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Stage 3 Mesothelioma

Stage 3 is the most common stage of diagnosis for mesothelioma. During this stage, cancer has spread to tissues, organs or lymph nodes near the original tumor, but not to other parts of the body. The median survival is around 18 months, though that can vary based on the type of mesothelioma. 


Stage 3 mesothelioma characteristics

Specialists consider stage 3 an advanced form of mesothelioma. The tumor is no longer localized to its point of origin and has spread to nearby areas on one side of the body.

If you’ve been diagnosed with stage 3 mesothelioma, you still have treatment options that can improve your quality of life. At this stage, your prognosis is better than patients diagnosed with stage 4, because the mesothelioma hasn’t spread beyond one side of your body, or to lymph nodes located at a distance from the primary tumor.

Treatment options may be limited at this stage of mesothelioma, but there are still potentially life-saving treatments available in clinical trials. Clinical trials are where specialists test novel treatments. Find out if you qualify for a clinical trial now.

Stage 3 Mesothelioma Quick Facts

  • A stage 3 tumor has spread from the lining of the lung to the chest wall, the lung, and lining of the heart.
  • Cancer cells invade nearby lymph nodes on one side of the chest.
  • Stage 3 patients who are in good overall health may still be eligible for curative treatment.
  • Receiving a stage 3 diagnosis could limit your treatment options. As a result, you should always confirm your diagnosis with a second–opinion from - an experienced doctor.
  • The 5-year survival rate for pleural mesothelioma at this stage is about 16%.
  • The 5-year survival rate for peritoneal mesothelioma at this stage is about 29%


Types of stage 3 mesothelioma

There are four main types of mesothelioma, named for where cancer originates in the body:

  • Pleural, found in the lining of the lungs (pleura)
  • Peritoneal, originating in the tissue lining the abdominal wall (peritoneum)
  • Pericardial, starting in the membrane surrounding the heart
  • Testicular, found in the testes

The cancer staging and progression for each type of mesothelioma will likely be different. The cell type of the tumors will also impact the progression and treatment plan for each mesothelioma patient.

Stage 3 pleural mesothelioma

Malignant pleural mesothelioma is the most common type of mesothelioma, accounting for an estimated 80 percent of new cases. This mesothelioma is staged with the TNM staging system – the main system used to stage mesothelioma. 

During stage 3, tumors develop beyond the pleura, and cancer cells may be found in nearby tissues, organs, and lymph nodes as fluid builds up around the lungs. Stage 3 can be divided into two substages depending on cancer’s spread.

Stage 3A tumors have grown to nearby areas, like the diaphragm or mediastinum, on one side of the chest, as well as to lymph nodes. It may also have spread to the chest wall or layers surrounding the heart (pericardium). Surgery may still be an option at this stage. 

In stage 3B, tumors have spread to the pleural lining on the other side of the chest. Surgery may be an option depending on the tumor spread, but chemotherapy is generally a better option for patients at this stage. 

Stage 3 peritoneal mesothelioma

Peritoneal mesothelioma is the second most common type of mesothelioma, accounting for 300-500 new cases per year. This kind of mesothelioma is staged either with the peritoneal cancer index (PCI) or an adapted version of the TNM staging system, but there is no widely recognized staging system for this kind of mesothelioma. 

During stage 3 of peritoneal mesothelioma, tumors are localized in the abdomen but may have spread to lymph nodes and, in some cases, beyond the abdomen. However, they have not yet traveled to distant parts of the body. In the PCI staging system, a score between 30-39 indicates stage 3. 

Stage 3 pericardial mesothelioma

Pericardial mesothelioma is a rare type of mesothelioma, accounting for just 1-2 percent of new cases. Because this cancer is so rare, there is no official staging system for pericardial mesothelioma, and it is not generally defined as “stage 3”. Diagnosis generally occurs in later stages after it has spread beyond the pericardium. 

Stage 3 testicular mesothelioma

Like pericardial mesothelioma, testicular mesothelioma is extremely rare and makes up just 1 percent of cases. Given the rarity of this type of cancer, there is no official cancer staging system for testicular mesothelioma. Oncologists evaluate tumors based on staging guidelines for testicular cancer. Stage 3 testicular cancer, for example, usually indicates that cancer has spread to other areas, like lymph nodes or bone. 


