Stage 4 Mesothelioma

Stage 4 mesothelioma is the final and most advanced stage of this cancer in most cases. By this point, metastasis (cancer spread) has occurred and tumors have invaded distant organs like the brain. Stage 4 mesothelioma patients often have a poorer health outlook than those in the earlier stages. However, we can help you pursue treatments for stage 4 mesothelioma to help you live longer.

Free Case Review
Written and Fact-Checked by: Lung Cancer Group

What Is Stage 4 Mesothelioma?

Stage 4 mesothelioma is the last and most advanced stage. By this point, mesothelioma cancer tumors have spread to one or more parts of the body that are far from where the cancer first formed. Stage 4 is also known as metastatic or late-stage mesothelioma due to this.

Stage 4 mesothelioma may have spread to the:
  • Adrenal glands
  • Brain
  • Bones
  • Distant lymph nodes
  • Kidneys
  • Liver
  • Lungs

Stage 4 mesothelioma patients have fewer treatment options available, as doctors cannot remove or destroy all of the cancer due to widespread tumor growth. Instead, palliative care is often used as the main course of treatment for stage 4 mesothelioma in order to ease the pain.

A nurse tends to an IV bag of an older male hospital patient who is sitting in a bedThat said, there are still many ways to treat stage 4 mesothelioma and some patients have lived for years after a diagnosis.

If you or a loved one has stage 4 mesothelioma, know that help is available. The only known cause of mesothelioma is asbestos exposure, and since major companies used asbestos for decades despite knowing the dangers, you can pursue financial aid from them.

You can use the financial compensation from makers of asbestos-based products to pay for your mesothelioma treatments and other bills. Further, our team has nursing support staff to help you access stage 4 mesothelioma treatments faster.

Learn how we can help you with a free case review now.

Get Help for Asbestos Lung Cancer
  • Access Financial Aid and Justice
  • Learn About Your Options
  • Contact Us for Free
Free Case ReviewAn older man and his wife hold each other.

Types of Stage 4 Mesothelioma

While there are four types of mesothelioma, only pleural mesothelioma is officially classified into four stages.

The other three types of mesothelioma are informally assigned “localized” or “advanced” stages depending on how far the cancer has spread. Often, these “advanced” stages are similar to a stage 4 diagnosis.

Learn about the types of stage 4 and advanced mesothelioma below.

Stage 4 Pleural Mesothelioma

Malignant pleural mesothelioma forms in the lining of the lungs (pleura). As mentioned above, this is the only type of mesothelioma that officially has four stages.

Doctors classify cases of pleural mesothelioma into one of four stages using the Tumor-Node-Metastasis (TNM) staging system. A patient has stage 4 mesothelioma once the cancer has metastasized, according to the TNM staging system.

Stage 4 pleural mesothelioma can spread to the:

  • Adrenal glands
  • Bones
  • Diaphragm (muscle at the bottom of the chest)
  • Lining of the heart or abdomen
  • Lungs
  • Lymph nodes on both sides of the body
  • Spinal column

Stage 4 pleural mesothelioma patients are not usually treated with major surgeries (which are often recommended for those in the earlier stages). Instead, thoracic oncologists (doctors that treat cancers in the lungs and/or chest cavity) recommend chemotherapy and palliative treatments.

Stage 4 Peritoneal Mesothelioma

Peritoneal mesothelioma forms in the lining of the abdominal cavity (peritoneum). Peritoneal mesothelioma rarely spreads outside of the abdominal lining, so doctors don’t typically classify it into four stages.

But, as noted earlier, peritoneal mesothelioma could be informally staged as localized or advanced. The advanced stage is often the equivalent of a stage 4 mesothelioma diagnosis.

In late-stage peritoneal mesothelioma, the cancer may reach the:

  • Female reproductive organs (ovaries and uterus)
  • Liver
  • Spleen

Peritoneal mesothelioma is often deadly even though it may not spread past the abdominal organs. Doctors can recommend treatments for patients with late-stage peritoneal mesothelioma depending on how far the cancer has spread and which organs have been overrun by cancer tumors.

