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Doctor discussing mesothelioma stages

Mesothelioma is an aggressive form of cancer that develops in the thin layer of tissue (mesothelium) that lines organs. Stages are used to indicate the size of a patient's tumor and extent of the cancer’s growth. This information is important when determining a patient’s mesothelioma treatment plan because certain approaches are most effective for particular stages of the cancer. For instance, surgery may be very effective for patients with early-stage mesothelioma, while chemotherapy may be a more appropriate choice for patients with a later stage of the disease.

Staging pleural mesothelioma

When physicians talk about mesothelioma stages, they are typically referring to pleural mesothelioma, which develops in the lining of the lungs and is the most common form of this cancer (accounting for 80% to 90% of all cases). Unlike other types of mesothelioma, pleural mesothelioma is formally staged according to the American Joint Committee on Cancer TNM system. This staging system evaluates:

  • The size of the primary tumor (T)
  • The number of affected lymph nodes (N), if any
  • If and how far the cancer has metastasized (M), or spread to other areas of the body

Based on these three key characteristics, pleural mesothelioma can be staged as:

Stage 1 mesothelioma

Stage 1 mesothelioma is localized, meaning it hasn’t spread outside the mesothelial lining of the affected lung. Most cases are diagnosed after stage 1.

A person with stage 1 mesothelioma may experience mild symptoms that are similar to a respiratory condition like asthma or a chest cold. Possible signs of early-stage mesothelioma include:

  • Shortness of breath
  • Frequent cough
  • Chest pain or pressure
  • Fever

Stage 1 mesothelioma generally has a positive prognosis. While most cases still aren’t curable, traditional methods such as surgery and chemotherapy can significantly extend a patient’s lifespan and improve their quality of life.

Stage 2 mesothelioma

Stage 2 mesothelioma is locally advanced, meaning that cancer cells have started to spread. The cancer may be located inside a single lung, the diaphragm, or a nearby lymph node, but is still confined to one side of the chest.

A person with stage 2 mesothelioma may experience pressure in their chest due to a buildup of fluid in the lining of the lungs. Weight loss may also occur, in addition to a worsening of stage 1 symptoms.

Treating stage 2 mesothelioma may involve surgically removing the affected lung as well as radiation therapy and chemotherapy to destroy cancer cells. Immunotherapy may be helpful in some cases. Timely treatment can improve a patient’s prognosis and extend their lifespan.

Stage 3 mesothelioma

Stage 3 mesothelioma is regionally advanced, meaning that cancer cells have reached surrounding structures such as the chest cavity and abdomen. By this stage, symptoms are typically noticeable and interfere with everyday life. Chest pain and pressure may worsen, and breathing may become increasingly labored. Many patients are diagnosed with stage 3 mesothelioma.

Surgical treatment aimed at removing as much cancer as possible may be feasible in this stage, but many care plans primarily involve palliative therapies that focus on easing symptoms, improving well-being and prolonging life.

Stage 4 mesothelioma

Stage 4 mesothelioma is metastatic, meaning that it has spread to distant areas of the body. This may include the liver, brain, spine or other bones. It is the most advanced stage. In addition to chest pain and respiratory symptoms, a person with stage 4 mesothelioma may experience:

  • Significant weight loss
  • Night sweats
  • Fatigue
  • Complete loss of appetite

Effective treatment methods are limited for stage 4 mesothelioma, but advancements in chemotherapies and promising clinical trials are helping many patients with advanced-stage mesothelioma stay active and live longer. Supportive care options and alternative therapies—such as pain medication, yoga and chiropractic care—can help ease discomfort for some patients.

Staging less common forms of mesothelioma 

While pleural (lung) mesothelioma makes up the large majority of cases, there are three other forms of this cancer: peritoneal (abdominal) mesothelioma, pericardial (heart) mesothelioma and testicular (testicle) mesothelioma.

Peritoneal mesothelioma may be staged according to the Peritoneal Cancer Index (PCI), which focuses on the size of the primary tumor. For pericardial and testicular mesothelioma—two very rare diseases—no standardized staging system is used. Some physicians and researchers rely on the Surveillance, Epidemiology and End Results (SEER) staging system to classify the spread of these cancers as either localized, regional or distant.

For the best cancer outcomes, choose Moffitt first

At Moffitt Cancer Center’s Mesothelioma Research and Treatment Center, our multispecialty team utilizes advanced diagnostic and staging methods to get a clear picture of each patient’s unique situation. Although staging is just one of the factors that our oncologists consider when creating a treatment plan, assessing the size and extent of a tumor is key to developing an individualized recommendation for each patient’s care. Moffitt’s tailored treatment plans and multispecialty approach—combined with our trailblazing research initiatives and clinical trials—have helped us achieve mesothelioma treatment outcomes that are two and a half times higher than national averages.

If you’ve been diagnosed with mesothelioma, choose Moffitt: Florida’s No. 1 cancer hospital. Our experts routinely provide second opinions and comprehensive treatment to patients with all stages of mesothelioma. To schedule an appointment, contact us by calling 1-888-663-3488 or submit a new patient registration form online. Referrals are not required, and you’ll be connected with a cancer expert in less than 24 hours after contacting us to help ensure timely treatment and the best possible outcome.

References Mesothelioma Stages 
American Cancer Society: Malignant Mesothelioma Stages 
Mesothelioma Group: Mesothelioma Stages