Stage 4 Mesothelioma

A patient with the most advanced type of mesothelioma is given a diagnosis of stage 4. This late stage is characterized by metastasis, the spread of the cancer from the original tumor to other, more distant locations in the body.[1] Symptoms at this stage are also more severe and more uncomfortable. Unfortunately, stage 4 mesothelioma is very difficult to treat and incurable. For many patients at this stage, treatments are palliative in nature.[2]

Mesothelioma is an aggressive type of cancer with a long latency period. Many patients who receive this diagnosis are in stage 3 or stage 4.[3] At this most advanced stage, the cancer 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. You can also still seek justice and compensation and hold responsible those negligent in your asbestos exposure.

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. The convention for pleural mesothelioma is to give a stage from one to four.[4] One is the earliest and least advanced stage and four is the most advanced and latest stage. 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:[5]

• Mesothelioma has a long latency period, the time between exposure to asbestos and diagnosis. Symptoms are not usually troubling until decades after exposure.
• Early symptoms mimic those of more common illnesses, often leading to multiple misdiagnoses that delay an accurate diagnosis.
• Diagnosing mesothelioma correctly is particularly difficult. Even when determined to be malignant, this kind of cancer is easy to mistake for lung cancer.

Characteristics of Stage 4 Mesothelioma

The staging system used for pleural mesothelioma is the TNM system in which T describes the original tumor, N describes the degree of the spread of the cancer to lymph nodes, and M describes any metastasis. There are three possible combinations of designations for T, N, and M that can be characterized as stage 4 mesothelioma: T4, any N, and M0, any T, N3, and M0, or any T, any N, and M1.

The T4, any N, and M0 designation describes a cancer that has grown extensively from the original tumor. The 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.

The TNM designation of any T, any N, and M1, means that the cancer has metastasized, or spread to more distant parts of the body. The spread into nearby tissues or lymph nodes may or may not be extensive.[4]

Symptoms at Stage 4

The symptoms of stage 4 mesothelioma are more severe and more widespread than those in earlier stages. Patients in stage 4 may have 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, as well as pain and discomfort anywhere the cancer has metastasized.[6]

Treatment Options

At stage 4, treatment options for mesothelioma are severely limited. Because the cancer is so widespread it is difficult to shrink, remove, or slow the progression of tumors. Treatment at this stage is focused on relieving pain and other symptoms and extending the patient’s life if possible. This is referred to as palliative rather than curative care.

For late stage cancer surgery is usually not 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 and to make the patient more comfortable.

Patients with stage 4 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 4 mesothelioma.[2]

Palliative Care for Stage 4 Mesothelioma

Prognosis is poor for stage 4 mesothelioma.  The decision to proceed with chemotherapy, radiation, or surgery need to include honest and open discussions about the goal of treatment.  Palliative care focuses on ensuring patients goals and wishes are the priority of care. This means that palliative care is important and can be used to improve quality of life for what time is left. Palliative care is not limited to medical treatment.

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.[7]

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 4 patients feel better.[8]

Prognosis and Life Expectancy

The prognosis for stage 4 mesothelioma is that the cancer is not curable and that life expectancy is short. The median survival time after a stage 4 diagnosis is just 15 months.[9] This is an average based on past cases, 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 4 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.

Page Medically Reviewed and Edited by
Luis Argote-Greene, M.D.

Luis Argote-Greene is an internationally recognized thoracic surgeon. He has trained and worked with some of the most prominently known thoracic surgeons in the United States and Mexico, including pioneering mesothelioma surgeon Dr. David Sugarbaker. He is professionally affiliated with University Hospitals (UH). His areas of interest and expertise are mesothelioma, mediastinal tumors, thoracic malignancies, lung cancer, lung transplantation, esophageal cancer, experimental surgery, and lung volume reduction. Dr. Argote-Greene has also done pioneering work with video-assisted thoracoscopic surgery (VATS), as well as robotic assisted minimally invasive surgery. He has taught the procedures to other surgeons both nationally and internationally.

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