Stage 4 Pericardial Mesothelioma

Pericardial mesothelioma forms in the heart lining (pericardium). Like peritoneal mesothelioma, pericardial mesothelioma only has a localized or advanced stage.

Late-stage pericardial mesothelioma can spread to the:

  • Kidneys
  • Liver
  • Lungs
  • Lymph nodes

Between 80% and 90% of pericardial mesothelioma patients are only diagnosed after they’ve died. That said, doctors may be able to recommend treatments for both early-stage and late-stage pericardial mesothelioma patients that are diagnosed while still alive.

Stage 4 Testicular Mesothelioma

Testicular mesothelioma is the rarest type of this cancer, and doctors don’t use a formal staging system to classify it. Cases of late-stage testicular mesothelioma can spread to the lungs and various lymph nodes, including those behind the abdomen.

Doctors typically need to use a combination of multiple treatments to help patients with advanced testicular mesothelioma, according to the Singapore Medical Journal.

Symptoms of Stage 4 Mesothelioma

Though the symptoms of mesothelioma are often mild or vague at first, they can become very intense by stage 4.

Symptoms of mesothelioma stage 4 may include:
  • Coughing up blood
  • Fatigue
  • Fever
  • Fluid buildup
  • Nausea
  • Night sweats
  • Rib, shoulder, upper back, or chest pain
  • Shortness of breath
  • Vomiting
  • Weight loss

The symptoms of stage 4 mesothelioma can vary depending on what specific type of this cancer a patient has.

Patients with stage 4 pleural mesothelioma often suffer from pleural effusions (painful buildups of fluid within the lung lining). Those with advanced-stage peritoneal mesothelioma may experience ascites (fluid buildup in the abdominal lining) and changes in bowel movements.

If you were exposed to asbestos decades ago and now have any of these symptoms, don’t wait: See a health care provider. The symptoms of mesothelioma take 10-50 years to develop after asbestos exposure — but the cancer can quickly reach stage 4 once symptoms appear.

We can help you find top doctors if you have possible symptoms of stage 4 mesothelioma. Learn more by calling (877) 446-5767.

Stage 4 Mesothelioma Diagnosis

Mesothelioma is not often diagnosed until it’s reached a later stage because its symptoms are mild at first and shared with more common health problems.

Doctors look at a chest X-rayNearly 40% of pleural mesothelioma cases were diagnosed in stage 4, according to a study of 302 patients from the American Cancer Society Journals.

There are two main components to a stage 4 mesothelioma diagnosis. The first is a series of imaging tests, which allow doctors to determine how far the cancer has spread within the body. If they find possible signs of cancer in multiple areas — such as the lungs, brain, or kidneys — they may worry that you’re in stage 4.

Doctors can then determine what type of cancer is present using a biopsy. This procedure allows them to take a sample of fluid or tissue from a possibly cancerous area. The sample is then analyzed under a microscope to see what type of cancer cells (if any) are present.

If mesothelioma cells are found on a biopsy — and cancer tumors have spread through your body — you’ll likely be diagnosed with stage 4 mesothelioma.

Stage 4 Mesothelioma Prognosis

Your prognosis is your expected outcome after developing an illness. Stage 4 mesothelioma has the worst prognosis of all stages, but there is hope for many patients thanks to advancements in treatments.

A prognosis is measured by life expectancy (the average amount of time someone lives after a diagnosis) and survival rate (the percentage of patients still alive after a set amount of time).

View stage 4 mesothelioma prognosis statistics below.

Life Expectancy for Stage 4 Mesothelioma

The average life expectancy for stage 4 pleural mesothelioma patients is 12 months. While this number may seem grim, it may be possible to live longer depending on the unique factors in your case.

Your overall health (outside of having cancer), your age, cancer cell type, and what type of mesothelioma you have can all impact your life expectancy.

Stage 4 Mesothelioma Survival Rates

Survival rates are typically measured in years. Those with stage 4 mesothelioma typically have the lowest survival rates of any stage.

Stage 4 pleural mesothelioma survival rates include:

  • 2-year survival rate: 26%
  • 5-year survival rate: 4%

Just like life expectancy statistics, it’s important to remember that survival rates are averages and you may be able to live longer with stage 4 mesothelioma.

