Stage 4 mesothelioma is the most advanced stage of mesothelioma. The average life expectancy for stage 4 mesothelioma is less than 12 months. Treatment options are limited.
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key points
- Stage 4 mesothelioma indicates that the disease has spread considerably.
- By stage 4, the symptoms of mesothelioma are most severe and often systemic.
- At this stage, patients typically have only palliative treatment options.
- Stage 4 mesothelioma has the worst prognosis, averaging about 12 months.
Because malignant mesothelioma is so difficult to detect early, many patients are not correctly diagnosed until later. Stage 4 mesothelioma is the most advanced form of the disease and indicates that cancer spreads beyond its initial location. At this point, the cancer cells have typically metastasized or spread throughout the chest cavity, to the abdomen and lymph nodes, to distant organs, and in some cases, can travel to the brain.
Due to the severity of the disease, the average life expectancy is about 12 months. Because of the spread, curative surgery and other treatments may not be an option. Most patients will only be able to undergo palliative care to help relieve their symptoms rather than trying to cure the disease itself.
Stage 4 Mesothelioma By Type
For each form of mesothelioma, as the stages progress, patients generally have more limited treatment options and a worse prognosis. For patients with pleural and peritoneal mesothelioma, more studies are emerging focused on finding better treatment options to slow disease progression and improve quality of life.
Stage 4 Pleural Mesothelioma
As the most common form,pleural mesotheliomais the only type with a defined staging system when diagnosing the disease. Doctors can currently rely on three systems when categorizing a patient’s cancer stage. Although each system has slightly different criteria and descriptions for each stage, all three systems generally define stage 4 malignant pleural mesothelioma similarly. The latest mesothelioma facts show that the TNM system is regularly modified.
IASLC Mesothelioma Stage – TNM System
Refers to a disease where one of the following occurs: the tumor is too extensive for surgery, or distant metastases are present. Tumors in patients occurring through the chest wall, ribs, abdominal cavity, heart, trachea, esophagus, chest, spinal cord, brachial plexus, or pericardium can qualify as stage IV disease body Patients with distant metastatic tumors are also classified as having stage IV disease.
The other two systems, the Butchart and Brigham systems, describe stage 4 pleural mesothelioma. According to the Brigham system, this stage of the disease demonstrates the distant spread of mesothelioma cancer throughout the body. Pleural mesothelioma at stage 4 spreads to other organs through the bloodstream.
Stage 4 Peritoneal Mesothelioma
Althoughperitonealdoes not have a formal staging system like pleural mesothelioma, oncologists have developed some methods to describe the severity of the disease better.
Some doctors may rely on the Peritoneal Cancer Index, or PCI, which creates a scoring system through the abdomen based on the number and size of tumors found in a particular region. The body will be divided into 13 sections, and each region will be assigned a number between 0 and 3. The score of each region added together is a patient’s PCI score.
According to the staging system for pleural mesothelioma, 31-39 is a typical score for stage 4 of the disease. Stage 4 peritoneal mesothelioma would likely indicate large, multiple tumors that spread throughout the abdominal cavity, chest wall, and even lymph nodes.
Because pericardial mesothelioma is rare, there is no widely accepted staging system for cancer.
Stage 4 Mesothelioma Giving Symptoms
By this stage, patients will likely have many noticeable and severe symptoms. Mesothelioma symptoms vary depending on the type and location of cancer. In many cases, a mesothelioma treatment plan developed for stage 4 patients will largely focus on helping to relieve these worsening symptoms.
Common symptoms of late-stage mesothelioma
- fever and night sweats
- Chest tightness and pain
- Shortness of breath and difficulty breathing
- Abdominal pain
- Fluid accumulation in the chest or abdomen ( pleural effusion or peritoneal effusion ).
- weight loss
- Difficulty swallowing (dysphagia)
- coughing up blood (hemoptysis)
Stage 4 Mesothelioma Life Expectancy
The average life expectancy for stage 4 mesothelioma is about 12 months with treatment.
Several factors can affect patient survival, including the type of mesothelioma they have, the type of cells in the tumor, and a patient’s age and overall health before diagnosis.
In some cases, stage 4 mesothelioma patients have been able to extend their life expectancy through treatment. However, it is important to remember how difficult it is to treat cancer at this point.
Improving the quality of life is the main focus for most patients. Having a good support system with your loved ones andfinding a support groupcan make dealing with this poor prognosis a little easier.
Treating Stage 4 Mesothelioma
Palliative care is the main focus for most patients with advanced-stage mesothelioma.
