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Stage 4 Mesothelioma

Stage 4 mesothelioma is the most advanced and final stage of the disease. At this point, cancer is found in 1 or both sides of the body and may have spread to the lymph nodes and/or to other parts of the body far from the original tumor site.

Stage 4 Symptoms

  • Chest pain becomes more painful.
  • Fluid develops in the abdomen.
  • There is unexplained weight loss.
  • A lump may develop in the chest or abdominal area.

Treatment Options

In stage 4 mesothelioma, the cancer is very advanced and cannot be surgically removed. The treatment options are similar to those in stage 3. The difference is that the stage 4 treatments are performed only to relieve symptoms and to help patients feel more comfortable.

Palliative surgery (symptom relief)

Palliative surgery can be performed to help stage 4 mesothelioma patients get much-needed relief from their uncomfortable symptoms, including painful breathing. Any of the 3 types of surgery that are typically prescribed in an effort to save the lives of stage 1 or 2 patients can now be recommended for symptom relief. These surgeries are:

In addition, 3 other surgical procedures can be performed to remove the fluid that has built up around a tumor and is causing painful symptoms. While these procedures help provide symptom relief, they may need to be repeated if the fluid builds up again. These procedures are:

  • Pleurodesis – This procedure is done as a preventative measure to try to keep fluid from building up in the chest. A doctor makes a small incision in the outside of the chest wall and inserts a hollow tube (called a chest tube). Then, the fluid is drained. The tube is usually left inside the patient’s body for 1 or 2 days to prevent additional fluid build-up.
  • Shunt placement – The shunt is a medical device made up of a long, thin, flexible tube with a small pump in the middle. The shunt is used to move fluid from one part of the body to another. A pleuro-peritoneal shunt allows fluid in the chest to move into the abdomen, where it can be absorbed by the body. Placing a shunt requires an operation in which a doctor inserts one end of the shunt into the chest wall and the other end into the abdomen. Once the shunt is in position, the patient uses the pump several times a day to remove fluid from the chest. This procedure may be performed if pleurodesis or other techniques are not effective.
  • Catheter placement – A catheter is a thin, flexible tube. In a procedure performed in a doctor’s office or a hospital setting, a doctor inserts one end of the catheter into the patient’s chest or abdomen through a small incision in the skin. The other end of the catheter remains outside the body, where it is attached to a special device that collects fluid as it drains.


Radiation is used to slow cancer down or to control symptoms. It is usually used in combination with surgery and chemotherapy. The length of treatment depends on the type, size, and stage of mesothelioma. Radiation is sometimes given after fluid has been drained from around the lung. This procedure is meant to prevent new mesothelioma tumors from developing on the chest wall.


This treatment is given to help control symptoms and to try to slow the cancer down. The chemotherapy process typically involves intravenous delivery of anti-cancer drugs. For pleural mesothelioma, however, chemotherapy may be injected directly into the pleural space around the lungs (intrapleurally). Depending on the type of chemotherapy drugs used, this treatment can be prescribed weekly or every 2 to 3 weeks.

Clinical trials

For some mesothelioma patients, participating in a clinical trial may be an appropriate treatment option. Clinical trials are part of the cancer research process. These studies are designed to find out whether new cancer treatments are safe and effective and possibly better than the existing options. Many of today’s most effective treatments were developed in earlier clinical trials.
For more information about clinical trials for mesothelioma patients, check out these sites:

Stage 4 Mesothelioma

  • Cancer is found in 1 or both sides of the body
  • Tumors may have spread to the lymph nodes
  • Tumors may be present in other parts of the body far from the original site