Stage 2 Mesothelioma
During stage 2 mesothelioma, the cancer has spread to nearby lymph nodes and tissues. The prognosis for stage 2 mesothelioma is more favorable than later stages as there are more treatment options available that can extend life expectancy. The median survival for stage 2 mesothelioma is around 19 months, though that can vary based on the type of mesothelioma.
Stage 2 mesothelioma characteristics
Stage 2 mesothelioma is an early–stage cancer. It hasn’t spread far from where it first appeared in the lining of the lungs, abdominal cavity, or heart. A diagnosis at this stage typically means that cancer cells have spread to hilar lymph nodes at the root of the lung.
If you’re diagnosed with stage 2 mesothelioma, you are likely eligible for more aggressive treatment options. Treatments at this stage can include a combination of surgery, chemotherapy, immunotherapy and radiation.
Stage 2 mesothelioma quick facts
- The tumor is limited to one side of the chest
- In more advanced cases, it may have spread to the diaphragm or the surface of the lung itself
- Stage 2 mesothelioma responds well to curative treatment, because its spread is limited
- Symptoms are usually mild or not noticed
- Two-year survival rate is around 38%
- Median survival rate is 19 to 67 months
Stage 2 mesothelioma by type
There are four main types of mesothelioma, named for where cancer originates in the body:
- Pleural, found in the lining of the lungs (pleura)
- Peritoneal, originating in the tissue lining the abdominal wall (peritoneum)
- Pericardial, starting in the membrane surrounding the heart
- Testicular, found in the testes
The cancer staging and progression for each type of mesothelioma will likely be different, and the cell type of the tumors will also impact progression.
Stage 2 pleural mesothelioma
Malignant pleural mesothelioma is the most common type of mesothelioma, accounting for an estimated 80 percent of new cases. This mesothelioma is staged with the TNM staging system – the main system used to stage mesothelioma.
During stage 2, tumors develop beyond the pleura, and cancer cells may be found in nearby lymph nodes. However, there is not yet distant metastasis beyond the chest wall to other parts of the body.
Stage 2 peritoneal mesothelioma
Peritoneal mesothelioma is the second most common type of mesothelioma, accounting for 300-500 new cases per year. This kind of mesothelioma is staged either with the peritoneal cancer index (PCI) or an adapted version of the TNM staging system, but there is no widely recognized staging system for this kind of mesothelioma.
During stage 2 of peritoneal mesothelioma, cancer may have spread to nearby organs and lymph nodes within the abdomen, but not yet to distant organs.
Because tumors are isolated to the abdomen and nearby organs in stage 2, hyperthermic intraperitoneal chemotherapy (HIPEC), a two-step surgery and chemotherapy procedure, can be an effective treatment.
Stage 2 pericardial mesothelioma
Pericardial mesothelioma is a rare type of mesothelioma, accounting for just 1-2 percent of new cases. Because this cancer is so rare, there is no official staging system for pericardial mesothelioma. Further, because early symptoms can be nonspecific, it is often not recognized in the early stages.
Stage 2 testicular mesothelioma
Like pericardial mesothelioma, testicular mesothelioma is extremely rare and makes up just 1 percent of cases. Given the rarity of this cancer, there is no official staging system for testicular mesothelioma. It is often not recognized in the early stages as symptoms might be mistaken for more common conditions.
How doctors make a stage 2 mesothelioma diagnosis
Doctors use three staging systems to describe how far stage 2 mesothelioma has spread. Using these systems helps them determine which treatment options will work best for your diagnosis.
TNM system
The TNM system describes the growth of mesothelioma using 3 factors: tumor, lymph nodes, and metastasis.
In stage 2 of the TNM system, the cancer has spread from the lining of one lung to the diaphragm, nearby lymph nodes and the lining of the heart.
Brigham system
In stage 2 of the Brigham system, the tumor may have spread to groups of nearby lymph nodes. Your doctor will be able to remove most of the mesothelioma via surgery.
Butchart system
In stage 2 of the Butchart system, the cancer has metastasized from its point of origin on the pleura of one lung to the pleura of the other. It may also have spread to the pericardium and nearby lymph nodes.
Symptoms of stage 2 mesothelioma
Like symptoms caused by stage 1 mesothelioma, stage 2 mesothelioma symptoms are similar to those caused by other diseases. In fact, it’s common for doctors to first diagnose stage 2 mesothelioma as pneumonia or Chronic Obstructive Pulmonary Disease (COPD).
If you’ve received a stage 2 diagnosis, your main source of discomfort may be pressure resulting from the build up of fluid in the lining of your lungs, abdomen, or heart. Where you feel this pressure depends on the location of the mesothelioma. For example, patients diagnosed with stage 2 pleural mesothelioma experience breathing difficulties caused by pressure from excess fluid in the lung’s lining, the pleura; more advanced cases may feel chest pain resulting from its hardening.
Stage 2 mesothelioma symptoms
- Chest pain
- Shortness of breath
- Chest pressure
- Persistent cough
- Fever
- Weight loss
How Stage 2 mesothelioma is detected
Most patients do not have—or have very mild—mesothelioma symptoms in stage 2. As a result, mesothelioma is rarely diagnosed in this early stage of the disease, less than a quarter of the time. Stage 2 mesothelioma is often discovered through cancer screening or accidentally through an unrelated chest screening.