How doctors make a stage 3 mesothelioma diagnosis

Generally, physicians define stage 3 mesothelioma as disease which has spread from the primary tumor to nearby tissues, organs, and lymph nodes, but not yet to distant organs. Doctors use three staging systems to describe how far mesothelioma has spread. These systems help oncologists determine your prognosis and treatment course. 

TNM system

In stage 3 of the TNM system, the mesothelioma has spread from the lining of one lung throughout the chest on one side of the body. It has also spread into the lining of the heart, the surface of the heart itself, ribs, and nearby lymph nodes.

Butchart system

At stage 3, surgical removal is no longer a possibility due to the tumor’s advanced metastasis throughout the chest cavity and nearby lymph nodes.

Brigham system

At stage 3 of the Butchart system, the tumor has spread from the lining of the chest to the lining of the abdomen, or vice versa. It may also have spread to lymph nodes located at a distance from the area where the tumor first appeared.


Symptoms of stage 3 mesothelioma

Stage 3 symptoms are more noticeable than those caused by stages one or two, but can still feel like symptoms from other diseases, like pneumonia or bronchitis. At this stage of the disease, patients usually seek medical attention and are subsequently diagnosed with mesothelioma.

Most stage 3 symptoms are caused by tumor growth, which produces excess fluid, scarring, and inflammation in the lining of the lungs, abdomen, or heart. The collection of excess fluid puts pressure on the lungs and organs in the abdomen. Scarring and inflammation restrict the movement of the lining of the lungs, causing pain and breathing difficulty.

Stage 3 mesothelioma symptoms

  • Chest pain
  • Difficulty breathing
  • Dyspnea, or shortness of breath
  • Fever
  • Pained breathing
  • Stomach pain
  • Weight loss

How stage 3 mesothelioma is detected

Most mesothelioma is diagnosed in stage 3. By this stage, patients typically are experiencing symptoms of mesothelioma that lead them to seek medical care and a diagnosis. This differs from earlier stages when mesothelioma is often diagnosed by screening for other issues. 

There is a long (20-60 years or more)  latency period between asbestos exposure and cancer development. How quickly cancer spreads depends on the cell type of the tumor and other factors, but advanced-stage cancer tends to grow quickly. 

Mesothelioma may be found in advanced stages as symptoms progress and patients seek care. Oncologists may use X-rays, CT scans MRIs, PET scans and biopsies to diagnose mesothelioma. 


Learn more about the stages of mesothelioma

Find out more about the other stages of mesothelioma, including the symptoms, treatment options, prognosis and how you or a loved one can get help.


Mesothelioma treatment options for patients in stage 3

Your doctor will determine if you’re healthy enough for curative treatment like surgery, chemotherapy, or radiation therapy. If you are, multimodal therapy may be a good option to improve your prognosis. If you aren’t, he or she will recommend palliative treatments, which they’ll use to relieve pain and discomfort caused by symptoms of mesothelioma.

Chemotherapy and radiation therapy

Depending on your state of health, you can have either chemotherapy or radiation therapy as a palliative treatment. Doctors use both to shrink and slow the growth of mesothelioma tumors. Doing so relieves the pressure caused by large tumors, build up of excess fluid, and inflammation.

If you receive chemotherapy as a palliative treatment, you’ll most likely get it in pill form, or intravenously through an IV. The most common chemotherapy drugs used for stage 3 patients include Alimta, gemcitabine, carboplatin, cisplatin, doxorubicin, and navelbine; doctors often combine two of these drugs for a greater effect.

Like chemotherapy, radiation therapy shrinks tumors, but in a more targeted manner. Doctors use concentrated beams of radiation to kill cancer cells and keep the growth of tumors in check. Being able to focus the cancer–killing effectiveness of radiation on a tumor cuts down damage to healthy cells and, as a result, reduces side effects.

Palliative surgical options for stage 3 patients

If your doctor doesn’t clear you for curative surgery like extrapleural pneumonectomy or pleurectomy with decortication, you still have palliative surgery as a treatment option.

