Written By: Devin Golden

Stage 2 Mesothelioma

Stage 2 mesothelioma involves tumors spreading beyond the point of origin. Surgery is still an option, and the prognosis is promising.

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 2 Mesothelioma

  • Stage 2 mesothelioma has tumors starting to spread beyond the mesothelial lining and cavity.
  • Symptoms become more noticeable and unique to mesothelioma in this stage.
  • Survival slightly worsens compared to stage 1 but all treatment options are available.

What Is Stage 2 Mesothelioma?

Stage 2 mesothelioma is a localized cancer. The tumors are mostly found in the point of origin — the pleura for pleural mesothelioma, or the peritoneum for peritoneal mesothelioma. They also might be near an organ.

pleural symptoms
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
  • 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. These forms of care can improve mesothelioma life expectancy.

What Symptoms to Expect With Stage 2 Mesothelioma

People in any stage of mesothelioma should be aware of common mesothelioma symptoms. While in stage 1 they may be moderate or unnoticeable, symptoms 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. Early detection of mesothelioma increases your chances of survival.

Stage 2 Mesothelioma Treatment Options

With stage 2 mesothelioma, you still have most treatment options available. The disease has not overrun your vital organs, and tumors are still confined. Surgery is an effective option for removing the tumors, and you may not need an organ removed during the operation.

Other options for stage 2 mesothelioma are chemotherapy and radiation. Doctors 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 removes the affected lung, pleura and part of the diaphragm. P/D spares both lungs but removes the pleura. P/D also possibly takes out part or all of 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 involves “debulking.” This is the meticulous removal of visible tumors.

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

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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 kill as much of the cancer as possible.

The disease consists of microscopic tumors that duplicate at unchecked rates. Therefore, bulk removal of all diseased cells is challenging, even for experienced mesothelioma surgeons. This is why mesothelioma recurrence occurs frequently.

To prevent recurrence, mesothelioma specialists use chemotherapy and radiation to shrink the disease before surgery. They also can use the therapies to attack remnant cells after surgery.


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

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 two-year survival rates between 35% and 40% for stage 2 pleural mesothelioma.
  • 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 rare. A study published in the Journal of Thoracic Oncology showed that only 21% of pleural patients were diagnosed in stage 2. An earlier diagnosis usually results in more treatment options, which is why you should 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 survived after P/D for an average of 23 months
  • Patients survived after EPP for approximately 18 months

Adjuvant treatment also improves 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 survival is by receiving high-quality treatment. Many doctors 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 nearby specialist who can perform these therapies.

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. This system defines stage 2 as spreading to the lung cavity, diaphragm, lymph nodes and chest wall.

Butchart System Icon

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.

Brigham System Icon

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.

Peritoneal Cancer Index Icon

Peritoneal Cancer Index

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

Frequenlty 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 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.

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: 04/10/2020.
  3. Mesothelioma: Symptoms and Signs. American Society of Clinical Oncology. Retrieved from: https://www.cancer.net/cancer-types/mesothelioma/symptoms-and-signs. Accessed: 04/10/2020.
  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: 04/14/2020.
  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. Malignant Mesothelioma Treatment (Adult). Vanderbilt-Ingram Cancer Center. Retrieved from: https://www.vicc.org/cancer-info/adult-malignant-mesothelioma. Accessed: 11/15/22.
  11. 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.
  12. 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.