Stage 2 Mesothelioma
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In stage 2 mesothelioma, cancer has spread beyond the initial area of growth and has infiltrated some of the lymph nodes. Treatment becomes more difficult at this stage, but surgery is usually still an option. The prognosis is limited but better than for later stages.
About Stage 2 Mesothelioma
Mesothelioma is often diagnosed after other illnesses have been eliminated as possibilities. It has a long latency period. This means that the time period between the initial incidence of asbestos exposure—the most likely cause of mesothelioma—to an accurate diagnosis can be as long as several decades.
Getting an accurate diagnosis with correct staging is crucial for determining the course of treatment and for the best possible prognosis. Like other types of cancer, a mesothelioma diagnosis comes with a designation for the stage of the disease, which is a description of its progression and current state.[1]
Here are some quick facts for anyone diagnosed with stage 2 mesothelioma:[2][3]
- Stage 2 is considered early-stage mesothelioma.
- Stage 2 mesothelioma comes with a median survival time of less than two years.
- Patients at this stage still have a wide range of treatment options.
- In stage 2, the cancer has spread to nearby lymph nodes.
- There is no metastasis, or distant spread, in stage 2.
How Do Doctors Stage Mesothelioma?
The most commonly used designation for cancer staging, the TNM system, helps doctors communicate clearly about the state of a patient’s illness.
A medical team uses physical exams, personal history, blood tests, imaging scans, and tissue and fluid biopsies to diagnose mesothelioma. They investigate the primary tumor, the cells involved, and the spread of the cancer, if there is any. Three letters are used to describe and designate a stage:[1]
- T describes the primary tumor and tells medical professionals how big the tumor is and whether or not it has moved into nearby tissues.
- N is a designation for the lymph nodes and describes if and to what extent the cancer has spread to this part of the immune system.
- M tells whether or not the cancer has metastasized, or spread to parts of the body distant from the primary tumor.
TNM Characteristics for Stage 2 Mesothelioma
To assign a stage to mesothelioma, specialists must describe each of these three characteristics and assign a certain level of each to the cancer:
- For stage 2 mesothelioma, T is described as T1 or T2. This means that the original tumor has spread within the pleura on one side of the chest. If the description is T2, it has also spread to the lung, the diaphragm, and the mediastinum on the same side of the chest.
- For the characteristics of lymph nodes, stage 2 mesothelioma is designated as N1, meaning cancer cells have spread to lymph nodes near the original tumor.
- The metastasis designation is M0. This means that the original tumor has not spread to any more distant parts of the body.
What Are the Symptoms of Stage 2 Mesothelioma?
By stage 2 of pleural mesothelioma, the symptoms are similar in intensity to those of pneumonia and other lung conditions. They are not as severe as in later stages of cancer and may include:[4]
- Mild chest pain and cough
- Shortness of breath
- Trouble breathing
- Unexplained weight loss
- Fever
Signs of Stage 2 Peritoneal Mesothelioma
Stage 2 peritoneal mesothelioma may cause swelling and pain in the abdomen, constipation or diarrhea, unexplained weight loss, nausea, and fatigue.[5]
What Are the Treatment Options for Stage 2?
Treatment options for any stage of mesothelioma depend significantly on individual factors. Generally, as mesothelioma progresses to the later stages, treatment options become more limited. At stage 2, patients may be eligible for surgery and are likely to undergo chemotherapy.
Surgery
At stage 2, there are still several options, and surgery is usually a possibility. Once cancer has spread too far, as in stage 3 or stage 4 mesothelioma, surgery becomes riskier and less effective.[6]
Aggressive surgery along with other treatment strategies may give a patient hope for a cure or remission for a period of time. Although curing mesothelioma is rare, treatment can extend a patient’s life expectancy at this earlier stage.
- Extrapleural pneumonectomy. This is most aggressive type of surgery that can be used to treat early-stage pleural mesothelioma. It requires a highly skilled surgeon and is risky. It involves removing the entire lung and all of the pleura from one side of the chest, along with the diaphragm on that side. The missing part of the diaphragm is reconstructed with synthetic materials.[6]
- Pleurectomy/decortication. A less aggressive surgery involves removing pleural tissue and part of the affected lung. It is less risky but comes with less hope of removing all of the cancer.