Doctors use palliative surgery to relieve discomfort caused by symptoms of mesothelioma, improving your quality of life. Palliative procedures doctors use to relieve stage 3 symptoms include:

  • Pleurodesis. A pleurodesis prevents excess fluid from collecting in the lining of your lungs. Your doctor accomplishes this by introducing an irritant into the pleural cavity, the space between the inner and outer parts of your lung’s lining. This irritant—which is usually talc, a form of iodine, or an antibiotic—causes inflammation that fuses both parts together, disallowing any more fluid from collecting in the pleural cavity.
  • Thoracentesis. A thoracentesis drains excess fluid from the pleural cavity. Paracentesis: a paracentesis drains excess fluid from your abdominal cavity, the space between the inner and outer parts of the lining of your abdomen.
  • Pericardiocentesis. A pericardiocentesis drains excess fluid from your pericardial cavity, the space between the inner and outer part of the lining of your heart.


Other treatment types


Immunotherapy is used to stimulate the immune system to fight cancer on its own. In particular, the combination of two immunotherapy drugs, Opdivo® (nivolumab) and Yervoy® (ipilimumab), has been shown to improve survival by 50 percent and is an FDA-approved treatment for malignant pleural mesothelioma. These treatments are now standard cancer treatment options for advanced stages of mesothelioma. 

Clinical trials and emerging treatments

Clinical trials are research studies to evaluate new interventions and emerging treatments, including for advanced malignant mesothelioma stages. While likely not curative, these treatments can extend the time mesothelioma patients have with loved ones. 

Recent areas of study for mesothelioma include:

  • Gene therapy, which alters the DNA of affected cells so the immune system can better target them
  • Immunotoxins, which are proteins that bind to cancer cells, enter the cell and kill them
  • Oncolytic virus therapy, which uses viruses like herpes simplex virus to kill cancer cells

Clinical trials and emerging treatments are not available to all patients and are often given to patients who are not responding to standard treatment methods. Your oncologist will have specific recommendations for clinical trials that show promise for treating your cancer. 

Palliative care

For late-stage mesothelioma, palliative care is the most common form of treatment. This type of care focuses on lessening symptoms of mesothelioma and making patients more comfortable as opposed to curing mesothelioma. Your oncologist may recommend pairing palliative care with standard forms of treatment like chemotherapy or immunotherapy.  


Life expectancy & survival rates with stage 3 mesothelioma

Life expectancy refers to how long a patient can expect to live with their cancer. For stage 3 mesothelioma patients, the typical median life expectancy is 18 months, compared to 19 months for stage 2 and 12 months for stage 4. 

Relative survival rate refers to the percentage of people who survive mesothelioma compared to the overall population for a certain increment, often two or five years. For stage 3 pleural mesothelioma, the two-year survival rate is around 29 percent. The five-year survival rate drops to roughly 16 percent according to the American Cancer Society.

Many factors can impact survival, including age, gender and overall health. Additionally, aggressive treatment can help to extend life expectancy and improve quality of life. Speak with your oncologist or other specialists about your prognosis to learn more. 


Can stage 3 mesothelioma patients be cured?

There is no cure for any stage of mesothelioma, though some patients have been able to go into short-term remission. Mesothelioma caught in an early stage has a better prognosis with more treatment options available compared to later stages. Early, aggressive treatment and some emerging clinical trials have shown promise in improving life expectancy for late-stage mesothelioma.


How to improve your mesothelioma prognosis

The average life expectancy for a patient diagnosed with stage 3 mesothelioma ranges from 6 to 12 months. If you’ve been diagnosed with stage 3 mesothelioma, you can improve your quality of life with palliative treatments. Curative treatment may not be an option at this stage, because the mesothelioma may have spread too far for it to be effective.

Your doctor will, however, determine which treatments you’re eligible for, and may enroll you in a clinical trial where you can access new, emerging treatments that may improve your prognosis.

You can learn more about how to improve your prognosis by speaking with our Patient Help Team. We can review your diagnosis, find financial aid to help pay for treatment, and even connect you to an experienced mesothelioma doctor—all for free. Speak to a member of our Patient Help Team and get started on improving your prognosis.