Stage 2 Mesothelioma

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] Assigning a stage between one and four is important because it informs treatment choices and gives patients the most accurate prognosis possible. Mesothelioma is most often diagnosed in the later stages, three or four, because it has a long latency period and is so often misdiagnosed.

Stage 2 mesothelioma comes with a median survival time of less than two years.[2] Even in this earlier stage, mesothelioma is very difficult to treat. It is aggressive and spreads quickly, but treatments are more effective during this stage than later stages, and patients have more treatment options, including surgery.[3]

How Mesothelioma is Diagnosed and Staged

Mesothelioma is often diagnosed after other illnesses have been eliminated as possibilities. This is because it is a rare type of cancer and because the symptoms of it mimic those of other conditions that are more common, like pneumonia. Mesothelioma has a long latency period, which means that the time period between the initial incidence of exposure to asbestos—the most likely cause of mesothelioma—to an accurate diagnosis can be as long as several decades.

The diagnosis is also often delayed because it is difficult to distinguish mesothelioma from other conditions. Initially it may seem as if a patient has pneumonia. Even when it is determined that a patient has cancer, it is easy to mistake mesothelioma for lung cancer, which is more common. Getting an accurate diagnosis, with correct staging, is so crucial for determining the course of treatment, and in turn, for giving a patient the best possible prognosis.

TNM Cancer Staging

The most commonly used designation for cancer staging, the TNM system, helps doctors communicate clearly about the state of a patient’s illness. To diagnose mesothelioma a medical team uses physical exams, personal history, blood tests, imaging scans, and tissue and fluid biopsies. 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.

Characteristics of 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 into all areas of the pleura on one side of the chest. This includes the pleura lining the chest cavity, the lungs, the diaphragm, and the mediastinum. Furthermore, the tumor has expanded into either the diaphragm or the lung on that side of the chest.[4]

For the characteristics of lymph nodes and metastasis, stage 2 mesothelioma is designated as N0 or N1 and M0. This means that the original tumor has not spread to any more distant parts of the body.

Stage 2 Symptoms

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 the cancer and may include:[5]

• Mild chest pains and cough
• Shortness of breath
• Trouble breathing
• Unexplained weight loss
• Fever

Stage 2 peritoneal mesothelioma may cause some swelling and pain in the abdomen, constipation or diarrhea, unexplained weight loss, nausea, and fatigue.[6]

Treatment Options for Stage 2

There are various treatment options for any stage of mesothelioma that depend a lot on each individual. But generally, as mesothelioma progresses to the later stages, treatment options become more limited. At stage 2 there are still several options and surgery is usually a possibility. Once the cancer has spread too far, as in stage 3 or stage 4 mesothelioma, surgery becomes riskier and less effective.[7]

During stage 2, 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, at this earlier stage, treatment can extend a patient’s life expectancy.

The most aggressive type of surgery that can be used to treat early-stage pleural mesothelioma is an extrapleural pneumonectomy. This procedure 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 diaphragm is reconstructed with synthetic materials.[7]

A less aggressive surgery involves removing most of the pleura, but not the lung or diaphragm. It is less risky, but comes with less hope of removing all of the cancer. A debulking surgery may also be done to remove as much of a tumor as possible. While not curative, this can relieve symptoms. Debulking surgery is also a possibility with peritoneal mesothelioma for many stage 2 patients.

Stage 2 mesothelioma is also often treated with chemotherapy and radiation. These are most often used in combination with each other or with surgery. The three-pronged approach to treatment gives the best chance of success. Chemotherapy or radiation can be used before or after surgery: to reduce the size of the tumor in advance of surgery or to eliminate any remaining cancer cells and reduce the risk of a recurrence.[8]

Stage 2 Mesothelioma Prognosis

Based on previous cases researchers have determined that 20 months is the average survival time for patients diagnosed with stage 2 mesothelioma.[2] Many factors determine the actual outcome, though, including cell type, the original tumor’s location, and the age and general health of the patient.

Treatment is also a factor in the prognosis. Patients who elect to undergo aggressive treatment, like an extrapleural pneumonectomy, 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 a number of challenges.

A more recent type of treatment that involves heating chemotherapy drugs and injecting them directly into the abdominal cavity for peritoneal mesothelioma has proven to give patients a better prognosis. The evidence that this extends life for pleural mesothelioma patients is less clear, but there is promise.[9]

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.

Page Medically Reviewed and Edited by
Luis Argote-Greene, M.D.

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.

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