There is a long (20-60 years or more) latency period between asbestos exposure and cancer development. How quickly cancer spreads depends on the cell type of the tumor and other factors.
Mesothelioma may be found in advanced stages as symptoms progress and patients seek care. Oncologists may use X-rays, biopsies, and other methods to diagnose mesothelioma in the pleura and surrounding tissues.
Learn more about the stages of mesothelioma
Find out more about the other stages of mesothelioma, including the symptoms, treatment options, prognosis and how you or a loved one can get help.
Mesothelioma treatment options for patients in stage 2
If you’ve been diagnosed with stage 2 mesothelioma, you’re eligible for curative treatment options that can extend your life expectancy. At this stage, the mesothelioma hasn’t spread far enough to render traditional treatments, like surgery or chemotherapy, ineffective.
Surgical options
As far as curative mesothelioma surgery is concerned, patients with pleural mesothelioma can have an extrapleural pneumonectomy (EPP) or a pleurectomy with decortication (P/D); several studies have shown that both have significantly extended patients’ survival times. Patients with peritoneal mesothelioma can have cytoreductive surgery; when paired with chemotherapy, this procedure has extended survival times to 5 years and beyond.
Regardless of the location of the mesothelioma, your doctor may also give you palliative treatment designed to relieve discomfort caused by symptoms.
The choice of surgery is always determined by how far a patient’s mesothelioma has spread outside the pleura or peritoneum. Because the spread of the cancer is still limited during stage 2, patients are eligible for more aggressive treatments and have a better chance of improving their prognosis.
Other treatment types
Chemotherapy and radiation therapy are also options for stage 2 patients. Your doctor will determine if you’re eligible for either, and may combine them with surgery in a multimodal therapy, which can include any of the following as well as surgery.
Chemotherapy
Chemotherapy is a treatment that uses medications to kill cancer cells and shrink tumors. This treatment option can be effective for stage 2 mesothelioma patients, and your oncologist may recommend it as part of your treatment plan. Chemotherapy is generally used following surgery to kill any remaining cancer cells or as a first line treatment. Intraperitoneal chemotherapy can be put directly into the abdomen, rather than the vein, to treat some mesotheliomas like peritoneal mesothelioma.
Radiation therapy
Radiation therapy uses high doses of radiation to treat cancer by killing mesothelioma cells. This radiation damages targeted cells, which hinders growth and helps to shrink tumors. Radiation therapy is most effective against localized tumors and, as a result, is most impactful during early-stage mesothelioma.
Immunotherapy
Immunotherapy is used to stimulate the immune system to fight cancer on its own. In particular, the combination of two immunotherapy drugs, Opdivo® (nivolumab) and Yervoy® (ipilimumab), has been shown to improve survival by 50 percent and is an FDA-approved treatment for malignant pleural mesothelioma. These treatments are now standard options for advanced stages of mesothelioma.
Clinical trials and emerging treatments
Clinical trials are research studies to evaluate new interventions and emerging treatments, including for advanced-stage mesothelioma. National Cancer Institute-designated cancer centers often lead the way in research studies for different cancers. Recent areas of study for mesothelioma include:
- Gene therapy, which alters the DNA of affected cells so the immune system can better target them
- Immunotoxins, which are proteins that bind to cancer cells, enter the cell, and kill them
- Oncolytic virus therapy, which uses viruses like herpes simplex virus to kill cancer cells
Clinical trials and emerging treatments are not available to all patients and are often given to patients who are not responding to standard treatment methods. Your oncologist will have specific recommendations for clinical trials that show promise for treating your cancer.
Life expectancy & survival rates with stage 2 mesothelioma
Life expectancy refers to how long a patient can expect to live with their cancer. For stage 2 mesothelioma patients, the typical median life expectancy is 19 months, compared to 12 months for stage 4.
Relative survival rate refers to the percentage of people who survive mesothelioma compared to the overall population for a certain increment, often two or five years. For stage 2 pleural mesothelioma, the two-year survival rate is around 38 percent. The five-year survival rate drops to 16 percent according to the American Cancer Society.
Many factors can impact survival, including age, gender, and overall health. Additionally, aggressive treatment can help to extend life expectancy and improve quality of life, especially for early-stage mesothelioma patients. Speak with your oncologist or other specialists about your prognosis to learn more.
Can stage 2 mesothelioma patients be cured?
There is no cure for any stage of mesothelioma, though some patients have been able to go into short-term remission. Mesothelioma caught at an early stage has a better prognosis with more treatment options available compared to later stages. Early and aggressive treatment can improve outcomes for patients with stage 2 mesothelioma. Additionally, maintaining good overall health can improve your prognosis.
How to improve your mesothelioma prognosis
Being diagnosed with stage 2 mesothelioma can be frightening, but you have hope. Stage 2 mesothelioma is still largely confined to one side of the body, and is easier for doctors to remove with curative treatment. In fact, patients with stage 2 mesothelioma survive an average of 2 years after having surgery and some exceed the average and live even longer.
You can learn more about getting treatment and extending your life expectancy past the average by speaking with a member of our Patient Help Team. We can review your diagnosis, help you connect to an experienced doctor, and even find financial aid to pay for your treatment.
