Stage 4 Mesothelioma

At stage 4 mesothelioma, cancer cells may have spread to lymph nodes and throughout the chest, abdomen and other parts of the body.

The cancer could be present in the lungs, liver, bones or elsewhere. Tumors may have grown into the layers of the chest wall and the heart sac (pericardium).

Stage 4 mesothelioma is the most difficult to treat because the few treatment options available cannot remove all tumors.

Even if visible tumors are removed, there is a high likelihood for recurrence.

Many patients are also too weak to withstand aggressive surgeries at this stage, which is also known as end-stage mesothelioma.

Although stage 4 mesothelioma is considered terminal, continued advancements in palliative care can help patients live longer and have a better quality of life.

Some stage 4 patients continue to defy the odds, living years beyond their initial mesothelioma prognosis.

Gene Hartline was ready to give up when doctors diagnosed him with advanced-stage pleural mesothelioma in July 2016.

Thanks to innovative medical oncologist Dr. Rama Balaraman and the experimental immunotherapy drug nivolumab (Opdivo), Hartline now feels he could live another 20 years.

“I would tell anyone who gets diagnosed with this disease, don’t just take the first advice you get and give up,” Hartline told Asbestos.com. “Look around and see what is out there.”

Survival outlook depends largely on the extent of tumor growth and how well patients respond to treatments. The patient’s age and overall health also play a role in life expectancy.

Mesothelioma Symptoms at Stage 4

At stage 4, common symptoms such as breathlessness and coughing are more severe.

Because tumors have spread beyond the lining of the lungs, symptoms are not isolated to the chest cavity.

Some patients also suffer from cachexia, a syndrome involving weight loss, muscle atrophy, weakness and appetite loss. Stage 4 cancer sometimes causes blood problems, including high platelet count (thrombocytosis) and low red blood cell count (anemia).

Diagnosing Stage 4 Mesothelioma

The three systems used to categorize pleural mesothelioma define stage 4 on similar characteristics and behaviors. TNM, the most widely used staging system, was recently updated in 2017.

• TNM Staging System: Mesothelioma may or may not have grown into nearby structures or to nearby lymph nodes. However, cancer cells have spread to other parts of the body and distant organs such as the liver, bones or lining of the abdomen (peritoneum).
• Brigham Staging System: Cancer cells have spread to distant parts of the body via the bloodstream.
• Butchart Staging System: The cancer has spread to distant sites such as the bones, liver, brain and other organs.

Learn more about mesothelioma staging systems

Stage 4 Mesothelioma Treatment Options

Although no curative treatment exists for any stage of mesothelioma, treatment options that aim to extend survival are the most limited at stage 4. Extensive tumor-removing surgery is typically not an option.

Palliative treatments — including chemotherapy and radiation therapy — can slow tumor growth and reduce tumor size.

Late Stages by Mesothelioma Type

Stage 4 typically refers to pleural mesothelioma, the most common type of the asbestos-related cancer.

There is no official stage 4 for peritoneal mesothelioma, which accounts for roughly 20 percent of all cases. However, it is generally accepted that peritoneal patients with extensive tumor spreading are classified as stage 4.

By this point, the cancerous tissue is more extensive and tumors have spread outside of the peritoneum — the protective lining of the abdomen where the cancer initially develops. Tumor-removing surgery is usually not an option at this phase.

Pericardial mesothelioma, a rare form of the cancer which develops on the lining of the heart, is typically diagnosed in the later stages, although it may not be defined as stage 4.

At stage 4, pleural mesothelioma is likely to continue to spread, which can lead to respiratory failure or heart failure if tumors spread to the heart.

How Long Are the Final Stages of Mesothelioma?

How long stage 4 mesothelioma lasts varies from patient to patient. Each case of mesothelioma grows and progresses at its own rate. There is no standard period of time that each stage lasts.

For example, pleural mesothelioma survivor Sallie Morton was diagnosed at stage 4 and lived for years without any chemotherapy, surgery or radiation therapy. She had slow-growing cancer.

Other patients may live for months in the final stage. It all depends on how fast your cancer grows and how well it responds to the treatments you try.

Stage 4 Mesothelioma Life Expectancy

	2-year survival rate	5-year survival rate
Stage 4	17%	>1%

The median survival rate for stage 4 mesothelioma is about 12 months. A positive response to treatment can extend survival, and patients with good prognostic factors often live longer than average.

Prognostic factors associated with better survival include having the epithelioid cell type, having no signs of blood disorders and being female, younger in age and in good overall health.

Mesothelioma Prognosis at Stage 4

Mesothelioma is considered a heterogeneous cancer, meaning no two cases are the same.

For this reason, survival statistics cannot predict how long someone with mesothelioma will live. Some people have particularly slow-developing mesothelioma, and some respond surprisingly well to treatment.

Each prognosis is unique and depends on the patient’s age, overall health, mesothelioma cell type, extent of cancer spread and other factors.

What to Expect After Stage 4 Mesothelioma Diagnosis

Although stage 4 is the most advanced of the mesothelioma stages, some patients, especially those in good overall health, live far beyond their life expectancy.

Through a variety of treatments, groundbreaking clinical trials and healthy life choices, patients can beat the odds and become survivors.

A stage 4 mesothelioma diagnosis can be devastating, but you shouldn’t take it as a death sentence. A positive outlook will do wonders when combined with a variety of treatments.