Written By: Devin Golden

Stage 3 Mesothelioma

Stage 3 mesothelioma is an advanced stage, which means the cancer has spread to the lymph nodes, nearby tissue and organs. Treatment options vary for each type of mesothelioma and each individual case.

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse


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Important Facts About Stage 3 Mesothelioma

  • Stage 3 malignant mesothelioma is considered an advanced stage of cancer because it has spread beyond the mesothelial lining (lining of the lungs or abdomen) and reached organs.
  • Symptoms become more severe and new ones emerge as fluid builds up in the chest or stomach and tumors spread.
  • The average life expectancy for stage 3 mesothelioma is a little more than one year.
  • Treatment plans for stage 3 patients vary, and some patients may not be candidates for surgery.

What Is Stage 3 Mesothelioma?

Stage 3 mesothelioma is considered advanced since the cancer has spread past the original site. This means the cancer has spread outside of the pleura (lining of the lungs) or peritoneum (lining around the abdomen), and local metastasis has started.

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stage 3 mesothelioma

Some characteristics of stage 3 mesothelioma include:

Stage 3 mesothelioma is considered advanced since the cancer is not confined to the point of origin. Local metastasis has started, but the cancer has not yet spread to the other side of the body.

Similar to stage 1 mesothelioma, stage 3 is split into 3A and 3B. The TNM system differentiates the two by how far the cancer has spread. While still considered localized metastasis, stage 3B is often more challenging to treat with surgery.

Stage 3B pleural mesothelioma involves tumors reaching one of the following:

  • The spine
  • Deep into the chest wall
  • The peritoneum
  • The mediastinum (area containing the heart, esophagus and trachea)

Common Symptoms of Stage 3 Mesothelioma

As the stages progress, symptoms of mesothelioma become more noticeable. Patients diagnosed with stage 3 mesothelioma should be prepared for discomfort. Additionally, some early-stage symptoms may persist in this stage.

If you haven’t received a mesothelioma diagnosis and experience many of the above symptoms, speak to your doctor immediately. You can undergo effective treatments for pain relief and may be eligible for surgery.

The stage 3 mesothelioma symptoms include:

  • Difficulty breathing or swallowing
  • Dry cough
  • Shortness of breath
  • Lumps and fluid buildup in the chest or abdomen
  • Persistent pain in the chest or ribs
  • Fever
  • Low appetite and weight loss
  • Coughing up blood (hemoptysis)

If you haven’t received a mesothelioma diagnosis and experience many of the above symptoms, speak to your doctor immediately. You can undergo effective treatments for pain relief and may be eligible for surgery.

Stage 3 Mesothelioma Treatment Options

Of all the mesothelioma stages, stage 3 probably involves the most debate regarding treatment options. Some doctors believe chemotherapy and radiation should be the primary treatment methods as they believe the cancer has spread too far to use a surgical approach. Other doctors support surgery for stage 3 mesothelioma. Due to the advanced stage of mesothelioma, treatment options for patients may be limited.

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Pleural Mesothelioma Surgery

In some cases, pleural mesothelioma surgery is an effective treatment for stage 3 mesothelioma. The primary surgeries for malignant pleural mesothelioma are extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D).

EPP is an aggressive surgery that removes the:

  • Pleura
  • Pericardium (lining around your heart)
  • Diaphragm
  • Affected lymph nodes
  • Affected lung

P/D is far less aggressive. It removes the pleura, which is where the cancer originates, and does not remove the lung.

Some doctors use a more aggressive version of P/D (called “extended P/D”). This surgery removes part or all of the diaphragm and pericardium. Many elderly patients cannot endure the removal of a lung, which eliminates EPP as an option. If combined with radiation and chemotherapy, extended P/D can help survival.

Dr. Raja Flores is the director of thoracic surgical oncology at Mount Sinai Medical Center in New York. He explained why more surgeons prefer P/D rather than EPP for stage 3 mesothelioma.

“The ‘pleurectomy’ part takes out the parietal pleura wall, which is the side against your chest,” Dr. Flores said. “‘Decortication’ is removing the visceral pleura wall, which is next to your lungs. Taking out that visceral pleura should remove many of the tumors off of the lung.”

