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Stage IV Mesothelioma

Stage IV is the latest stage for mesothelioma, or any type of cancer. It is characterized by metastasis, which is the spread of the cancer from the original tumor to other, more distant locations in the body as well as more uncomfortable and severe symptoms. Unfortunately, stage IV mesothelioma is very difficult to treat and virtually incurable. For many patients at this stage, treatments are palliative in nature.

Mesothelioma is an aggressive type of cancer with a long latency period. Many patients who receive this diagnosis are in stage III or stage IV. At this most advanced stage, the cancer most likely cannot be cured or easily treated, but there are strategies that can reduce pain, improve quality of life, and possible extend life just a little bit longer.

Diagnosis and Staging of Mesothelioma

When mesothelioma is diagnosed it is also given a stage. Staging is determined as a way to describe how far the cancer has advanced and by most conventions for pleural mesothelioma is given as a stage from one to four. One is the earliest and least advanced stage and four is the most advanced. An examination of cells from the biopsy along with imaging scans of the patient’s body is used to stage the cancer.

Late stage diagnoses are common among patients with mesothelioma. This is true for several reasons. One is the long latency period characteristic of mesothelioma. From the time at which a person is first exposed to asbestos—the most common cause of this type of cancer—to the time of diagnosis can take decades, time enough for the cancer to advance to stages III and IV. Another reason that most diagnoses for mesothelioma are staged later is that diagnosing this cancer is difficult. Many people go through multiple misdiagnoses before finally finding they have mesothelioma.

Characteristics of Stage IV Mesothelioma

The staging system used for pleural mesothelioma is the TNM system in which T describes the original tumor, N describes the spread of the cancer to lymph nodes, and M describes metastasis of the cancer. There are three possible combinations of designations for T, N, and M that can be characterized as stage IV mesothelioma: T4, any N, and M0, any T, N3, and M0, or any T, any N, and M1.

The first set of TNM designations describes a cancer that has grown extensively from the original tumor. That tumor has expanded into both layers of the pleura, deep into the chest wall, into the diaphragm, into the peritoneum around the abdominal cavity, into the spine, into the pleura on the other side of the chest, and possibly even into the pleura around the heart. It has not metastasized, but may or may not have spread into the lymph nodes.

A designation of any T, N3, and M0 describes mesothelioma that may or may not have grown well into surrounding tissues, but has spread to lymph nodes both near the site of the original tumor and in those on the opposite side of the chest. There is no metastasis. For the designation of any T, any N, and M1, the cancer has metastasized, or spread to more distant parts of the body, but the spread to nearby tissues or lymph nodes may or may not be extensive.


The symptoms of stage IV mesothelioma are likely to be more intense and more widespread than in earlier stages. Patients with this diagnosis may be experiencing chest pains, difficulty breathing, fever and night sweats, fatigue, weight loss, and general malaise. Because the cancer may have spread to the abdomen, heart, and other parts of the body, the patient may also experience tightness in the chest, and swelling and pain in the abdomen.

Treatment Options

At stage IV, treatment options for mesothelioma become less about trying to cure the cancer and more about relieving pain and other symptoms and extending the life if possible. For late stage cancer surgery is not always an option. Surgical removal of all of a tumor is nearly impossible because it has either spread to multiple locations or it has penetrated too much of the tissue in the chest. Smaller surgical procedures may be used, however, to remove some of the bulk of a tumor.

Patients with stage IV mesothelioma may also opt for chemotherapy or radiation to shrink the size of tumors. Chemotherapy uses drugs to kill cancer cells, and these are generally injected intravenously. Radiation is targeted at a tumor externally and uses high-energy beams to kill cancer cells. Either of these may reduce the bulk of tumors in stage IV mesothelioma.

Palliative Care for Stage IV Mesothelioma

The sad fact is that most patients at stage IV of mesothelioma have very limited time left. This means that palliative care is important and can be used to improve quality of life for what time is left, and is not limited to medical treatment. Palliative caregivers must also consider psychological needs of the patient. Any kind of treatment that will make the patient more comfortable is usually considered. Traditional treatments like chemotherapy, radiation, and surgery may be performed to reduce the size of tumors, which can reduce pain and make breathing easier.

If those treatments cause more pain and discomfort, though, a patient may choose to forgo them. Rejecting treatments like chemotherapy is not unusual for palliative cancer patients. Many choose to live out the time they have left without the terrible side effects of that treatment. Less invasive treatments with fewer side effects, such as draining excess fluids from the chest or abdomen, can be used to help patients feel better.

At this stage, complementary and alternative therapies may also be used to help improve quality of life, along with psychological care and spiritual interventions. Working with a therapist or chaplain, trying mediation or massage, using minimal exercise, or improving nutrition, are all strategies that can help make stage IV patients feel better.

Prognosis and Life Expectancy

The prognosis for stage IV mesothelioma is that the cancer is not curable and that life expectancy is short. The median survival time after a stage IV diagnosis is just 12 months. This takes into account all patients with this type of cancer, but there are individual factors that can make the life expectancy longer or shorter. A longer survival time is expected for younger patients with otherwise good health and for patients who are eligible for and able to withstand more aggressive treatments.

Being diagnosed with stage IV mesothelioma is devastating, especially if you find out that the cancer was likely caused by exposure to asbestos that you either didn’t know about or that came with risks you weren’t aware of at the time. A mesothelioma lawsuit or settlement may make you feel better in terms of getting justice and the money may help cover bills. Let a lawyer help guide you if you choose to take legal action against a former employer or manufacturer of asbestos products.

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