- Debulking surgery. This term refers to removing as much of a tumor as possible. While not curative, this can relieve symptoms. Debulking surgery is also a common option for many stage 2 peritoneal mesothelioma patients.
Chemotherapy
Patients not eligible for surgery will most likely receive chemotherapy as first-line treatment. Pemetrexed combined with cisplatin or carboplatin is the standard choice.
Patients undergoing surgery are also likely to have chemotherapy. They may receive it before surgery to shrink tumors or after to clear up cells the surgeon couldn’t reach and to reduce the risk of recurrence.[7]
Multimodal Treatment
The most common treatment choice for stage 2 patients is multimodal. This means using a combination of two or more treatments, typically surgery and chemotherapy. Some patients also benefit from radiation before or after surgery.
Other Treatments
Researches continue to make advancements in mesothelioma treatments, providing patients with more options. Some of these include immunotherapies, photodynamic therapy, cryotherapy, tumor treating fields, and gene therapy.
Patients may also benefit from clinical trials. These are studies of experimental treatments. Eligibility varies by study, so talk to your doctor to find out if you qualify for any trials.
How Fast Does Stage 2 Mesothelioma Progress?
Not many patients get an early-stage diagnosis for mesothelioma. It is rare and difficult to diagnose. Most symptoms don’t appear for decades after asbestos exposure. However, once detected, this cancer is already rapidly advancing.
Mesothelioma at any stage is aggressive and progresses quickly. Patients in an early stage have a unique opportunity to benefit from immediate and aggressive treatment. Without treatment, the cancer will spread rapidly.
What Is the Prognosis for Stage 2 Mesothelioma?
The outlook for mesothelioma at any stage is not positive. This is an aggressive cancer that spreads readily. The actual prognosis is different for every patient and depends on several factors but especially treatment.
According to the American Cancer Society, the five-year survival rate for localized, early-stage mesothelioma is 18%.[8] This means that just 18% of patients are still alive five years after diagnosis.
Patients who elect to undergo aggressive treatment may be able to extend their lives much longer than those who are more conservative.
There are trade-offs, of course, as the surgery is risky and could cause complications. Living life without one lung presents several challenges.
What Is the Prognosis for Stage 2 Peritoneal Mesothelioma?
Peritoneal mesothelioma patients generally have a better prognosis than pleural patients. This is especially true if they choose HIPEC, a treatment that involves heating chemotherapy drugs and injecting them directly into the abdominal cavity.[9]
How Long Can I Live with Stage 2 Mesothelioma?
The answer to this question is highly variable and depends on individual factors. It depends on your treatment choices and how soon you start, your age, and your overall health.
Based on previous cases, researchers have determined that twenty months is the average survival time for patients diagnosed with stage 2 mesothelioma.[2]
Is a Cure Possible at Stage 2?
Curing mesothelioma is possible in stage 2 but very rare. Most specialists don’t approach treatment as curative. If you are in the early stages and have other positive prognostic factors, remission may be a treatment goal.
The prognosis for mesothelioma of any type is not usually positive, but with research into more advanced treatments, patients at stage 2 have more hope than ever before. Make sure you get a rigorous examination to determine an accurate stage for your cancer and be prepared to make tough treatment choices.
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Luis Argote-Greene is an internationally recognized thoracic surgeon. He has trained and worked with some of the most prominently known thoracic surgeons in the United States and Mexico, including pioneering mesothelioma surgeon Dr. David Sugarbaker. He is professionally affiliated with University Hospitals (UH). His areas of interest and expertise are mesothelioma, mediastinal tumors, thoracic malignancies, lung cancer, lung transplantation, esophageal cancer, experimental surgery, and lung volume reduction. Dr. Argote-Greene has also done pioneering work with video-assisted thoracoscopic surgery (VATS), as well as robotic assisted minimally invasive surgery. He has taught the procedures to other surgeons both nationally and internationally.