If there are any remaining tumors on the lung or elsewhere in the thorax, Dr. Flores said patients usually undergo radiation.

Peritoneal Mesothelioma Surgery

Patients with stage 3 peritoneal mesothelioma can undergo cytoreduction with heated intraperitoneal chemotherapy (HIPEC). This operation involves “debulking,” which is the medical term for removing as many tumors as possible.

HIPEC is a warm liquid chemotherapy treatment delivered directly into the abdomen, which is used to kill any remaining microscopic cancer cells.

Chemotherapy, Radiation and Palliative Surgery Icon

Chemotherapy, Radiation and Palliative Surgery

Chemotherapy and radiation are effective treatment options available for patients with stage 3 mesothelioma. These therapies are typically used along with surgery or to relieve pain. Both therapies can reduce the size of tumors before surgery, which makes an operation more effective. Chemotherapy and radiation also can eliminate recurrence after surgery.

If surgery isn’t an option, then doctors often recommend chemotherapy and radiation. They slow the growth of tumors and decrease pain caused by tumors pressing against the chest.

Another option is immunotherapy, specifically Opdivo and Yervoy (FDA-approved in 2020). These two drugs outperform chemotherapy for non-surgery mesothelioma cases.

Stage 3 patients may also undergo palliative surgery, which relieves pain by decreasing fluid buildup. Pain-relief surgeries for stage 3 mesothelioma include:

  • Pleurodesis (pleural mesothelioma) – Closes the pleural cavity and stops the buildup of fluid
  • Thoracentesis (pleural mesothelioma) – Uses a needle to drain fluid from the pleural cavity
  • Paracentesis (peritoneal mesothelioma) – Uses a needle to drain fluid from the peritoneal cavity
  • Pericardiocentesis (pericardial mesothelioma) – Uses a needle to drain fluid from the pericardium, which is the protective sac around your heart

Stage 3 Mesothelioma Life Expectancy

A stage 3 mesothelioma patient’s mesothelioma life expectancy depends on various factors, notably whether you’re a candidate for surgery. The average survival time for stage 3 pleural mesothelioma patients is between 14 and 16 months, according to multiple studies.

Stage 3 is the most common mesothelioma diagnosis, especially for pleural mesothelioma. According to a study published in the Journal of Thoracic Oncology, nearly 50% of diagnoses were stage 3.

Stage 3 pleural mesothelioma patients see significant survival benefits from surgery. According to the same study:

  • Around 40% of stage 3 patients undergoing P/D survived for at least two years
  • Patients also had a median survival time of 19 months

Peritoneal mesothelioma doesn’t follow the same staging system as pleural mesothelioma, but some doctors and researchers can correlate a patient’s diagnosis to one of the four stages.

Surgery has increased the survival time for many patients. According to a study published by the American Cancer Society:

  • Around 53% survived for five years after cytoreduction with HIPEC
  • Patients also had a median survival time of 67 months

Numerous studies compare EPP and P/D for stage 3. In one study, around 37% of patients who had an extended P/D survived for at least three years. By comparison, around 23% of EPP patients survived that long.

Clinical trials offer increased hope for stage 3 patients. These studies provide you access to treatment options not yet available at most hospitals. These include:

  • New chemotherapy drugs
  • Immunotherapy
  • Gene therapy
  • Oncolytic virus therapy

We can help you learn if you’re eligible for any clinical trials. We also can help you find a doctor who specializes in surgery for stage 3 mesothelioma. Use our free Doctor Match resource to get started.

How to Improve Your Stage 3 Mesothelioma Prognosis

There are many ways to improve your stage 3 prognosis. Some of the factors affecting a patient’s prognosis are within their control. A mesothelioma patient should always seek a second opinion with a mesothelioma specialist to learn more about their diagnosis and possibly improve their treatment plan, which could result in extended survival.

One of the most effective ways a patient can extend life expectancy is by maintaining their personal health or focusing on ways to improve quality of life.