Stage 4 Mesothelioma Survivors

Stage 4 mesothelioma has a very poor prognosis but it is not a death sentence. There have been reports of stage 4 mesothelioma patients living much longer than they were originally expected to.

For example, the Journal of Medical Case Reports found a stage 4 pleural mesothelioma patient whose cancer unexpectedly shrunk after various treatments. The cancer tumor was completely gone 29 months after his diagnosis, but it eventually grew back.

Further, an advanced-stage peritoneal mesothelioma patient was diagnosed in 2015 and doctors gave him one year to live. However, he is still alive as of late 2022 thanks to medical care.

These survivor stories go to show that anything is possible and that you may be able to live for years with stage 4 mesothelioma.

Treatment of Stage 4 Mesothelioma

There are two main goals when it comes to treating stage 4 mesothelioma: Easing symptoms and helping patients live longer.

Most stage 4 mesothelioma cancer treatments are palliative care, meaning they’re designed to reduce painful symptoms. Some mesothelioma stage 4 patients may qualify for treatment options that could improve their overall life expectancy too.

Which stage 4 mesothelioma treatments you’ll receive depends on factors unique to your case. Mesothelioma specialists can recommend treatments based on your diagnosis and how far the cancer has spread.


Surgeries are often considered the best treatment for early-stage mesothelioma — but by stage 4, they are not often used.

Did You Know?

Most cases of stage 4 mesothelioma aren’t resectable. This means that doctors can’t remove all of the cancer with surgery due to the spread of the tumors.

Further, major mesothelioma surgeries like pleurectomy with decortication (P/D), extrapleural pneumonectomy (EPP), or cytoreductive surgery can be taxing on a patient’s body. Stage 4 mesothelioma patients wouldn’t be able to withstand the risks or side effects of these surgeries.

That said, some minor surgeries may be used as a form of palliative care. Doctors can sometimes remove the lung lining (pleura) and as much cancer as they can through a partial pleurectomy (also known as a debulking surgery).

Similar surgeries can be performed in cases of peritoneal and pericardial mesothelioma to ease discomfort.


Chemotherapy is the main treatment for stage 4 pleural mesothelioma, according to the health network Texas Oncology. Doctors typically administer chemotherapy drugs like pemetrexed and cisplatin to destroy cancer cells and reduce the size of tumors.

Peritoneal mesothelioma is somewhat resistant to chemotherapy. However, chemotherapy may be used on late-stage peritoneal mesothelioma patients when surgery isn’t an option, according to the journal Translational Lung Cancer Research.

Palliative chemotherapy can also be used to help late-stage pericardial mesothelioma patients.


Radiation therapy (where doctors use concentrated X-rays or other energy beams to shrink tumors) may be used to ease symptoms when a stage 4 mesothelioma patient can’t undergo surgery.

“Radiation therapy can be used to treat a focal area to try to help to decrease or potentially eliminate that pain altogether. In addition to helping with pain, it can also help with breathing.”

— Charles B. Simone, Mesothelioma Specialist

Radiation may also be used alongside chemotherapy to possibly treat pleural mesothelioma patients that can’t get surgery.


Immunotherapy medications improve the body’s immune response, which is important as mesothelioma cells can sometimes hide from the immune system.

Immunotherapy and chemotherapy can be used together to treat pleural mesothelioma patients that can’t get surgery, according to the U.S. Food and Drug Administration (FDA). Patients that aren’t candidates for surgery are usually in a later mesothelioma stage.

Other studies are currently reviewing if immunotherapy can help patients with other types of mesothelioma, whether they’re in an early stage or advanced stage.

Palliative Treatment Options

Outside of minor surgeries or less-intense doses of chemotherapy, doctors can use additional palliative treatments to help stage 4 mesothelioma patients live with less pain.

Palliative care options for stage 4 mesothelioma include:

  • Catheters: Doctors can insert a catheter into a patient’s body to easily drain pleural effusions or ascites.
  • Mental health treatments: Having stage 4 mesothelioma is very stressful. Doctors may recommend speaking with a counselor or support group, or trying activities like yoga or meditation, to help ease emotional health problems like anxiety or depression.
  • Pleurodesis: This procedure is also used to treat pleural effusions. Medical-grade talcum powder is inserted into the lung lining. The talc seals the lung lining shut so fluid won’t fill up again.
  • Thoracentesis: With this procedure, doctors use a small needle to drain pleural effusions so patients can breathe better and live with less pain. A similar treatment called paracentesis is used to treat ascites in peritoneal mesothelioma patients.

