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Like other types of cancer, mesothelioma diagnoses come with a designation for the stage of the disease. Assigning a stage between one and four allows doctors to plan the best course of treatment for a patient and to give that patient 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 II mesothelioma comes with a median survival time of less than two years. 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.

Mesothelioma Diagnosis and Staging

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 TNM system for staging cancer is the most common of multiple systems that can be used. To diagnose and stage mesothelioma, doctors, specialists and pathologists must examine imaging scans and examine tumor cells under a microscope, and they may use other techniques like immunohistochemistry. They look for the extent of the original tumor, how far it has moved into other tissues, if it has spread to lymph nodes, and if it has spread to distant parts of the body.

In the TNM staging system, each letter represents a different characteristic of the cancer. T is for the primary tumor and describes its size and its penetration into surrounding tissues. The N is representative of the extent of the cancer’s spread to lymph nodes. M is for metastasis and describes if and how far the cancer has spread to distant parts of the body, beyond the lymph nodes.

Characteristics of Stage II Mesothelioma

To assign a stage to mesothelioma, specialists must describe each of these four characteristics and assign a certain level of each to the cancer. For stage II mesothelioma, T is described as 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.

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

Stage II Symptoms

By stage II 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 caner and may include mild chest pains and cough, shortness of breath, trouble breathing, unexplained weight loss, and a fever. Stage II peritoneal mesothelioma may cause some swelling and pain in the abdomen, constipation or diarrhea, unexplained weight loss, nausea, and fatigue.

Treatment Options

As mesothelioma progresses to the later stages, treatment options become more limited. At stage II there are still several options and surgery may still be a possibility. Once the cancer has spread too far, as in stage II or stage IV mesothelioma, surgery becomes riskier and less effective. During stage II, 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.

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 II patients.

Stage II 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.

Stage II Mesothelioma Prognosis

Among all mesothelioma patients the median survival time after a stage II diagnosis is 19 months. This can vary widely by individual, though, and depends on several factors. The cell type of the mesothelioma, the location of the original tumor, the age and overall health of the patient all affect survival times.

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. The prognosis for mesothelioma of any type is not usually positive, but with research into more advanced treatments, patients at stage II have more hope than ever before.

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