Palliative care still involves one or a combination of standard treatments, such as surgery, chemotherapy, and radiation, but with different intentions. Rather than trying to remove or cure cancer, palliative treatment focuses on reducing symptoms, although it can sometimes improve the prognosis of mesothelioma.
Surgery
Although tumors at this stage are usually too extensive for complete resection of the disease, palliative operations may have a role in treatment to alleviate symptoms. Depending on the type of mesothelioma, patients may also have surgery to remove excess fluid. For example, pleural mesothelioma patients typically undergo either pleurodesis or thoracentesis. To aid breathing and relieve pressure from this added fluid in the lungs.
Chemotherapy
Like its therapeutic use, chemotherapy can be applied palliatively to reduce tumor size. Since chemotherapy can be used for a wider area, rather than a focal point, such as with surgery or radiation, it may be a beneficial treatment to reduce symptoms caused by metastases at this stage. In some more recent studies, It has also have found that certain combinations of chemotherapy can help late-stage mesothelioma patients live longer than expected. One study found that the combination of pemetrexed and cisplatin (a standard of care for pleural mesothelioma) with another drug, bevacizumab, could extend the survival of late-stage pleural mesothelioma patients by an average of about 19 months
To Irradiate
In more advanced stages of mesothelioma, radiation therapy is often not even palliative. This is because, at this point, cancer often spreads to the entire abdominal area, and radiation is considered a local treatment. In some cases, this therapy can be applied to help reduce the size of the tumor and relieve some of the pressure in the abdominal region. Radiation has proven beneficial for some patients in reducing pain and improving breathing.
A Clinical Trial To Emerge Treatment
Even though the prognosis is more severe in the late stages of the disease, there is always hope. Although most patients focus on palliative care, there have been few studies around new treatment options for late-stage mesothelioma. Researchers are conducting clinical trials around new types of treatments and new treatment combinations to extend the life expectancy of these patients potentially.
One of these treatments focused on combining surgery with photodynamic therapy, a new treatment that uses light with reactive agents to target and kill cancer cells. All the study participants were diagnosed with stage 3 or stage 4 pleural and underwent surgery before implementing therapy. patient achieved median overall survival of 3 years for 73 of these patients. The median survival was seven years for the 19 patients whose advanced mesothelioma had not yet spread to their lymph nodes.
These surprising results give patients and researchers hope that they can potentially treat mesothelioma in advanced stages. I am confident that continued research into standard and emerging treatments will provide researchers with more opportunities and success in treating late-stage mesothelioma.
End Life Planning
Despite some of the successes in these clinical trials, an unfortunate reality of mesothelioma. is that researchers have yet to find a cure and these later stages are extremely difficult to treat when faced with a malignant disease, e.g., It can be difficult, patients and their loved ones need to plan for what lies ahead.
Medical Decisions
At this advanced level, it may be more comfortable for patients to receive palliative care outside the hospital walls. It is important to consider whether hospice or home care will make this trying time a little more manageable and less stressful. Hospice focuses on palliative care and keeping patients comfortable as they face the final stages of illness. It can be provided through a specialized hospice facility or in the patient’s home.
When seeking specialized home care, those who have treated can suggest facilities or organizations with excellent professional caregivers in hospitals. Whatever you choose, ensure that the patient is comfortable, supported, and with their loved ones.
Patients may also consider implementing a DNR or “do not resuscitate” order. A DNR is a legal agreement that the patient must sign by their doctor and in their hospital file, which ensures that the medical team cannot resuscitate the patient during respiratory or cardiac arrest. Although it is difficult to think about the possibility of fighting for life, a DNR has given many patients peace of mind knowing they will have a natural passing.
Legal Decisions
One of the most important things patients and their loved ones must do when facing advanced mesothelioma is create a will. By executing a last will, patients can ensure that any of their belongings, property, business assets, and financial accounts distributed to their chosen accounts. Without a will, surviving family members would otherwise have to go through a process known as probate to dispose of the estate.
Patients may also find it necessary to hire someone to help them make future decisions as mesothelioma progresses. By appointing a health care power of attorney, this person can make medical decisions that are consistent with the patient’s wishes on behalf of the patient. This can include decisions such as where treatment takes place, what medications are appropriate, and whether or not a patient wants to put on life support. Selecting a power of attorney that understands the patient’s ethics and wishes is important to ensure that the patient receives the care they want.
When going through these difficult decisions and planning for the future, it is important to know thatyou have supportand do not have to face this journey alone. Finding a support group and leaning on friends and family can make this trying time a little easier.