Palliative care may be the main treatment for patients reaching the end of life. These treatments can also be used alongside life-extending ones.

Stage 4 Mesothelioma Clinical Trials

Closeup of a doctor holding a beaker filled with blue liquid to a bunch of test tubesBesides the common stage 4 mesothelioma treatments, doctors continue to study new and more effective ones through clinical trials.

Recent clinical trials have led to new treatment options becoming available, such as immunotherapy for those with advanced mesothelioma.

You may qualify for new treatments from a clinical trial if you have stage 4 mesothelioma. Top doctors can help you find clinical trials that you may be able to join.

Call (877) 446-5767 to learn more about joining a stage 4 mesothelioma clinical trial or accessing other cancer treatments. Our team may be able to help you right now.

Help for Stage 4 Mesothelioma Patients

Battling any stage of mesothelioma can be very scary and stressful — but our team is here for you.

Lung Cancer Group is well-equipped to help stage 4 mesothelioma patients get medical treatment and financial aid. Our nursing support staff has assisted many other patients in the past, finding the best resources to fit their needs.

Our team may be able to:

  • Connect you with top stage 4 mesothelioma treatments faster
  • Help you and your family find peace of mind in this trying time
  • Pursue a financial claim to pay for mesothelioma treatments and other bills

Get started today with a free case review.

FAQs About Stage 4 Mesothelioma

How long can you live with stage 4 mesothelioma?

The average life expectancy for most stage 4 mesothelioma patients is 12 months. That said, it’s sometimes possible to live for many years with stage 4 mesothelioma depending on how your body responds to treatments.

Working with cancer specialists offers you the best chance at living longer with stage 4 mesothelioma.

Possibly, yes. There have been several cases where stage 4 mesothelioma patients went into remission (where the cancer shrinks or disappears).

In one instance, a 76-year-old man with stage 4 pleural mesothelioma went into remission after having a thoracocentesis and using alternative therapies. It should be noted that alternative therapies should never be substituted for proper medical care and that this patient received regular supervision from his doctors.

In the final stages of mesothelioma, the cancer tumors have spread past where they first formed and have often reached major organs like the brain, liver, or bones.

Stage 4 mesothelioma patients may experience painful symptoms like difficulty breathing, coughing up blood, and severe weight loss due to cancer spread. Fortunately, doctors can recommend medical care to ease the pain and, in some cases, help stage 4 mesothelioma patients live longer.

Lung Cancer Group was established by a team of caring advocates so those with lung cancer and other asbestos-related diseases can get the help they deserve. Our site provides the most accurate and up-to-date information about lung cancer, its link to asbestos, and financial compensation available to patients. Contact us to learn more and get assistance.

  1. Akin, Y., Bassorgun, I., Basara, I., & Yucel, S. (2015, March). Malignant mesothelioma of tunica vaginalis: An extremely rare case presenting without risk factors. Retrieved November 3, 2022, from

  2. American Cancer Society. (n.d.). Malignant mesothelioma stages. Retrieved November 3, 2022, from

  3. American Cancer Society. (n.d.). Surgery for malignant mesothelioma. Retrieved November 3, 2022, from

  4. Badiyan, S. N., Molitoris, J., Zhu, M., Glass, E., Diwanji, T., & Simone, C. (2018, April). Proton beam therapy for malignant pleural mesothelioma. Retrieved November 3, 2022, from

  5. Brecht, I. B., Agaimy, A., Besendörfer, M., & Et al. (n.d.). Malignant peritoneal mesothelioma in a 16-year-old girl: Presentation of a rare disease. Retrieved November 3, 2022, from

  6. Brun, C., Giusiano, S., Thiam, K., Guinde, J., Froudarakis, M., & Astoul, P. (2019, October 12). The necessity of a more aggressive initial surgical treatment in patients with mesothelioma of the testicular tunica vaginalis. Retrieved November 3, 2022, from

