Stage 2 Mesothelioma

Stage 2 mesothelioma involves the disease starting to spread beyond the point of origin. Curative surgery is still a treatment option in most cases, and the prognosis is promising.


Written by Jenna Campagna, RN


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What Is Stage 2 Mesothelioma?

Stage 2 mesothelioma is considered a localized version of mesothelioma. The tumors are mostly found in the point of origin — the pleura for pleural mesothelioma or the peritoneum for peritoneal mesothelioma. They also may have started spreading into a nearby organ.

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Some characteristics of stage 2 mesothelioma are:

  • Tumors have spread beyond the pleura or peritoneum, and there might be lymph node involvement
  • Symptoms may become more noticeable and uncomfortable
  • Tumors have started growing in size
pleural symptoms

Some characteristics of stage 2 mesothelioma are:

  • Tumors have spread beyond the pleura or peritoneum, and there might be lymph node involvement
  • Symptoms may become more noticeable and uncomfortable
  • Tumors have started growing in size

Stage 2 mesothelioma patients are still candidates for aggressive treatment options. These forms of care are the primary methods to improve their mesothelioma life expectancy.

What Symptoms to Expect With Stage 2 Mesothelioma

People with stage 2 mesothelioma should be aware of the common mesothelioma symptoms. While in stage 1 they may be moderate or unnoticeable, symptoms usually are more detectable in stage 2.

If you notice these symptoms, speak with your primary physician immediately. Detecting your mesothelioma in an early stage increases your chances of receiving curative treatment.

Patients may experience:

  • Painful breathing
  • Coughing
  • Shortness of breath
  • Unexplained weight loss
  • Fluid buildup
  • Lumps in the chest or abdomen

If you notice these symptoms, speak with your primary physician immediately. Detecting your mesothelioma in an early stage increases your chances of receiving curative treatment.

Stage 2 Mesothelioma Treatment Options

If you have stage 2 mesothelioma, then you still have most of the treatment options available to you. The disease has not overrun your vital organs, and the mesothelioma tumors are still centralized. Therefore, surgery is an effective option for removing the majority of tumors — and you may not need a lung or another vital organ removed during the operation.

Other common treatment options for stage 2 mesothelioma are chemotherapy and radiation. Doctors often use these methods in collaboration with surgery.

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The two stage 2 pleural mesothelioma surgeries are extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D). EPP involves the removal of the affected lung, pleura and part of the diaphragm. P/D spares both lungs but removes the pleura and possibly the diaphragm and pericardium (the lining of the heart).

Which operation a patient undergoes is dependent on their overall health and how far the tumors have spread.

Stage 2 peritoneal mesothelioma patients can undergo cytoreduction with heated intraperitoneal chemotherapy (HIPEC). Cytoreduction is a surgery that involves “debulking”, which is the mass removal of tumors from the abdomen.

HIPEC involves hot liquid chemotherapy drugs delivered into your abdomen. Inserting the drugs directly into the location of the disease focuses on attacking diseased cells while minimizing the damage to healthy cells elsewhere in your body.

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Chemotherapy and Radiation

Curative treatment for stage 2 mesothelioma often involves more than just surgery. Specialists rely on chemotherapy and radiation to team with aggressive surgery and kill as much of the cancer as possible.

The disease consists of many microscopic tumors, which duplicate at unchecked rates. Therefore, removal of all diseased cells through an operation is challenging, even for experienced mesothelioma surgeons. This is how mesothelioma recurrence occurs.

To prevent recurrence, mesothelioma specialists use chemotherapy and radiation to shrink the size of the disease — making it more easily removed during surgery. They also can use them to attack remnant cells not removed during surgery.


Stage 2 patients usually have a promising mesothelioma prognosis. They can undergo curative treatment options and address the disease before it spreads to vital organs.

There are numerous scientific 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 two-year survival rates between 35% and 40% for stage 2 pleural mesothelioma patients.
  • The American Cancer Society reported that 53% of peritoneal mesothelioma patients receiving cytoreduction with HIPEC survived for at least five years.

Diagnosing stage 2 mesothelioma is still rarer than more advanced stages. A study published in the Journal of Thoracic Oncology showed that only 21% of pleural patients were diagnosed at stage 2. An earlier diagnosis usually results in more treatment options, which is why you should know the signs of mesothelioma and receive regular check-ups with your doctor.

Many doctors 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 who underwent P/D survived for an average of 23 months
  • Those who underwent EPP survived for approximately 18 months

Adjuvant treatment also improves a stage 2 mesothelioma patient’s prognosis. Adjuvant treatment refers to therapy used following surgery. Chemotherapy and radiation are the two primary methods.

A study published in the Journal of Thoracic Disease showed the benefits of radiation after surgery. Around 70% of stage 1 and stage 2 pleural mesothelioma patients lived for two years after receiving surgery plus radiation. This percentage was much higher than the 35% two-year survival rate for patients who only underwent surgery.

The best way to increase your chances for long-term survival is by receiving high-quality treatment. There are doctors who specialize in mesothelioma and have experience performing the curative surgeries to help stage 2 patients. Our free Doctor Match program can help you connect with a specialist who can perform the most effective procedure to treat your cancer.

Stage 2 by Different Staging Systems

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TNM System

The TNM System (Tumor, Nodes, and Metastasis) is the most common staging system for pleural mesothelioma. It focuses on three aspects. This system defines stage 2 as spreading to the lung cavity, diaphragm, lymph nodes and chest wall.

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Butchart System

The Butchart System stages pleural mesothelioma depending on the collective size of the tumors. This is the original staging system for mesothelioma. For stage 2, tumors have grown into the chest wall and possibly the heart or esophagus.

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Brigham System

The Brigham System focuses on whether surgery is an option and if tumors have affected lymph nodes. This system was developed at Brigham and Women’s Hospital.

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Peritoneal Cancer Index

The peritoneal cancer index is the primary staging system for peritoneal mesothelioma. Doctors examine the extent of the disease within the abdominal cavity. They assign a score between 0 and 3 for each of the 13 sections within the cavity. Total scores between 11 and 20 correlate to a stage 2 cancer. This disease is still centralized and can be mostly removed through cytoreduction and HIPEC.

Common 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 the lung cavity and possibly the nearby lymph nodes. For peritoneal mesothelioma, the cancer has a PCI score of 11-20, meaning it has spread to multiple sections of the abdominal cavity.

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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 stomach 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 — or any stage of the cancer. However, people diagnosed in this stage often survive for multiple years. The average life expectancy is 19 months, and surgery can increase it to 2-3 years.

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How often do people have stage 2 mesothelioma?

A stage 2 mesothelioma diagnosis is quite common. In one study, around 40% of patients were diagnosed in this stage. Symptoms are significant enough for patients to seek medical care and for doctors to identify the cancer’s presence.

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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, is the preferred route for many mesothelioma specialists. Other treatment options include chemotherapy, radiation and immunotherapy, which are often used before or after surgery.

Last Edited: October 26, 2020.

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