Stage 2 mesothelioma indicates the cancer has started to spread to surrounding areas.
Symptoms start to become more noticeable and intense at this stage.
Curative treatment is still possible at this stage, usually through a multimodal plan.
Approximately 25% of patients diagnosed at Stage 2 survive for at least 2 years.
Stage 2 mesothelioma indicates an early stage of the disease, as there is limited, localized metastasis to organs and tissues near the primary tumor. With a diagnosis at an earlier stage, patients have more treatment options, including curative surgery. Though prognosis is still poor, patients have a greater chance at extending survival with more aggressive treatment.
Stage 2 Mesothelioma By Type
A patient’s prognosis is largely influenced by the type of mesothelioma and stage of disease. For all forms of mesothelioma cancer at this stage, patients are likely still eligible for curative surgery and other conventional treatments to remove visible tumors and prevent the cancer from spreading any further.
Stage 2 Pleural Mesothelioma
Malignant pleural mesothelioma is the only form of the asbestos cancer that has its own staging systems, since it is the most commonly diagnosed. The TNM system, Brigham system and Butchart system can all be used to properly identify the stage of mesothelioma, though the TNM system is the most commonly used and updated. Researchers using the system identify the extent and size of the tumors present, if the cancer has spread to nearby lymph nodes and if metastasis has occurred to distant sites.
At the most recent update, researchers describe stage 2 mesothelioma as T1-2N1. This means the cancer is either only present in the pleura on one side of the chest (T1) or it has spread locally into the lung itself or the diaphragm (T2). The N1 of the staging signals that the mesothelioma cells have spread to nearby lymph nodes on the same side of the body, but there is no distant spreading. Across the three staging systems, researchers agree that stage 2 indicates the disease that can still be resected.
Stage 2 Peritoneal Mesothelioma
Peritoneal mesothelioma, which develops in the lining of the abdomen, does not have its own staging system because of its rarity. Instead, doctors rely on broader stage 2 mesothelioma characteristics, including localized tumors and limited metastasis that may include some lymph node involvement.
Doctors may also turn to the Peritoneal Cancer Index (PCI), which is another broad staging tool for abdominal cancers. The abdomen is divided into regions and given a score to describe if there are tumors present and their size. The scores for all the regions are totaled, which doctors can then use to approximate a stage. Researchers estimate a score of 11 – 20 indicates stage 2 cancer.
At stage 2, doctors can still pursue one of the most successful multimodal treatments for peritoneal mesothelioma: cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). This combination therapy entails a mesothelioma specialist first removing all visible tumors followed by a heated chemotherapy wash applied to the abdomen, hopefully eradicating any other existing mesothelioma cells. Surgery with HIPEC has been found in some clinical trials to improve 5-year survival rate to at least 50%, with some studies even finding a median survival of 92 months or more.
Stage 2 Pericardial Mesothelioma
As the rarest form of mesothelioma, research for pericardial mesothelioma is limited. Like peritoneal mesothelioma, researchers base staging and diagnosis off of more general mesothelioma characteristics. A pericardial mesothelioma diagnosis at an early stage, however, is extremely rare. In the limited case reports available, patients often weren’t properly diagnosed until stage 3 or 4, with many diagnosed through an autopsy posthumously.
Even at this earlier stage, patients may experience more severe symptoms than the other forms of mesothelioma since the cancer is impacting the heart. Though all types of mesothelioma are considered aggressive, various clinical studies have noted that pericardial mesothelioma may progress more quickly and severely because of its location, making it very difficult to diagnose at an early stage.
Symptoms of Stage 2 Mesothelioma
Since there is some metastasis occurring by stage 2, patients may experience more noticeable symptoms. Still, symptoms are nonspecific and may not be so bothersome at this earlier stage, making it easier for patients to ignore the potential signs of mesothelioma or face a misdiagnosis. At early stages especially, mesothelioma can be mistaken for common illnesses, like the flu.
Stage 2 Mesothelioma Symptoms
- Persistent cough
- Chest pain
- Shortness of breath
- Unexplained weight loss
Stage 2 Mesothelioma Prognosis
An early mesothelioma diagnosis is the best chance for long-term survival. Mesothelioma patients diagnosed at stage 2 have an average life expectancy of 19 months, which can potentially be extended with conventional and emerging treatments. A patient’s prognosis will also differ based on the type and cell type of mesothelioma, gender, age, overall health and a variety of other factors.
In recent years, survival rates for peritoneal and pleural mesothelioma have improved, largely thanks to clinical trials testing new combinations of standard treatments, like chemotherapy, and new treatments, like immunotherapy.
Stage 2 Mesothelioma Treatment
When diagnosed at an earlier stage, mesothelioma patients generally have more treatment options. Since the cancer has limited spreading, surgery to remove the tumors is often recommended in combination with other treatments, like chemotherapy and radiation therapy. In most instances at this stage, treatment has a curative intent, though some of these therapies may also be applied palliatively to help with worsening symptoms.
At earlier stages, mesothelioma specialists often utilize aggressive surgeries to remove as many tumors as possible and delay disease progression. Pleural mesothelioma patients, for instance, may undergo a pleurectomy decortication or an extrapleural pneumonectomy to remove diseased membrane and visible tumors. Researchers have found these surgeries can increase 2-year survival rate from 19% when treated with chemotherapy alone to upwards of 40%. However, it’s important to note these surgeries are more invasive and risky compared to other types of treatments.
Chemotherapy is considered a standard of care for mesothelioma and is often utilized in combination with other therapies. Many times, mesothelioma surgeries are followed by chemotherapy to kill any remaining cancer cells. The multimodal treatment plan has successfully extended survival for some patients, like surgery and HIPEC achieving a median survival of 53 months across various clinical trials.
Researchers have found chemotherapy alone is not always the most effective at extending life expectancy, with some clinical trials finding an average survival of 16 months for pleural mesothelioma patients treated with the standard alimta and cisplatin. However, additional clinical trials have found systemic chemotherapy can extend survival from about 12 months to 39 months for patients with recurrent mesothelioma previously treated with radical surgery and chemotherapy.
Radiation is sometimes recommended in combination with surgery and chemotherapy for patients diagnosed at earlier stages. Radiation is a targeted, localized therapy that kills cancer cells and stops them from reproducing. Since the therapy can also easily destroy healthy tissue, it is considered ineffective as mesothelioma continues to advanced stages and spreads to more distant organs in the body.
Emerging treatments from immunotherapy to photodynamic therapy have shown promise in effectively treating malignant mesothelioma. In fact, the National Comprehensive Cancer Network (NCCN) recently revised its first-line treatment recommendation for pleural mesothelioma cases where surgery is not an option to include immunotherapy. For decades, the first-line treatment was a combination of chemotherapy, but now includes a triplet therapy with the monoclonal antibody bevacizumab (Avastin).
Other types of immunotherapy have also shown success, like personalized cancer vaccines. In early-phase clinical trials, researchers have found the treatment could extend survival to at least 24 months, with some patients surviving to 55 and 60 months at the most recent follow ups. With continued research into these new treatments, mesothelioma patients and their loved ones have more hope for extended survival.