Quality of life is a broad term for a patient’s mental, physical, emotional and spiritual well-being. The patient’s quality of life can play a role in how well the body responds to treatment. Maintaining good health throughout your mesothelioma journey can improve the effects of treatment.

Stage 3 by Different Staging Systems

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TNM System

The TNM System is the most popular staging system for pleural mesothelioma. It classifies the status of the tumor, nodes, and metastasis of the cancer.

In stage 3, the mesothelioma has now spread to organs. Tumors are all on the same side of the body. However, cancer cells may also be found in the lymph nodes.

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Butchart System

The Butchart System is the oldest of the three staging systems for pleural mesothelioma. It focuses on the size of the tumors and where the disease has spread. This system classifies stage 3 as tumors reaching the abdominal cavity and distant lymph nodes.

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Brigham System

The Brigham System was created by Dr. David Sugarbaker for staging pleural mesothelioma. It focuses on whether patients can undergo surgery to resect most or all of the disease.

Doctors who followed the Brigham System often used radiation and chemotherapy before surgery to slow the growth or kill tumors. Doing so can make surgery an option.

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Peritoneal Cancer Index

The peritoneal cancer index (PCI) measures how far peritoneal mesothelioma has spread in the abdominal cavity. This index is the primary staging system for peritoneal mesothelioma.

Doctors assign a score between 0 and 3 to each of the 13 sections of the abdominal cavity. They add up the scores for a total PCI number. Patients with a PCI between 21 and 30 correlate to stage 3. Cytoreduction with HIPEC is still an option for these cases.

Frequently Asked Questions About Stage 3 Mesothelioma

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What are the characteristics of stage 3 mesothelioma?

Stage 3 mesothelioma is considered an advanced disease. For pleural mesothelioma, stage 3 means it has spread to lymph nodes, the diaphragm and the tissue between the lungs. For peritoneal mesothelioma, it has a PCI score of 21-30, meaning it’s in most of the abdominal cavity sections.

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What are the symptoms of stage 3 mesothelioma?

The symptoms in stage 3 mesothelioma become more severe than earlier stages. Fever gets worse, as does pain in either the chest or stomach. Night sweats, bowel issues, anemia, coughing up blood and face or arm swelling are all potential symptoms of this stage.

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What is the survival rate of stage 3 mesothelioma?

Stage 3 mesothelioma has a survival rate of around 16 months. Most patients live for at least one year. There are survival stories of people with stage 3 mesothelioma living well past their prognosis with multimodal treatment.

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How often do people have stage 3 mesothelioma?

Stage 3 mesothelioma is diagnosed in 35% of all cases, making it a common stage for this cancer. Early detection is difficult, which is why mesothelioma is diagnosed in later stages.

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How is stage 3 mesothelioma treated?

Surgery is still possible for people with stage 3 mesothelioma who are able to endure aggressive surgery. Other treatment options include chemotherapy, radiation, tumor treating fields, and immunotherapy.

Sources & Author

  1. Malignant Mesothelioma Treatment (Adult). Vanderbilt-Ingram Cancer Center. Retrieved from: https://www.vicc.org/cancer-info/adult-malignant-mesothelioma. Accessed: 11/15/22.
  2. Mesothelioma. National Organization for Rare Disorders. Retrieved from: https://rarediseases.org/rare-diseases/mesothelioma/. Accessed: 04/09/2020.
  3. Signs and Symptoms of Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/signs-symptoms.html. Accessed: 04/10/2020.
  4. 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.
  5. Types of surgery for pleural mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/treating/surgery.html. Accessed: 04/23/2020.
  6. 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: 04/14/2020.
  7. Malignant pleural mesothelioma: key determinants in tailoring the right treatment for the right patient. Journal of Thoracic Disease. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394047/. Accessed: 04/24/2020.
  8. 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: 04/14/2020.
  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.
  10. Peritoneal Cancer Index. ResearchGate. Retrieved from: https://www.researchgate.net/figure/Peritoneal-Cancer-Index-PCI-scoring-system-PCI-is-a-diagnostic-and-prognostic-tool_fig1_315691686. Accessed: 04/12/2020.
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.