Written By: Devin Golden

Pleural Mesothelioma Stages

The pleural mesothelioma stages are an important part of every pleural mesothelioma diagnosis. Learning the stage of your pleural mesothelioma cancer will give insight into your life expectancy and the recommended treatment options. Mesothelioma Guide’s medical experts advise you to get your stage diagnosed from a mesothelioma specialist, as they have the most experience with this cancer.

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse


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How Many Stages Does Pleural Mesothelioma Have?

Pleural mesothelioma has four stages: stage 1, stage 2, stage 3 and stage 4. Stage 1 is the first stage of the cancer and the least severe in terms of symptoms. Stage 1 also has the best life expectancy and the widest range of treatment options. Stage 4 is the final stage – is the most advanced stage – and has the most challenging symptoms and the fewest options for treatment.

Pleural mesothelioma is a rare cancer that forms in the pleura, which is a narrow lining encapsulating the lungs. However, the cancer quickly and easily spreads beyond the pleura, either to the lungs or the chest wall (or both). So if the cancer is only in the pleura, then it’s likely in stage 1 or stage 2. If it has advanced beyond the pleura, then it’s most likely in stage 3 or stage 4.

The majority of people diagnosed with pleural mesothelioma are in stages 2, 3, and 4. According to studies, stage 3 is the most common stage. Stage 1 is rarely diagnosed because the symptoms aren’t severe or recognizable, and most people don’t visit a doctor until the cancer has progressed.

Pleural Mesothelioma Stage 1

Stage 1 is the first stage of pleural mesothelioma and has the best outlook for survival. If you’re diagnosed in this stage, it means you caught the cancer early and can treat it before it reaches the lungs or any other organs.

Unfortunately, a stage 1 pleural mesothelioma diagnosis is rare. In one study, only 11% of patients were in stage 1.

The average survival in stage 1 is close to two years. Many patients diagnosed in stage 1 have pleurectomy/decortication surgery to remove their pleura, which takes out most or all of the tumors. A successful surgery can lead to patients living for many years despite the cancer.

Pleural mesothelioma in stage 1 is limited to the pleura. Stage 1 is split into 1A and 1B. In 1A, the tumors are just on one tissue layer of the pleura. In 1B, the tumors are on both tissue layers of the lining.

Pleural Mesothelioma Stage 2

Stage 2 of pleural mesothelioma is still considered a “localized” or “regional” cancer. The tumors are beginning to spread beyond the pleura and reach other areas, most notably the chest cavity. They may also begin reaching nearby lymph nodes.

Stage 2 is still a rare diagnosis for pleural mesothelioma. According to one study, around 22% of cases are diagnosed in stage 2. The average survival is around 19 months for patients diagnosed in this stage.

Surgery is still an option for a stage 2 diagnosis. Pleurectomy/decortication spares both lungs while stripping the pleural lining off of the lung. Stripping the lining can address any tumors that may be on the organ’s surface.

In stage 2 of pleural mesothelioma, the cancer has reached:

  • The nearby lung
  • Diaphragm
  • Nearest lymph nodes to the pleura

Pleural Mesothelioma Stage 3

Stage 3 is the most common diagnosis for pleural mesothelioma. It’s a regional disease where tumors have likely spread throughout the nearby lung and even reached the space in between the lungs.

Nearly 50% of pleural mesothelioma cases are diagnosed in stage 3. The life expectancy is on average 14-16 months, which is also the average survival for all mesothelioma cases.

Surgery is an option sometimes for stage 3 pleural mesothelioma. Depending on the cancer center and doctor, patients may be offered a pleurectomy/decortication surgery or extrapleural pneumonectomy surgery.

Pleurectomy/decortication spares the lung, and extrapleural pneumonectomy removes the lung. In stage 3, the tumors may have started to overrun the lung. Many doctors recommend taking out the lung to remove most of the tumors.

Stage 3 of pleural mesothelioma has spread to the:

  • Tissue between the ribs and chest wall
  • Area in between the lungs (mediastinum)
  • Soft tissue in the chest wall
  • Lining of the heart (pericardium)

Pleural Mesothelioma Stage 4

Stage 4 is the last stage of pleural mesothelioma cancer. People in this stage usually receive palliative therapy to increase comfort to maintain quality of life in their final months.

There are not many treatment options aiming for extending the patient’s life in this stage. Most are low doses of chemotherapy or radiation – or a surgery to remove pleural fluid building – with the hope of treating pain and discomfort. The life expectancy for patients in stage 4 is 11 months or less.

