Stage IV Mesothelioma

After a mesothelioma diagnosis, a patient will generally learn about their stage of development from their doctor. Doctors utilize a staging system to indicate the level of progression of a disease.

Doctors often use three main systems when staging malignant mesothelioma. Each system divides mesothelioma into four main stages characterized by a certain size of tumor, level of metastasis, and/or operability. In each system, stage I represents a cancer that has not progressed as far, while stage IV represents a cancer that has greatly developed. The earlier stages generally respond more favorably to treatment.

Stage IV mesothelioma is very advanced. It is characterized by cancerous cells that have metastasized to locations far away from the tumor's point of origin. This may include various locations in the abdomen, organs throughout the abdominal and chest cavities, and the brain. The degree to which stage IV mesothelioma is likely to spread has led to a common moniker: "distant metastatic cancer."

Stage IV in the Butchart System

The Butchart System is the oldest staging system available and is utilized only in cases of pleural mesothelioma. Under the Butchart System, the main criterion for categorization is the size of the primary tumor. Stage IV in this system is used to refer to a case in which the mesothelioma has metastasized (spread) widely. Cancerous cells have likely spread via the blood stream and can be found in a variety of organs and tissues that are far away from the tumor's original location.

Stage IV in the TNM System

The TNM System (Tumor, Lymph Nodes, and Metastasis) is occasionally used for malignant mesothelioma. Under the TNM System, malignant mesothelioma is categorized according to the size of the tumor, the level of metastasis, and the degree of lymph node involvement. The TNM System is typically used in cases of pleural mesothelioma, but it can also be useful in staging peritoneal mesothelioma.

Under the TMN System, stage IV indicates a cancer that may be found on one or both sides of the body. The key factor, however, is that the cancer has likely spread to other organs beyond the initial site. The neck and lymph nodes are almost certainly involved.

Stage IV in the Brigham System

The most recent staging system developed for use with mesothelioma is the Brigham System. This system also uses four stages, but its variables include the extent to which lymph nodes are or are not involved and the likelihood that a given tumor can be surgically removed. For patients with mesothelioma, the Brigham System has limited utility due to the fact that many mesothelioma cases are inoperable.

Under the Brigham System, stage IV refers to a scenario in which the mesothelioma is entirely inoperable. Tumors may be too large to remove surgically, or the cancer may have penetrated vital organs so deeply that surgery is in no way useful. The Brigham System's stage IV also generally includes an indication that the cancer has metastasized to a point that cancerous cells are located all over the body, leading to likely recurrence even after removal of the primary tumor.

Stage IV Mesothelioma Diagnosis and Treatment

To diagnose mesothelioma, most patients will undergo the same series of diagnostic tests. The first step is generally an imaging test, such as an x-ray, MRI scan, CT scan, or PET scan. This test allows physicians to get a visual picture a disease inside the body. Medical professionals use these images to look for any abnormal areas and identify where cancer might be present. Imaging tests are then followed by biopsies of various tissues to chemically determine if the cells are cancerous. Because stage IV mesothelioma has spread beyond the point of origin, the diagnosis process will likely involve biopsies from more than one area of the body.

Stage IV sesothelioma is very serious and unfortunately generally comes with a poor prognosis. As explained above, surgery (generally the first-line defense for a mesothelioma patient) is typically not an option due to the extent of the cancer's involvement throughout the body. The general health of the patient also often rules out the possibility of surgery since, in many cases, a stage IV mesothelioma patient is not strong enough to withstand surgery or other aggressive treatment.

For these reasons, treatments available for stage IV mesothelioma are generally palliative. Palliative treatments are designed to ease symptoms and improve quality of life - not to cure or attempt to cure. Common options include chemotherapy or radiation therapy designed to shrink tumors (which can take pressure off vital organs and improve the patient's comfort) or thoracentesis or paracentesis to remove built-up fluid from the patient's lungs or abdomen. offers a complimentary comprehensive packet on mesothelioma and treatment options to patients and their loved ones who fill out the request form on this page. Patients with stage IV mesothelioma may desire this additional information to aid in learning about new and innovative treatment options tested through clinical trials.

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