Chat with us, powered by LiveChat Stage 2 Mesothelioma — How to Treat This Diagnosis

Written By: David Statman

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.

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Medically reviewed for accuracy 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.

Progression of Stage 2 Mesothelioma


Diagram illustrating stage 2 pleural mesothelioma, highlighting the pleura between the lung and chest wall.

Diagram illustrating Stage 2 peritoneal mesothelioma affecting the peritoneum and a small part of the abdomen
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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.

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In peritoneal mesothelioma, the cancer remains within the abdominal lining (peritoneum) but may start affecting nearby organs.

Key Characteristics of Stage 2 Mesothelioma

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Tumor Spread – The cancer extends beyond the pleura (for pleural mesothelioma) or peritoneum (for peritoneal mesothelioma), potentially reaching nearby organs.

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Lymph Node Involvement – Mesothelioma may have begun spreading to nearby lymph nodes.

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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.

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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.

Diagnosing Stage 2 Mesothelioma

Diagnosing stage 2 mesothelioma can be challenging, as the cancer’s signs and symptoms are often still subtle and similar to more common diagnoses like a cold or pneumonia. Stage 2 mesothelioma is diagnosed through a combination of imaging tests and a tissue biopsy.

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.

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Diagnostic Imaging

Mesothelioma imaging tests help doctors see the tumors’ location and size in the patient’s body. This is crucial to diagnosing the cancer by stage and determining a treatment plan.

Imaging tests to diagnose stage 2 mesothelioma include:

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X-rays

Chest X-rays are often the first imaging tool used to detect abnormalities, such as fluid buildup in the pleural space (pleural effusion), which may indicate mesothelioma.

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CT scans

Computed Tomography (CT) scans provide more detailed images and can help identify the size, location, and extent of the tumor within the pleura or peritoneum. CT scans are instrumental in detecting early-stage tumors that might not be visible on routine X-rays.

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MRI scans

Magnetic Resonance Imaging (MRI) scans may be employed for more detailed soft tissue evaluation, helping to assess the invasion of tumors.

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Biopsy and Histological Analysis

A biopsy is the definitive method for diagnosing mesothelioma. Doctors collect a sample of tissue from the area where they believe tumors exist. They send it to a lab to be examined under a microscope by a professional, who tests whether cancer cells exist.

The biopsy types for mesothelioma are:

  • Thoracoscopy – A minimally invasive procedure where a camera is inserted into the chest cavity to visually inspect the pleura and obtain tissue samples for biopsy
  • Laparoscopy – Similar to thoracoscopy but used to obtain samples from the peritoneal cavity in patients with peritoneal mesothelioma
  • Needle biopsy – A needle is used to obtain tissue from the tumor for examination. This method may be used when the tumor is accessible or when a thoracoscopy or laparoscopy is not feasible.

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.

Visual representation of the human body and its organs, focusing on common symptoms of mesothelioma.

General Symptoms of Mesothelioma

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close button icon Visual representation of the human body and its organs, focusing on common symptoms of mesothelioma.

Stage 2 Patients May Experience These Symptoms

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Coughing – A dry or painful cough

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Painful breathing – Discomfort or sharp pain while inhaling

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Shortness of breath – Difficulty breathing due to tumors pressing against the lungs

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Unexplained weight loss – Sudden weight loss due to the body’s response to cancer

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Fluid buildup – Excess fluid in the pleural cavity or abdominal cavity

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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:

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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)

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Extrapleural Pneumonectomy (EPP)

A more radical approach that removes the entire affected lung, the pleura and parts of the diaphragm

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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.

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.
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RESOURCES FOR BEATING THE ODDS

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.

Example of the TNM System


Illustrated depiction of a tumor, showing the TNM system used for cancer staging and assessment.

Diagram illustrating a cell with a node and another cell, representing an example of the TNM system.

Diagram illustrating the TNM system for classifying cancer metastasis and the growth of cancer cells.

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).

Example of the PCI System


Diagram illustrating the stages of the digestive system, highlighting the 13 abdominal regions and their Peritoneal Cancer Index scores.

Diagram illustrating the stages of the digestive system, highlighting the 13 abdominal regions and their Peritoneal Cancer Index scores.

PCI Score: 8 - Stage 1

Frequently Asked Questions About Stage 2 Mesothelioma

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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.

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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.

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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.

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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.

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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

  1. Mesothelioma. National Organization for Rare Disorders. Retrieved from: https://rarediseases.org/rare-diseases/mesothelioma/. Accessed: 04/09/2020.
  2. Signs and Symptoms of Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/signs-symptoms.html. Accessed: 04/10/19.
  3. Mesothelioma: Symptoms and Signs. American Society of Clinical Oncology. Retrieved from: https://www.cancer.net/cancer-types/mesothelioma/symptoms-and-signs. Accessed: 04/10/19.
  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. 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.
  7. 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.
  8. 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.
  9. Cancer Staging. American Cancer Society. Retrieved from: https://www.cancer.org/treatment/understanding-your-diagnosis/staging.html. Accessed: 04/06/2020.
  10. 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.
  11. 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: 04/12/19.
  12. Bonomi M, De Filippis C, Lopci E, et al. Clinical staging of malignant pleural mesothelioma: current perspectives. Lung Cancer (Auckl). 2017;8:127-139. Published 2017 Aug 18. doi:10.2147/LCTT.S102113
  13. Martella S, Aiello MM, Bertaglia V, et al. Malignant Pleural Mesothelioma: Staging and Radiological Response Criteria in Patients Treated with Immune Checkpoint Inhibitors. Target Oncol. 2024;19(1):13-28. doi:10.1007/s11523-023-01017-w
  14. 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
David Statman, content writer

About the Writer, David Statman

David Statman is a Content Writer for Mesothelioma Guide. He received both his bachelor's and master's in journalism from West Virginia University, and has been in medical publishing since January 2022. He previously worked in sports journalism, primarily reporting on West Virginia sports for a number of publications.

He lives in Delaware with his wife, dog and two cats, and avidly competes as a professional wrestler in the Philadelphia area.

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