Mesothelioma is a rare form of cancer caused by asbestos exposure. Stage 4 mesothelioma is the most advanced stage, which means treatment options become limited and survival rates drop significantly. However, the exact types of treatment available and the overall prognosis depend on the individual patient.

At stage 4, the cancer has spread from the original point affected to other parts of the body. Usually, treatment is designed to alleviate symptoms and improve quality of life, rather than being curative in nature. The tumors are generally found in several organs, and often also in the lymph nodes.

Symptoms of Stage 4 Mesothelioma

Stage 4 mesothelioma is often characterized by a number of specific symptoms, including:

  • Severe pain in various parts of the body. This is caused by tumors affecting multiple organs. The most significant pain tends to be found in the lungs and chest (pleural mesothelioma), or the abdomen (peritoneal mesothelioma).
  • Many patients have difficulty swallowing, drinking, and eating and experience nausea and vomiting. This happens if the esophagus and stomach have been affected.
  • Cachexia can also happen, which involves muscle atrophy, weight loss, fatigue, weakness, and loss of appetite.

Other common symptoms include:

  • Night sweats
  • Fever
  • Shortness of breath
  • Pain in the chest wall
  • Fluid retention in the abdomen
  • Tightness in the chest
  • Fatigue
  • Abdominal pain
  • Malaise
  • Anorexia
  • Anemia
  • Thrombocytosis

Treatment of Stage 4 Mesothelioma

Most treatment strategies at this stage are palliative in nature. This means that they are designed to alleviate symptoms, rather than curing the disease. Commonly, surgical treatments are offered to combat fluid buildup on the abdomen and/or lungs, which significant alleviates feelings of pain and discomfort. However, this is a temporary form of treatment and will likely have to be repeated.

While it is possible for someone to be provided with chemotherapy to shrink the tumors, it is more likely that radiotherapy is offered instead, as this is less invasive. At stage 4, patients are often not strong enough anymore to withstand the harshness of chemotherapy.

Surgery is generally no longer an option, as the tumors have spread to multiple areas, which makes it impossible to remove them all. Furthermore, surgery is often too risky for patients, with the toll of the disease being too great to bear. A physician will be able to decide on this.

Effectively, treatment is palliative in nature, designed to increase quality and length of life. Specific forms of treatment include:

  • Surgery, which is rarely offered to remove all tumors. However, less significant surgical procedures can be offered, for instance by only removing the tumors that cause the greatest amount of discomfort and pain.
  • Chemotherapy is commonly used, generally after a PET scan to show where the tumors are now found. Drugs can help to slow the growth of tumors and sometimes even shrink them. While not a cure, it can improve quality of life and extend prognosis.
  • Radiation therapy is not always used on stage 4 patients, although it can be recommended if their overall health is good enough to withstand it. Again, this treatment can help to make the tumors smaller, thereby decreasing pain, lessen chest pressure, and improve breathing.
  • Supportive care is always offered to improve quality of life. This includes oxygen therapy, pain medication, and respiratory therapy. These therapies help to improve the function of the lungs and alleviate symptoms.

As stated, most treatment for stage 4 mesothelioma is palliative in nature. Even aggressive surgery is generally not effective, which means it is unlikely to be offered. Through palliative care, symptoms such as pain can be significantly improved. The most common form of palliative treatment is to remove the buildup of fluid, with the location of the fluid determining which procedure will be performed. As such, they can be offered through thoracentesis (pleural mesothelioma), paracentesis (peritoneal mesothelioma), or pericardiocentesis (pericardial mesothelioma).

These procedures are reasonably easy to perform and withstand. The skin is numbed and a hollow, thin needle is inserted in the place where fluid is building up. A syringe is then attached to the needle, through which the fluid can be removed. This procedure is very beneficial to help lower symptoms, but it is temporary in nature. This is because the fluid will start to build up again.

A possible, more long term solution exists for those with pleural mesothelioma. This procedure, pleurodesis, involves draining the fluid from the chest cavity, while at the same time including bleomycin (a chemotherapy drug), doxycycline (an antibiotic), and/or talc powder. This irritates the lining, which means the area where fluid builds up contracts and seals. In so doing, it may help to prevent future buildup.

Typically, patients will also be provided with chemotherapy if they are strong enough. During chemotherapy, they will generally be provided with pemetrexed and cisplatin, as a 2003 study demonstrated that this combination is the most effective. In fact, when providing cisplatin alone, survival rates were 9.3 months, but when offered in combination with pemetrexed, the survival rate increased to 12.1 months. Additionally, the study showed that 41.3% of those offered the treatment responded positively. When offered only cisplatin, the response rate was just 16.7%. There have been a number of small scale studies looking at other types of drug combinations, but none have been able to achieve results as well as these. That said, a number of other drugs may also be offered, including:

  • Cyclophosphamide
  • Carboplatin
  • Gemcitabine
  • Doxorubicin
  • Methotrexate
  • Mitoxantrone
  • Mitomycin
  • Oxaliplatin
  • Vinorelbine
  • Raltitrexed

Those who have reached stage 4 mesothelioma may also be interested in taking part in clinical trials. While this does not guarantee any more positive outcomes, it may do so. Additionally, they will provide benefits to anyone going through the disease in the future. A number of clinical trials that have been quite successful to date include:

  1. Gemcitabine and cisplatin, followed by mitomycin, methotrexate, and mitoxantrone, leading to a 13 months median survival rate
  2. Raltirexed and cisplatin, leading to an 11.4 months median survival rate
  3. Gemcitabine and cisplatin, leading to a 10 months median survival rate
  4. Oxaliplatin and vinorelbine, leading to an 8.8 months median survival rate

Finally, complementary and alternative treatments may be used. These therapies will not cure the condition, but can greatly improve someone’s quality of life. These therapies include things such as yoga, meditation, proper nutrition, and more.

Prognosis for Stage 4 Mesothelioma

The prognosis for mesothelioma is poor, unfortunately. Treatment, therefore, is directed mainly at increasing quality of life and managing pain. Life expectancy is around six months, although this does vary from one patient to the next. There are many factors affecting prognosis, including pain tolerance and stress levels.

Unfortunately, at stage 4, the cancer still spreads, and often more rapidly as well. This can lead to heart failure or respiratory failure and, ultimately, death. At stage 4, the median survival rate is 12 months, but this can be extended if people respond properly to treatment.

The cancer is classed as heterogeneous, which means it is experienced uniquely by each patient. This is why the survival figures and estimates vary greatly. Some people seem to develop the condition very slowly, and some people also respond incredibly well to treatment. Some of the factors associated with prognosis include the patient’s overall health, the epithelial cell type, gender (women have a longer life expectancy), age (younger people have a better prognosis), and the absence or presence of blood disorders.