According to a study published in the Journal of Thoracic Oncology, around 20% of patients with pleural mesothelioma cancer are diagnosed in stage 4. Most patients are diagnosed earlier.

In stage 4 of pleural mesothelioma, tumors can be found in the:

  • Opposite side of the chest
  • Both lungs
  • Distant organs and the spine
  • Peritoneum (lining of the abdominal cavity)

Symptoms of the Pleural Mesothelioma Stages

Symptoms play a major role in determining the stage of a pleural mesothelioma diagnosis. The pleural mesothelioma stages have different symptoms, ranging from light coughing to difficulty breathing.

Some of the symptoms of pleural mesothelioma in each stage are:

  • Stage 1 – Persistent coughing, loss of appetite, and mild chest pain
  • Stage 2 – Shortness of breath, painful breathing, and fluid buildup in the chest
  • Stage 3 – Difficulty breathing or swallowing, lumps in the chest, and fever
  • Stage 4 – Intense chest pain, chronic fatigue, night sweats and fever, face or arm swelling, and consistent fluid buildup in the chest

Pleural Mesothelioma Staging System

The staging system for pleural mesothelioma is TNM, or “Tumor, Node, Metastasis.” The system measures the size of the tumors, whether tumors have reached lymph nodes, and whether the cancer has metastasized within the chest cavity or even beyond the cavity.

TNM defines each stage as follows:

  • Stage 1 – Small tumors that have not reached the lymph nodes and are restricted to the pleural cavity
  • Stage 2 – Tumors reaching nearby lymph nodes and beginning to spread beyond the pleura
  • Stage 3 – Large tumors, lymph node involvement, and metastasis in the chest cavity (such as tumors in the space between the lungs)
  • Stage 4 – Large tumors, lymph node involvement, and distant metastasis (such as tumors reaching the liver)

Frequently Asked Questions About Pleural Mesothelioma Stages

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What Stage Is Malignant Pleural Mesothelioma?

Malignant pleural mesothelioma can be one of four stages: stage 1, stage 2, stage 3 and stage 4. When the cancer first forms in the pleura, it’s in stage 1. As it worsens, pleural mesothelioma progresses all the way to stage 4.

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How is Pleural Mesothelioma Staged?

Doctors use the TNM (Tumor, Node, Metastasis) Staging System when diagnosing pleural mesothelioma to stage the cancer. This system examines the size of tumors, lymph node involvement, and level of metastasis. For example, stage 1 is characterized by smaller tumors that are just in the pleura. Stage 4 is large tumors and cancer found in distant organs.

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What is the Survival for Each Pleural Mesothelioma Stage?

Pleural mesothelioma survival is on average 1-2 years. The wide range depends on the stage, treatment options used, and patient’s health. For example, stage 1 pleural mesothelioma has an average survival of nearly two years. Stage 4 has an average survival of around 1 year.

Sources & Author

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    3. Mesothelioma: Symptoms and Signs. American Society of Clinical Oncology. Retrieved from: https://www.cancer.net/cancer-types/mesothelioma/symptoms-and-signs. Accessed: 04/10/2020.
    4. Life Expectancy in Pleural and Peritoneal Mesothelioma. Lung Cancer International. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292397/. Accessed: 04/09/2020.
    5. Presentation, initial evaluation, and prognosis of malignant pleural mesothelioma. UpToDate. Retrieved from: https://www.uptodate.com/contents/presentation-initial-evaluation-and-prognosis-of-malignant-pleural-mesothelioma?topicRef=4625&source=see_link. Accessed: 04/13/2020.
    6. Initial Analysis of the International Association For the Study of Lung Cancer Mesothelioma Database. Journal of Thoracic Oncology. Retrieved from: https://www.jto.org/article/S1556-0864(15)33132-4/fulltext. Accessed: 06/12/2020.
    7. Palliative Procedures for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/treating/palliative-procedures.html. Accessed: 05/01/2020.
    8. Malignant Mesothelioma Treatment (Adult). Vanderbilt-Ingram Cancer Center. Retrieved from: https://www.vicc.org/cancer-info/adult-malignant-mesothelioma. Accessed: 11/15/22.
    9. A novel tumor‐node‐metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi‐institutional database. American Cancer Society Journals. Retrieved from: https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.25640. Accessed: 04/14/2020.
Devin Golden

About the Writer, Devin Golden

Devin Golden is a content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.