Pleural Mesothelioma Stages 1-4

Quick Summary

When diagnosed with pleural mesothelioma, doctors look at how far the cancer has spread (metastasis). Based on where the mesothelioma has spread to, doctors stage the disease at 1, 2, 3 or 4. Stage 1 is the least advanced and stage 4 is the most advanced. No matter what stage you’re diagnosed at, you have treatment options that can improve your symptoms or possibly extend your life expectancy.

Pleural Mesothelioma Stages Overview

If you’ve been diagnosed with pleural mesothelioma, it’s important to understand what doctors look at to make a diagnosis. One the main aspects of cancer diagnostics is the staging system.

Here is what you need to know about pleural mesothelioma stages:

As of now, only pleural mesothelioma has an official staging system. The other forms of mesothelioma—peritoneal, pericardial and testicular—are too rare to draw enough similarities in cases to define specific stages.

In these cases, doctors will usually just refer to the individual’s condition as early or advanced, which refers to whether the cancer is still localized or has metastasized (spread to distant sites).

What Are the Pleural Mesothelioma Stages?

Pleural Mesothelioma Update

Each pleural mesothelioma stage defines different details about the tumor. In each stage, doctors may describe the tumor itself as well as how far it has spread from the point at which it originated in the pleura. The farther it has spread away from the primary location, the more advanced the stage is.

With this information, doctors can determine how severe the condition is. Disease stage allows doctors to choose the treatment options that will be most effective for that patient based on the extent of their condition.

Mesothelioma stage also helps doctors rule out any treatment options that won’t be effective due to the disease severity.

Stage 1 Pleural Mesothelioma

In stage 1, the tumor remains localized to one side of the body. It has not yet spread to the lymph nodes. There are 2 substages of stage 1: Stage 1A and Stage 1B.

  • In stage 1A, the mesothelioma remains in the outer layer (parietal) of the pleura.
  • In stage 1B, the mesothelioma has moved into the inner layer (visceral) of the pleura.

In stage 1 pleural mesothelioma, cancer can be found in:

  • In one lung
  • In the chest wall lining
  • In the lining of the lungs and chest wall
  • In the lining of the diaphragm

Stage 1 pleural mesothelioma is the least advanced condition a patient can be diagnosed with. Mesothelioma is rarely diagnosed at stage 1 because early symptoms are often undetectable or are easy to mistake for other conditions. This makes stage 1 pleural mesothelioma very difficult for doctors to diagnose properly.

In cases where there are initial mesothelioma symptoms such as pleural effusion, dry cough and chest pain, and there is a known history of asbestos exposure, doctors may be able to detect mesothelioma early enough. At this stage, mesothelioma is still considered respectable, meaning the tumor can be removed by surgery.

There are excellent treatment options available to stage 1 patients, including surgeries, chemotherapy and radiation therapy.

The 2 primary surgeries available to stage 1 patients are the extrapleural pneumonectomy or the pleurectomy with decortication. Both are considered curative surgeries and offer pleural mesothelioma patients the best chance at survival.

The median life expectancy of stage 1 pleural mesothelioma patients is 21 months. However, with early and aggressive treatments, patients can live several years.

Stage 2 Pleural Mesothelioma

In stage 2, the tumor has spread into the others areas of the lungs and chest wall but is still contained on one side of the body. It may have also grown into the pleural layer of the diaphragm.

In stage 2 pleural mesothelioma, cancer may be found in:

  • Surrounding lung tissues
  • Part of the diaphragm
  • Possibly into the lymph nodes
  • Into the chest wall

Stage 2 mesothelioma is considered slightly advanced because it has begun to metastasize to nearby chest and lung areas. Stage 2 pleural mesothelioma symptoms worsen and breathing becomes more difficult and painful.

It’s possible for doctors to detect pleural mesothelioma in stage 2, especially if there is a known history of asbestos exposure and the patient has reported all their symptoms.

Mesothelioma Treatment Update

Stage 2 pleural mesothelioma is still considered resectable because it remains contained to one side of the body. Treatment options for stage 2 pleural mesothelioma include curative surgeries—either extrapleural pneumonectomy or pleurectomy with decortication—chemotherapy and radiation therapy. Aggressive stage 2 treatment options give patients an increased chance of long-term survival.

The median life expectancy for stage 2 pleural mesothelioma patients is 19 months. With a personalized treatment plan, patients can live much longer. Approximately one-quarter of stage 2 mesothelioma patients live longer than 2 years.

Stage 3 Pleural Mesothelioma

In stage 3, the tumor is still contained to one side of the chest but has spread throughout the affected side. In addition to spreading into the lung, the chest wall, and the diaphragm, it has also possibly spread to other organs.

In stage 3 pleural mesothelioma, cancer may be found in:

  • Pericardium (heart lining)
  • Rib tissue
  • Deeper into the tissue of the chest wall
  • Nearby lymph nodes

Stage 3 mesothelioma is quite advanced and its symptoms have significantly worsened. Stage 3 patients will continue to experience difficulty breathing and tightness in the chest. Fever, fatigue and weight loss are also common at this stage.

Though it’s quite advanced, stage 3 pleural mesothelioma may still be removable by surgery in certain cases. Younger, healthier patients may still be eligible for aggressive surgeries such as the extrapleural pneumonectomy followed by chemotherapy and radiation.

The median life expectancy for stage 3 pleural mesothelioma patients is 16 months. However, those who are eligible for surgery can improve their life expectancy by several months.

Stage 4 Pleural Mesothelioma

In stage 4, the tumor has spread to the other side of the body. As it continues to spread to distant sites, it may also affect distant organs. It is the most advanced stage of the disease and is treated using palliative therapies.

In stage 4 pleural mesothelioma, cancer may be found in:

  • The lymphatic system
  • The other lung
  • The peritoneum (abdomen lining)
  • The spine, brain, and other distant places

By stage 4, pleural mesothelioma symptoms have often progressed to include coughing up blood and difficulty swallowing. In stage 4, the patient’s immune system is also affected, making them more susceptible to illness.

Stage 4 pleural mesothelioma patients are no longer eligible for curative surgeries. Instead, the goal of stage pleural mesothelioma treatment is palliative care. End-stage treatments help patients feel more comfortable by managing their symptoms and increasing their ability to breathe.

The median life expectancy of stage 4 pleural mesothelioma patients is 12 months. However, some therapies can help extend life by a few months.

Stage 4 pleural mesothelioma patients are usually good candidates for novel treatments being tested in clinical trials. These therapies can give patients more treatment options and improve their quality of life.

Getting Treatment at all Stages of Pleural Mesothelioma

No matter what stage you’ve been diagnosed with, you have treatment options. Seeing a mesothelioma specialist is critical to getting the right diagnosis and receiving the most effective treatments. All patients are encouraged to get a second opinion to confirm their disease stage.

To learn more about working with a mesothelioma specialist, contact our Patient Advocates today. We work with pleural mesothelioma patients each day to review their cases and help them get access to the top treatments available. We can also help you in obtaining legal compensation to pay for your treatments and other expenses. Don’t delay in getting the pleural mesothelioma treatments you deserve.

View Author and Sources

  1. American Cancer Society, “How is Malignant Mesothelioma Staged?” Retrieved from: Accessed on December 14, 2017.
  2. Cancer Research UK, “Mesothelioma Stages” Retrieved from: Accessed on December 14, 2017.

Last modified: October 24, 2018