Mesothelioma is a malignant cancer caused by exposure to asbestos. This highly-aggressive cancer affects the mesothelium, a tissue layer that lines or contains certain organs and body tissues. Mesothelioma can affect the lungs (pleural mesothelioma), abdomen (peritoneal mesothelioma), heart (pericardial mesothelioma) and testicles (testicular mesothelioma). Stage 4 mesothelioma is the most advanced stage of the cancer and is generally considered to be untreatable though patients may receive palliative care to relieve symptoms.

The Fourth and Last Stage

Stage 4 mesothelioma is the most advanced stage of this malignant cancer cancer. Any type of mesothelioma may be diagnosed at Stage 4. It is the stage at which mesothelioma tissue has spread beyond the local area and has traveled to distant organs such as the liver, brain, or kidneys and has begun growing new tumors. At Stage 4, mesothelioma is not considered curable but medications and procedures may be used to increase quality of life and reduce the severity of symptoms.

Major Characteristics of Stage 4 Mesothelioma

  • Cancer has metastasized and cells have begun dividing to produce new tumors in distant areas of the body.
  • Symptoms at Stage 4 are likely to be significant, severe and persistent including frequent and persistent cough, fever, weight loss, fatigue, chest, testicular or abdominal pain, heart palpitations, and swelling in the area affected by mesothelioma.
  • Any treatment will be done conducted as a palliative measure to reduce symptoms and improve patient quality of life. Though multiple treatments may be used, none of these treatments are attempts at a cure, but simply done to relieve pain and other severe syptoms

What to Expect

  • Stage 4 mesothelioma is the most advanced.       Symptoms are often severe and persistent, even with symptomatic treatment. Mesothelioma diagnosis will be performed using X-ray, CT and PET scans if possible, through blood testing and if possible, through biopsy.
  • As Stage 4 mesothelioma is so advanced, every patient diagnosed at this stage should seek a second opinion from a mesothelioma specialist. Mesothelioma is extremely rare, with only 3,000 new diagnoses emerging each year. A physician who specializes in mesothelioma will ensure that the diagnosis and staging are correct and will know of any treatment options and what procedures are likely to be most helpful.
  • Treatment of Stage 4 mesothelioma may include multiple options but each is intended only for palliative means. Surgery, chemotherapy, and radiotherapy may be used to reduce pain and other symptoms but none are likely to be intended as a cure. In addition, some procedures may not be possible or appropriate for every patient, depending on type of mesothelioma and the proximity of tumors to vital organs such as the lungs or heart.

Stage 4 Symptoms

It may take many years after asbestos exposure for mesothelioma to develop. Symptoms may emerge in early stages, but some cases are not diagnosed until Stage 4. This is because:

  • The “latency” time or time between exposure and symptom development may be as much as 20 to 50 years;
  • Symptoms may emerge slowly and progress over time or may emerge suddenly in a severe state
  • Symptoms of the cancer may mimic other conditions, delaying diagnosis as other causes are investigated
  • The disease is extremely rare, only causing 3,000 new cases each year

This is why patients diagnosed with this aggressive disease should seek immediate assistance from a mesothelioma specialist to confirm diagnosis and stage. Mesothelioma specialists have experience in treating this rare cancer and will know of the best treatment procedures available for each type of mesothelioma at each Stage.

Symptoms of Stage 4 Mesothelioma are commonly severe and may include:

  • Dyspnea – difficulty breathing and shortness of breath
  • Frequent, persistent cough that can be severe
  • Feeling of “fullness” and / or difficulty with swallowing
  • Chest, abdominal or testicular pain which may be severe
  • Swelling of abdomen (ascites) or scrotum
  • Weight loss
  • Lethargy
  • Fever
  • Symptoms of cancer in other organs
  • Symptoms of organ failure

Diagnosis of Stage 4 Mesothelioma

A diagnosis of mesothelioma at stage 4 has a poor diagnosis. The cancer spread to other organs and may have begun growing tumors of mesothelial tissue.

Diagnosis and staging will be determined by:

  • Medical history – shows general health, previous illnesses, and exposure to asbestos.
  • Imaging studies – X-ray, CT scans, and PET scans may be useful in determining the size of original tumor but also in determining the spread of cancer
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  • Blood testing – may identify proteins that are present in blood stream due to mesothelioma development
  • Biopsy – in some case, a biopsy of original tumor or biopsy of new tumors may be used to confirm cell types present in tumors. Biopsy may not be possible or necessary in all types of mesothelioma due to location of tumors.

Stage 4 Treatment Options

Stage 4 mesothelioma is highly advanced and treatment options are generally limited to palliative care. This may include fluid drainage and tumor size reduction. It is highly unlikely that cancer eradication will be possible at Stage 4. For symptom reduction and palliative care and depending on the patient’s medical state, the following treatments may be used:

Chemotherapy – cancer-killing medications given at this stage may be used to reduce size of tumors which may be causing significant discomfort. It will be given through IV infusion or administered as an oral medication and may be used alongside other regimens.

Radiotherapy – concentrated waves or beams of energy may be focused in the tumor location. This may help to reduce tumor size, depending on where the tumor is located and how close it is to vital organs such as the heart, lungs or brain. Radiotherapy may not be useful or appropriate in all cases.

Palliative treatments – treatments intended to reduce severity of symptoms may include chemotherapy, radiation and some types of surgery. In addition, pain medications may be used to relieve severe pain caused by tumor formation in the original location or in distant tissues such as bone.

Surgeries used as palliative treatments during Stage 4 mesothelioma may include:

  • Thoracentesis – drainage of fluid that has collected in pleural cavity surrounding lungs. This fluid may be causing chest pain, breathing difficulties including coughing and shortness of breath, heart arrhythmia, and difficulty swallowing.
  • Paracentesis – drainage of fluid that has collected in the peritoneal cavity or abdomen. This fluid may be causing abdominal pain, feeling of fullness and difficulty swallowing, and cough and breathing difficulties. When severe, it may also cause heart irregularities.
  • Pericardiocentesis – drainage of fluid that has collected in pericardial sac surrounding heart. This fluid may be causing chest pain, heart arrhythmia, and breathing difficulties including coughing and shortness of breath.


Stage 4 mesothelioma is the most advanced form of the cancer. It has metastasized and spread to other organs and new tumors, composed of mesothelioma tissue have begun forming on distant organs and tissues. The prognosis for this stage is poor, with most patients having a life expectancy of an average of 6 months.

Despite the poor prognosis, in some cases, the staging is incorrect. For this reason, a second opinion is vital to ensure that curative procedures are not dismissed as inappropriate. A consult or treatment from a mesothelioma specialist will provide the most accurate information possible.

Mesothelioma Staging Systems for Stage 3

Three “systems” are used for staging mesothelioma, any one or combination of which can be used to determine the stage of the disease.

TNM system – classification of the cancer stage in the TNM system is based on assignment of numbers for (T) tumor size, (L) lymph node involvement and (M) metastases. In most cases, Stage 4 TNM results will be T=2, L=2, M=1 or 2, meaning that the mesothelioma tumor is quite large and invasive, has spread to multiple, distant lymph nodes in great numbers and has metastasized, traveling to distant tissues and organs to begin growing tumors.

Butchart System – identifies that tumor is large and has metastasized to distant locals. It also confirms that additional curative treatments are unlikely to be helpful.

Brigham System – is an older system that is largely focused on whether or not curative surgery to remove tumor(s) will be successful in curing the disease. At stage 4 mesothelioma, recommended surgeries are palliative only.