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If you’ve been diagnosed with stage 4 mesothelioma — the most advanced stage of the disease — you’re still eligible for palliative treatment that can improve your quality of life.

Stage 4 mesothelioma has spread, or metastasized, to organs and structures of the body far from where the tumor first appeared. If you’ve been diagnosed with stage four mesothelioma, the disease may have spread too far for curative treatment. You can, however, have palliative treatment and participate in clinical trials where researchers test new treatments that may improve your prognosis.

Learn more about clinical trials that may offer unique treatments for stage 4 mesothelioma patients.

Quick Facts About Stage 4 Mesothelioma

  • At stage 4, the cancer has spread throughout the chest wall, pericardium, and diaphragm.
  • Mesothelioma cells have invaded lymph nodes located far from where the tumor first appeared.
  • Because the mesothelioma has spread so far, doctors primarily use treatment to improve a patient’s quality of life.

Stage 4 Symptoms

Symptoms caused by stage 4 mesothelioma are more noticeable than those caused by any other stage. This is due to the extensive growth of the tumor throughout both sides of the body; at this stage, it can cause shortness of breath, chest pain, stomach pain, or anorexia.

Stage 4 symptoms also include:

  • Pleural effusion, the buildup of fluid in the lung’s lining
  • Ascites, the buildup of fluid in abdomen’s lining
  • Cachexia, the severe loss of weight, body mass, and appetite
  • Anorexia
  • Fatigue
  • Fever
  • Night sweats

Your Treatment Options

The advanced growth of stage 4 mesothelioma may limit your curative treatment options. Your doctor will use palliative treatments to relieve pain and discomfort caused by symptoms of mesothelioma. Depending on your state of health, he or she will most likely treat you with radiation therapy, chemotherapy, or a palliative surgery.

If you have chemotherapy, your doctor will administer chemotherapy in pill form or intravenously, via IV drip. Both types of chemotherapy are systemic; they travel through your bloodstream, attacking and killing any cancer cell they contact.

Treating patients with stage 4 mesothelioma, doctors have been most successful with two chemotherapeutic drugs, Alimta (pemetrexed) and Cisplatin. In a recent study, researchers demonstrated that the combination extended the survival rate of patients with advanced mesothelioma from 6 months to an average of 12.1 months. The same study showed that patients who received B12 and folic acid with both drugs had a longer average survival rate of 13.3 months.

Your doctor may also enroll you in a clinical trial, where new treatments are developed and tested. In fact, most standard curative treatments—like the highly successful extrapleural pneumonectomy (EPP), and the combination of Alimta and cisplatin—began in clinical trials. Getting access to cutting-edge treatments gives you a chance to improve your prognosis, and help doctors develop these treatments to help other patients.

Alternative Therapies and Supportive Care

You also have the option of supplementing treatment with complementary and alternative medicine (CAM). These treatments can’t cure cancer, but they may help manage your symptoms. Common CAM therapies include:

  • Chiropractic care
  • Yoga
  • Physical therapy
  • Acupuncture
  • Breath and relaxation exercises


Your doctor may also recommend supportive care during and after treatment. Receiving it can help ease your symptoms and side effects caused by treatments. Supportive care includes pain medication, exercises, and visits from a registered nurse.

Discover How You Can Beat The Odds

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Stage 4 by Staging Systems

TNM System, Stage 4: In stage 4 of the TNM system, the mesothelioma has has spread to both sides of the body. Tumors may appear in the esophagus, lungs, heart, and lymph nodes throughout the body.

Brigham System, Stage 4: In stage 4 of the Brigham system, tumors have grown too large—and have spread too far into other organs—to be removed by surgery.

Butchart System, Stage 4: In stage 4 of the Butchart system, the mesothelioma has spread to parts of the body far removed from the tumor’s point of origin.

Your Stage 4 Prognosis

The average life expectancy for stage 4 patients is 6 to 12 months. This is, however, just a statistic; your life expectancy depends on a number of factors, including the cell type and location of the mesothelioma. You should interpret statistics related to stage 4 life expectancy as guidelines doctors use to determine which treatment options—palliative treatment, new treatments in clinical trials, supportive care—will work best for you.

Speak to a member of our Patient Help Team and get connected to an experienced doctor who can review your diagnosis and make sure you’re getting the best treatment possible—for free.