Written By: Devin Golden
Stage 2 Mesothelioma
Stage 2 mesothelioma is a local stage of mesothelioma in which tumors have started spreading beyond the original diseased area. Despite the progression, treatments such as surgery are still viable options for many patients.
Medically Reviewed By
Dr. Stephen Williams
Precision Oncology Scientist
Medically Reviewed By
Dr. Stephen Williams
Precision Oncology Scientist
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Important Facts About Stage 2 Mesothelioma
- During stage 2 mesothelioma tumors have begun to extend beyond the mesothelial lining into nearby tissues, organs, or lymph nodes.
- Symptoms become more pronounced, often including chest pain, shortness of breath, persistent cough, and fatigue.
- Survival slightly worsens compared to stage 1, but patients are still eligible for most treatment options.
Overview of Stage 2 Mesothelioma
Stage 2 mesothelioma is a local form of cancer where tumors have started to spread beyond their initial point of origin.
In pleural mesothelioma, the tumors primarily affect the pleura (the lining of the lungs) but may extend to nearby structures such as the diaphragm or lung tissue. In peritoneal mesothelioma, the cancer remains within the abdominal lining (peritoneum) but may start affecting nearby organs.
Key Characteristics of Stage 2 Mesothelioma
- Tumor Spread – The cancer extends beyond the pleura (for pleural mesothelioma) or peritoneum (for peritoneal mesothelioma), potentially reaching nearby organs.
- Lymph Node Involvement – Mesothelioma may have begun spreading to nearby lymph nodes.
- Noticeable Symptoms – Patients may start experiencing more distinct mesothelioma symptoms, such as chest or abdominal pain, shortness of breath, persistent cough, fatigue, and unexplained weight loss.
- Tumor Growth – The tumors are increasing in size, making early intervention crucial for better treatment outcomes.
- Despite the progression, aggressive treatment options such as surgery, chemotherapy, immunotherapy and radiation remain viable options, offering hope for extended survival and improved quality of life.
What Symptoms to Expect With Stage 2 Mesothelioma
People in any stage of mesothelioma should be aware of the most common mesothelioma symptoms. While in stage 1 mesothelioma symptoms may be mild or unnoticeable, mesothelioma stage 2 symptoms are more detectable and bothersome.
Patients may experience:
- Painful breathing – Discomfort or sharp pain while inhaling
- Coughing – A dry or painful cough
- Shortness of breath – Difficulty breathing due to tumors pressing against the lungs
- Unexplained weight loss – Sudden weight loss due to the body’s response to cancer
- Fluid buildup – Excess fluid in the pleural cavity or abdominal cavity
- Lumps in the chest or abdomen – Tumor growth may result in noticeable lumps
If you notice these symptoms, consult with your primary physician immediately. Early detection of mesothelioma increases your chances of survival.
Stage 2 Mesothelioma Treatment Options
During stage 2 mesothelioma, the cancer remains localized enough that patients still have access to most mesothelioma treatment options.
Since the cancer has not yet spread to distant organs, aggressive treatments like surgery can still be highly effective in removing tumors and improving long-term survival.
Other treatment options for stage 2 mesothelioma are chemotherapy, immunotherapy and radiation. Doctors often use these therapy methods in collaboration with surgery.
Surgery
Surgery is a viable treatment option for removing tumors while preserving organ function. Depending on the type of mesothelioma, surgical procedures may include:
- Pleurectomy with Decortication (P/D) – Removes the pleura while sparing the lung (may also remove parts of the diaphragm and the lining around the heart)
- Extrapleural Pneumonectomy (EPP) – A more radical approach that removes the entire affected lung, the pleura and parts of the diaphragm
- Cytoreductive Surgery (CRS) with HIPEC – Used for peritoneal mesothelioma, this procedure removes tumors from the abdominal cavity, followed by heated chemotherapy delivered into the abdomen. Injection of HIPEC (heated intraperitoneal chemotherapy) directly into the abdominal cavity focuses on attacking any diseased cells left after surgery while minimizing the damage to healthy cells.
Chemotherapy, Immunotherapy and Radiation
An aggressive treatment plan for stage 2 mesothelioma often involves more than just surgery. Specialists rely on chemotherapy, immunotherapy and radiation to shrink tumors, kill cancer cells, and improve quality of life.
Mesothelioma develops as microscopic tumors that duplicate at an accelerated rate. Therefore, the ability to fully remove the cancer is challenging, even for experienced mesothelioma surgeons. This is why mesothelioma recurrence occurs frequently.
To prevent recurrence, mesothelioma specialists use chemotherapy, immunotherapy and radiation to shrink the disease before surgery (neoadjuvant therapy). They also can use these therapies to attack remaining cancer cells still in the patient’s body after surgery (adjuvant therapy).
Prognosis
People diagnosed with stage 2 disease usually have a promising mesothelioma prognosis. They can have an aggressive treatment plan and address the cancer before it spreads significantly.
There are numerous sources reporting hopeful data:
- According to a study published on UpToDate, patients with stage 2 pleural mesothelioma live for an average of 19 months following their diagnosis.
- A few studies report 2-year survival rates between 35% and 40% for stage 2 pleural mesothelioma.
- The American Cancer Society reported that 53% of peritoneal mesothelioma patients who received cytoreduction surgery with HIPEC survived for at least 5 years.
