Mesothelioma is a terrible cancer of the linings of the major organs, especially the lungs, heart and various organs in the abdomen. The final near death stages of mesothelioma are painful and life expectancy is short. The cancer is likely to continue to spread and it can lead to heart or respiratory failure if the tumors get into the heart. The median rate of survival for stage 4 mesothelioma is approximately 12 months with treatment and much less without. (cancer.org).
Stage 4 is the final near death stage of this deadline cancer. By stage 4, pleural mesothelioma cancer is spreading into the wall of the chest, bones, heart lining, and into the abdomen, liver and lymph nodes. This stage of the cancer is nearly always terminal. Stage 4 mesothelioma may also be expressed with roman numerals – Stage IV.
Stage 4 mesothelioma is the most difficult to treat; cancer has spread so much around the body that few treatments can get rid of all tumors. Many patients at this point are too weak to take aggressive therapies.
While the final near-death stages of mesothelioma are thought to be terminal, there have been advancements in palliative care that can help the patient to live longer and maintain a higher quality of life. Some patients in stage 4 of the disease have defied all odds and have lived for years since their diagnosis.
The outlook for the stage IV patient will depend upon how much the tumors have spread, how large they are, and how well the patient responds to treatments.
Stage 4 Mesothelioma Symptoms
At stage 4, which is the final near death stage of mesothelioma, the typical symptoms of mesothelioma have grown more severe. Because the tumors have spread outside the lungs, the symptoms are not just isolated to the chest.
Some of the common symptoms of stage 4 mesothelioma include the following:
- Extreme shortness of breath
- Abdominal pain
- Pain and tightness in the chest
- Night sweats and fever
- Hard to swallow – dysphagia
- Coughing up blood
- Fluid buildup in abdomen or chest
- Severe loss of weight
- Feeling of malaise
Some stage 4 patients also suffer from cachexia. This is a syndrome that involves loss of weight, atrophy in the muscles, appetite loss and weakness. This stage of the cancer also could cause blood problems, including a high platelet count and low red blood cell count.
Late Mesothelioma Stages By Type
Stage 4 normally is referred to as the form of the disease called pleural mesothelioma, which is the most common type of the disease. There is no exact stage 4 for peritoneal mesothelioma, which is the disease as it is referred to in the abdomen. This type of the disease accounts for 20% of all mesothelioma cases. Doctors generally accept that patients with peritoneal mesothelioma with large numbers of tumors spreading are classified as in stage 4 of the disease.
By stage 4 of peritoneal mesothelioma, cancer has spread outside the peritoneum. This is the name of the lining that protects the abdomen where cancer first develops. As with pleural mesothelioma, surgery is not usually an option for this phase. One of the possible treatment options for this form of the disease at stage 4 is heated intraperitoneal chemotherapy or HIPEC. This is a quite promising treatment that combines heated chemotherapy drugs and surgery.
Pericardial mesothelioma is a very rare form of cancer that develops in the lining surrounding the heart. It is usually diagnosed in the late stages of cancer, but it may not actually be defined as stage 4.
Mesothelioma Stage 4 Treatment Options
There is no curative treatment for any stage of mesothelioma, but any treatment options that are intended to extend survival at stage 4 are very limited. Extensive surgeries to remove tumors, such as pleurectomy/decortication or extrapleural pneumonectomy are not usually a possibility. Palliative treatments, such as radiation and chemotherapy, can reduce the rate of tumor growth and decrease the size of the tumors.
The spread of the tumors is usually too severe in stage 4 for doctors to get rid of all the growths, but some patients can receive benefits from less extensive surgeries. Surgeons can try to remove as much of the tumor mass as possible. They also can try to target the most problematic tumors so the patient is able to breathe better and have less pain.
Some of the less invasive surgeries for stage 4 mesothelioma and other stages are:
- Thoracentesis: Drains the fluid from the chest cavity
- Paracentesis: Removes fluid from the abdomen
- Pericardiocentesis: Drains fluid from the heart region
- Pleurodesis: Long term option to get fluid out of the chest
This is one of the most common options of treatment for stage IV mesothelioma. Drugs in chemotherapy reduce tumor growth and can reduce tumors in some situations. This helps to reduce symptoms and to improve survival times. For example, Wayne State University researchers determined that chemotherapy doubles life expectancy for people with mesothelioma, including people in stage 4. Combining chemotherapy with various types of surgery extended survival by several months.
The most common type of chemotherapy for stage 4 mesothelioma is carboplatin with pemetrexed or cisplatin.
Doctors may not treat stage 4 mesothelioma with radiation. They could recommend this treatment depending upon the size of the tumor and your overall health. Radiation therapy at stage 4 could reduce the size of the tumors. This can reduce chest pressure, reduce pain and make it easier to breathe.
Immunotherapy and Clinical Trials
Some stage IV mesothelioma patients could qualify for clinical trials. Some of these trials will look at several treatment options for people in the later stages of mesothelioma. In some of these cases, experimental treatments can help stage 4 patient to survive past their prognosis by months or years. Some of these treatments include immunotherapy, gene therapy, and some new and emerging therapies.
A study that was published in The Annals of Thoracic Surgery showed that photodynamic therapy could boost late-stage mesothelioma survival. (annalsthoracicsurgery.org). Some patients with pleural mesothelioma who had no form of cancer in their lymph nodes lived approximately 7.3 years compared to the typical one-year life expectancy.
Life Expectancy Without Treatment Options
How long you can live with mesothelioma without any treatment depends upon several things. For example, how advanced the cancer stage is, and how fast the tumors grow. Patients who have been diagnosed with stage 1A who will not get treatment live for about two years. Those who have stage 4 and decline treatment live about six months.
Researchers have developed ways to determine how fast tumors will grow; this is called tumor grading. It looks inside the cells of cancer for various abnormalities and counts how quickly the cells are dividing. These factors are closely related to survival.
Tumor Grades and Survival
- Grade 1 survival is approximately 28 months
- Grade 2 survival is approximately 14 months
- Grade 3 survival is approximately 5 months
Life Expectancy and Prognosis
By stage 4 of cancer, the disease usually spreads all over the body and can lead to respiratory and heart failure. As noted earlier, you can expect to live 12 months with this form of the disease if you get treatment.
If your body responds well to treatment, you can improve survival. Patients who have a good prognosis may live longer than the average person. Some of the factors that can improve survival include the type of epithelioid cell type, being in good health, being younger, female, and having no blood disorders.
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- Photodynamic Therapy in Thoracic Surgery. (2002). Retrieved from https://www.annalsthoracicsurgery.org/article/S0003-4975(01)03369-0/fulltext
- Detection and Diagnosis of Malignant Mesothelioma. (n.d.). Retrieved https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/staging.html
- Does Mesothelioma Cancer Cause a Cough? (2019). Retrieved from https://www.mesolawsuitafterdeath.com/mesothelioma/does-mesothelioma-cancer-cause-a-cough/