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Vanessa Blanco, patient advocate for the Mesothelioma Prognosis Network
Written By Vanessa Blanco
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What Is Stage 4 Mesothelioma?

Mesothelioma is classified by how advanced the cancer is. The higher the stage number, the more the cancer has spread beyond the original tumor.

Stage 4 is the most advanced stage of mesothelioma. Tumors and cancer cells have spread beyond the pleura –– the chest cavity lining –– to the bones, the liver or other organs.

This stage may appear as the Roman numeral IV. However, many health care providers now use the number 4 to avoid confusion when talking with patients.

Survival Rate and Life Expectancy of Stage 4 Mesothelioma

The median survival for stage 4 pleural mesothelioma is about 12 months.

The two-year survival rate is 17 percent. This means between one in five and one in six people with stage 4 pleural mesothelioma will be alive two years after diagnosis.

Stage 4 mesothelioma is considered terminal, but advances in palliative care can help patients live longer with good quality of life.

Clinical trials and other cutting-edge therapies may help some stage 4 patients live years after their initial diagnosis.

This is why consulting with a mesothelioma specialist is important. They may be able to find treatment options not available through a general oncologist.

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Symptoms of Stage 4 Mesothelioma

In stage 4, pleural mesothelioma tumors have metastasized. They have spread beyond the original location to the lymph nodes and other organs, such as the liver, brain or bones.

Because stage 4 disease may occur in many areas of the body, symptoms can vary widely.

More common symptoms of stage 4 mesothelioma include:
  • Pain and tightness in the chest, back or abdomen
  • Shortness of breath
  • Hoarseness
  • Fluid buildup in the chest or other areas
  • Swelling in the face and arms
  • Fatigue
  • Difficulty swallowing
  • Lack of appetite
  • Bloating and nausea
  • Weight loss
  • Loss of muscle and strength
  • Excessive sweating, night sweats and fever
  • Coughing up blood

Some patients with stage 4 pleural mesothelioma experience changes in blood laboratory values, too.

This may include low red blood cell counts (anemia), changes in immune cell levels (neutropenia), elevated liver function tests or high platelet counts (thrombocytosis).

How Different Types of Mesothelioma Are Staged

Malignant pleural mesothelioma accounts for around three-quarters of people affected by the disease. It is the only type of mesothelioma with an official staging system.

Peritoneal mesothelioma makes up most of the remaining cases. A few percent of cases are pericardial and testicular. These types of mesothelioma are not staged using a formal numbering system.

For peritoneal disease, if the cancer has spread beyond the abdominal cavity, it is assumed to be stage 4.

Treatment Options for Stage 4 Mesothelioma

Existing treatments cannot cure stage 4 mesothelioma. However, surgery, chemotherapy and radiation therapy may be used to extend survival and improve quality of life for people living with this cancer.


The widespread nature of stage 4 disease makes surgery impractical or ineffective for many patients.

However, surgeons can perform a centesis, a process using a long hollow needle to remove fluid from the body.

Thoracentesis drains fluid from the chest cavity, while paracentesis removes fluid from the abdomen.

These procedures can relieve pressure, lessen pain, ease breathing and improve appetite.


The most common chemotherapy regimen prescribed for stage 4 pleural mesothelioma is a combination of cisplatin or carboplatin and Alimta (pemetrexed).

These drugs do not offer a cure, but they can extend life by many months.

Radiation Therapy

Radiation therapy for stage 4 disease can shrink tumors. This can lessen chest pressure, decrease pain and improve breathing.

Doctors consider a person’s overall health when deciding if radiation therapy is an appropriate option for managing disease symptoms.

Clinical Trials

Because there is no cure for stage 4 pleural mesothelioma, many patients are interested in clinical trials.

A mesothelioma oncologist can help determine which clinical trials may be a good fit for each patient.

Clinicaltrials.gov provides a way to search for mesothelioma clinical trials.