, treatment may be limited. Tumor development at this state frequently does not allow for tumors to be removed completely via surgery. Surgery may instead be used to preserve quality of life as tumors begin to impact the functioning of organs and systems, such as the heart or lung. A surgery to treat these symptoms should be considered.

What are the Symptoms Associated with Stage 4 Mesothelioma?

Symptoms from stage 4 mesothelioma include:

  • Fevers
  • Tightness in the chest
  • Chest pain
  • Abdominal pain
  • Shortness of breath
  • Fatigue
  • Weight loss, including anorexia
  • Malaise
  • Fluid build up around lung, heart, or in abdomen
  • Additional symptoms depending on location(s) of tumor growth

Stage 4 Prognosis

At stage 4, the cancer has invaded local tissues and organs and the lymphatic system, as well as progressed deeply into nearby organs or into distant sites. Aggressive treatment with surgery is typically not possible, but every case is different. The average life expectancy for a patient diagnosed with stage 4 mesothelioma is under 1 year.

Stage 4 Surgery Treatment

Surgery to remove tumors discovered with a stage 4 diagnosis involves the removal of all tumors capable of being excised. In addition a surgeon will remove any surrounding tissue that can be safety removed as the edge of the tumor can be difficult to view or determine. This surgery is known as a pleurectomy.

The doctor and patient may wish to proceed with an extrapleural pneumonectomy if possible and the location of tumors allows this attempt with curative surgery. An extrapleural pneumonectomy removes the heart lining, lymph nodes, portions of the diaphragm and one lung in addition to all possible tumors and the surrounding tissue. A patient and doctor can decide together what decisions to make regarding surgery treatment in each individual case, and whether stage 4 surgery makes the surgery likely to have a positive effect.

A doctor may not know the extend of tumor growth until surgery, so communication between a doctor and patient prior to surgery is critical. A doctor and patient should discuss what may be discovered during a surgery, and what the patient wishes to have performed in different situations.

Stage 4 Care – Palliative Therapy

You and your doctor may decide that due to the progression of cancer to instead focus on quality of life treatment. Patient therapy to improve patient condition but not life expectancy is known as “Palliative Therapy”. This therapy may include treatment to reduce symptoms caused by tumor growth, and may include surgery to remove tumors depending on their location.

Treatment includes the removal of fluid buildup around organs. Treatments include pericardiocentisis, paracentisis, or thoracentesis. Each of these procedures removes the fluid found around the heart, abdomen or chest respectively.

Radiation Therapy

Radiation therapy is used to shrink any tumors not removed by surgery and to reduce the risk of recurrence of tumors.


Chemotherapy is used to kill cancer cells that remain after resection surgery. One version used “heated chemotherapy” to try and prolong survival times in patients. For patients with stage 4 mesothelioma, combination chemotherapy involving the use of both pemetrexed and Cisplatin may be considered, which has shown the ability to prolong lifespans of patients by several months.

Multimodal Therapy

The combination of chemotherapy and radiation therapy is known as multimodal therapy. Multimodal means multiple types, in this case the combination of both chemo and radiation therapies. Some variants of this treatment has been shown to add several months to the average lifespan of patients.

Stage 4 Mesothelioma Life Expectancy

With stage 4 mesothelioma some tumors may not be accessible to a surgeon to remove. Resection can increase life expectancy in some patients, or can be used as a palliative treatment to improve quality of life and reduce symptoms. Chemotherapy and radiation therapy may be used both to prolong lifespan or to reduce symptoms from tumor growths.

Patients with a stage 4 mesothelioma diagnosis averaged a lifespan of just 9-12 months. Some patients have achieved many multiples of this lifespan, and each case is different, however patients with stage 4 mesothelioma should understand the seriousness of this diagnsosis.

Other Stages of Mesothelioma

To read more about other stages of mesothelioma, click here:

Stage 1 Mesothelioma & Prognosis

Stage 2 Mesothelioma & Prognosis

Stage 3 Mesothelioma & Prognosis

More Information about Mesothelioma

To read about Mesothelioma, click here.

To read about the TNM staging system, click here.

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To see answers to Frequently Asked Questions, click here.