Written By: David Statman
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 for accuracy by
Dr. Stephen Williams
Precision Oncology Scientist
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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.
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.
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.
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:
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.
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.
MRI scans
Magnetic Resonance Imaging (MRI) scans may be employed for more detailed soft tissue evaluation, helping to assess the invasion of tumors.
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:
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.
Coughing – A dry or painful cough
Painful breathing – Discomfort or sharp pain while inhaling
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.
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 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.
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).
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:
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:
A study published in the Journal of Thoracic Disease showed the benefits of radiation after surgery:
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.
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.
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.
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
PCI Score: 8 - Stage 1
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.
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.
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.
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.
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
Stage 2 mesothelioma is an early but more advanced stage of this cancer, where tumors begin to spread beyond their original location. In cases of pleural mesothelioma, which affects the lining of the lungs, the cancer might extend to nearby structures such as the diaphragm or the lung tissue itself. For peritoneal mesothelioma, which involves the abdominal lining, the disease can start affecting adjacent organs within the abdominal cavity. During this stage, cancer has often begun to involve nearby lymph nodes and has increased in size, creating more noticeable symptoms. Patients typically experience more pronounced signs like chest or abdominal pain, persistent coughing, difficulty breathing, fatigue, and unexplained weight loss. Recognizing these symptoms early and seeking medical evaluation can lead to more treatment possibilities and potentially better outcomes.
Diagnosing stage 2 mesothelioma involves imaging tests and tissue biopsies. Initial X-rays might reveal fluid buildup around the lungs or abdomen, but more detailed imaging methods like CT scans and MRIs are essential to determine the tumor's size and extent of spread. A biopsy, where a tissue sample is examined under a microscope, confirms the presence of mesothelioma. This is usually done through minimally invasive procedures such as thoracoscopy or laparoscopy, depending on whether the tumor affects the chest or abdominal cavity. Because symptoms can resemble less serious illnesses at this stage, early diagnosis can be challenging but is crucial for effective treatment.
When it comes to treatment, stage 2 mesothelioma generally remains manageable with a combination of therapies. Surgery, such as pleurectomy with decortication (P/D) — which removes part of the lining around the lungs while sparing the lung itself — offers a chance to remove tumors while preserving organ function. More aggressive surgeries, like extrapleural pneumonectomy (EPP), involve removing the affected lung but are less common due to their complexity. Alongside surgery, chemotherapy, immunotherapy, and radiation are often used to shrink tumors, prevent recurrence, and improve quality of life. Although there is currently no cure for mesothelioma, these combined approaches can extend survival, with recent studies showing patients living beyond two years after diagnosis. Consulting with specialized mesothelioma treatment centers can significantly enhance the chances of achieving the best possible outcomes at this stage.