  7. Cancer Research UK. (2021, May 21). Stages of mesothelioma. Retrieved November 3, 2022, from

  8. Carbone, M., Bueno, R., Alexander, H. R., & Et al. (2019, July 8). Mesothelioma: Scientific clues for prevention, diagnosis, and therapy. Retrieved November 3, 2022, from

  9. Cedrés, S., Fariñas, L., Stejpanovic, N., Martinez, P., Martinez, A., Zamora, E., . . . Felip, E. (2013, April). Bone metastases with nerve root compression as a late complication in patient with epithelial pleural mesothelioma. Retrieved November 3, 2022, from

  10. Farthing, M., Shanmugalingam, T., Dean, E., & Muthukumar, D. (2017, November 10). Invasive sarcomatoid mesothelioma resulting in spinal cord compression: Case report. Retrieved November 3, 2022, from

  11. Gong, W., Ye, X., Shi, K., & Zhao, Q. (2014, December 10). Primary malignant pericardial mesothelioma-a rare cause of superior vena cava thrombosis and constrictive pericarditis. Retrieved November 3, 2022, from

  12. Greenbaum, A., & Alexander, H. (2020, February). Peritoneal mesothelioma. Retrieved November 3, 2022, from

  13. Kheir, F. (2019, January 17). Pleural plaques/mesothelioma. Retrieved November 3, 2022, from

  14. Kim, J., Bhagwandin, S., & Labow, D. (2017, June). Malignant peritoneal mesothelioma: A Review. Retrieved November 3, 2022, from

  15. Pandya, H. (2021, June 02). Five years later, Quincy Jones is still burning the light. Retrieved November 3, 2022, from

  16. Pass, H., Giroux, D., Kennedy, C., Ruffini, E., Cangir, A. K., & Rice, D. (2016, September 23). The IASLC Mesothelioma Staging Project: Improving staging of a rare disease through international participation. Retrieved November 3, 2022, from

  17. Penn Medicine (Director). (2014, August 01). 0:19 / 4:45 From an accredited hospital Learn how experts define health sources in a journal of the National Academy of Medicine Mesothelioma: Radiation-Oncology [Video file]. Retrieved November 3, 2022, from

  18. Raeside, M., Gormly, K., Neuhaus, S., Kotasek, D., & James, C. (2016, November 12). Primary pericardial mesothelioma presenting as multiple pericardial masses on CT. Retrieved November 3, 2022, from

  19. Raphael, J., Lui, M., Jimenez-Juan, L., Khanna, S., & Verma, S. (2015, February 19). Spontaneous regression of malignant pleural mesothelioma: A case report. Retrieved November 3, 2022, from

  20. Rodríguez, M., Mallidi, H., Silva, A., & Bueno, R. (2018, May 22). Recurrence of pericardial mesothelioma affecting the myocardium after pericardial resection. Retrieved November 3, 2022, from

  21. Rossini, M., Rizzo, P., Bononi, I., Clementz, A., Ferrari, R., Martini, F., & Tognon, M. (2018, April 03). New Perspectives on diagnosis and therapy of malignant pleural mesothelioma. Retrieved November 3, 2022, from

  22. Shavelle, R., Vavra-Musser, K., Lee, J., & Brooks, J. (2017). Life expectancy in pleural and peritoneal mesothelioma. Retrieved November 3, 2022, from

  23. Sherborne, V., Seymour, J., Taylor, B., & Tod, A. (2020, June 28). What are the psychological effects of mesothelioma on patients and their carers? A scoping review. Retrieved November 03, 2022, from

  24. Texas Oncology. (n.d.). Stage IV/recurrent malignant pleural mesothelioma. Retrieved November 3, 2022, from

Free Case Review

Get Financial Compensation for Lung Cancer

  • Afford medical expenses and any other bills
  • Find peace of mind for you and your family
  • Get justice from the companies that harmed you

Call (877) 446-5767 or fill out the form to connect with our team and pursue financial compensation after a lung cancer diagnosis.

Start a Free Case Review

Secure Submission

Call us at (877) 446-5767 Talk to us via Live Chat