Diagnosing stage 2 mesothelioma is still rare. A study published in the Journal of Thoracic Oncology showed that only 21% of pleural mesothelioma patients were diagnosed in stage 2. An earlier diagnosis usually results in more treatment options and longer life.
Mesothelioma specialists prefer P/D surgery for stage 2 pleural mesothelioma because it spares the lung. In a study published by the Annals of Translational Medicine:
- Mesothelioma patients survived an average of 23 months following P/D surgery
- Patients survived approximately 18 months following EPP surgery.
A study published in the Journal of Thoracic Disease showed the benefits of radiation after surgery:
- Approximately 70% of stage 1 and stage 2 pleural mesothelioma patients lived for 2 years after receiving surgery and radiation.
- This percentage was much higher than the 35% 2-year survival rate for patients who only underwent surgery.
The best way to increase your survival is by receiving high-quality treatment from a mesothelioma specialist. Doctors with specialized mesothelioma training and experience in performing mesothelioma surgeries can improve the outcomes for stage 2 patients. This free Find a Doctor program can help you connect with a nearby specialist who can perform these therapies.
Stage 2 by Different Staging Systems
TNM System
The TNM System (Tumor, Nodes, and Metastasis) is the most common staging system for pleural mesothelioma. This system defines stage 2 pleural mesothelioma as spreading to the lung tissue, diaphragm, lymph nodes and chest wall.
Butchart System
The Butchart System, developed in 1976, is the original staging method for pleural mesothelioma. This system divides mesothelioma into four stages (1-4) based on how far the cancer has spread within the pleura and to other organs. For stage 2 pleural mesothelioma, tumors may have progressed into the lung tissue, chest wall, diaphragm and possibly the lining of the heart.
Brigham System
The Brigham Staging System was developed at Brigham and Women’s Hospital in Boston, Massachusetts. It focuses on whether surgery is a viable treatment option for pleural mesothelioma. Doctors explicitly look for lymph node involvement.
Peritoneal Cancer Index
The Peritoneal Cancer Index (PCI) is the primary staging system for peritoneal mesothelioma. Doctors divide the abdominal cavity into 13 sections and examine the extent of the disease within the different sections, assigning a score between 0 and 3 for each section. Stage 2 peritoneal mesothelioma will have a total score of 11-20. At this stage, the cancer is still centralized and can often be treated with cytoreduction and HIPEC (heated intraperitoneal chemotherapy).
Frequenlty Asked Questions About Stage 2 Mesothelioma
What defines stage 2 mesothelioma?
Stage 2 mesothelioma involves tumors spreading beyond the point of origin. For pleural mesothelioma, the cancer has spread into lung tissue, nearby lymph nodes, the chest wall and the diaphragm. For peritoneal mesothelioma, the cancer has a PCI score of 11-20, meaning it has spread to multiple sections of the abdominal cavity and is possibly affecting some of the abdominal organs.
What are the symptoms of stage 2 mesothelioma?
The stage 2 mesothelioma symptoms are usually more severe than stage 1. Signs like chest or abdominal pain may get worse, along with more fluid buildup and a higher-grade fever. Persistent coughing, shortness of breath, weight loss and decreased appetite are common stage 2 symptoms.
Is stage 2 mesothelioma curable?
Unfortunately, there is no cure for stage 2 mesothelioma. However, people diagnosed in this stage often survive for multiple years. The average life expectancy for stage 2 mesothelioma is 19 months, and surgery can improve survival by 2-3 years.
How often do people have stage 2 mesothelioma?
A diagnosis of mesothelioma in stage 2 is quite common. In one study, an estimated 40% of patients were diagnosed in this stage. Symptoms are significant enough for patients to seek medical care and for doctors to identify the presence of cancer.
How is stage 2 mesothelioma treated?
Surgery is still beneficial for most people with stage 2 mesothelioma. A lung-sparing procedure, pleurectomy with decortication (P/D), is the preferred surgery for many mesothelioma specialists. Other treatment options include chemotherapy, immunotherapy and radiation, which can be used before and/or after surgery.
Sources & Author
- Mesothelioma. National Organization for Rare Disorders. Retrieved from: https://rarediseases.org/rare-diseases/mesothelioma/. Accessed: 04/09/2020.
- 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.
- Mesothelioma: Symptoms and Signs. American Society of Clinical Oncology. Retrieved from: https://www.cancer.org/cancer/types/malignant-mesothelioma/detection-diagnosis-staging/signs-symptoms.html. Accessed: 04/10/2020.
- 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.
- 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.
- 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.
- 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.
- Extrapleural pneumonectomy (EPP) vs. pleurectomy decortication (P/D). Annals of Translational Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497106/table/t5/. Accessed: 04/14/2020.
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- Malignant Mesothelioma Treatment (Adult). Vanderbilt-Ingram Cancer Center. Retrieved from: https://www.vicc.org/cancer-info/adult-malignant-mesothelioma. Accessed: 11/15/22.
- Defining the role of adjuvant radiotherapy for malignant pleural mesothelioma: a propensity-matched landmark analysis of the National Cancer Database. Journal of Thoracic Disease. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531726/. Accessed: 04/15/2020.
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- Gill RR, Nowak AK, Giroux DJ, et al. The International Association for the Study of Lung Cancer Mesothelioma Staging Project: Proposals for Revisions of the “T” Descriptors in the Forthcoming Ninth Edition of the TNM Classification for Pleural Mesothelioma. J Thorac Oncol. 2024;19(9):1310-1325. doi:10.1016/j.jtho.2024.03.007
