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Stage IV Mesothelioma

In stage IV asbestos cancer, patient medical needs are mainly focused on end-of-life care, which includes pain management and emotional support. Aggressive treatments and invasive surgical procedures are typically not recommended for this end-stage cancer.

Many asbestos cancer patients are diagnosed in stages III and IV because the disease is known to develop slowly and without obvious symptoms. By the time patients are diagnosed with the disease, it is in the late stage. That means the cancer has spread throughout the abdominal cavity, distant lymph nodes and into the bloodstream. Up to 30 percent of patients are diagnosed in stage IV.

Stage IV Cancer

In stage IV asbestos cancer, the tumors have spread from the point of origin in the lungs, heart or abdomen. The most common symptoms for stage IV mesothelioma is pain, shortness of breath and chest and abdominal tightness. Other common symptoms include the following:

  • Night sweats
  • Fever
  • Excess fluid in chest and abdomen
  • Anorexia
  • Malaise
  • Weight loss
  • Fatigue

Doctors use diagnostic testing, such as MRIs and PET scans, to locate the disease. The best prognostic tests include biopsies and surgery to determine the stage.

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Stage IV Staging Systems

All oncologists depend on cancer staging systems, among other things, to determine the best course of treatment. Each of the three popular staging systems allow physicians to determine the best course of treatment:

  • Butchart - Developed in 1976 by Dr. Eric Butchart, this is often considered the most dependable way to measure how much asbestos cancer has spread. For stage IV mesothelioma, the disease has spread to organs and through the bloodstream.
  • TNM - The TNM system describes the cancer by the tumors (T), lymph node involvement (N) and metastasis (M). In stage IV asbestos cancer, the disease has spread into most lymph nodes and organs in the abdominal cavity.
  • Brigham - This staging system was designed specifically for mesothelioma treatment. It is intended to determine if surgery is a viable treatment option and the extent of the lymph-node involvement. In stage IV, the asbestos cancer is considered metastatic.

Common Treatments

In stage IV, cancer treatments are aimed at improving the quality of life and prolonging survival. The typical treatments used during any asbestos-cancer treatment -- surgery, radiation and chemotherapy -- can be used to prolong life or for palliative measures as directed by the patient.

  • Surgery - Some patients can benefit from surgical procedures that will pare down invasive and painful tumors. This can help decrease pain.
  • Chemotherapy - This is often the first line of defense in a stage IV diagnosis. Chemotherapy is known to slow the growth of tumors to extend survival.
  • Radiation - Targeted radiation is sometimes used to slow or stop tumor growth.

Other treatments are commonly used in stage IV:

  • Palliative Care - This includes pain medications, respiratory therapy and other care that will relieve pain and offer comfort.
  • Clinical Trials - Some stage IV patients may qualify for clinical trials that offer new and unique treatments not otherwise offered. These allow late-stage patients the opportunity for life-extending treatment and the chance to provide scientific data for future mesothelioma patients.

Stage 4 Prognosis

Most stage IV patients live six months to a year following a diagnosis. Some treatments and other factors can extend this survival time. These factors include the following:

  • Good overall health
  • Epithelial cell type
  • Younger Age

Every case of mesothelioma responds differently to the disease progression and treatment.


Vanderbilt University Medical Center. Mesothelioma. Retrieved from https://www.mc.vanderbilt.edu/root/vumc.php?site=thoracic&doc=3594

The University of Texas, M.D. Anderson Cancer Center. Staging of Malignant Pleural Mesothelioma: A Guideline for Patients. Retrieved from http://www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-types/mesothelioma/mpm%20staging.pdf