Stage 2 mesothelioma is the early stage of the disease because cancer has just begun to spread. Patients have curative treatment options, with an average prognosis of 19 months.
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- Stage 1 mesothelioma 2 indicates that cancer has spread to the lymph nodes.
- The symptoms become more noticeable and intense at this stage.
- Curative treatment is still possible at this stage, usually through a multimodal plan.
- About 25% of patients diagnosed at stage 2 mesothelioma survive for at least 2 years.
Stage 2 mesothelioma indicates an early stage of the disease because there are limited, localized metastases in organs and tissues near the primary tumor. When diagnosed at an early stage, patients have more treatment options, including curative surgery. Although the prognosis is still poor, patients have a better chance of survival with more aggressive treatment.
Stage 2 Mesothelioma By Type
The patient’s prognosis is greatly influenced by the type of mesothelioma and the stage of the disease. At this stage, with all forms of mesothelioma cancer, patients likely still have curative surgery and other conventional treatments to remove visible tumors and prevent cancer from spreading further.
Stage 2 Pleural Mesothelioma
Malignant pleural mesothelioma is the only form of asbestos cancer that has its own staging system because it is the most commonly diagnosed. The TNM system, the Brigham system, and the Butchart system can all be used to correctly stage mesothelioma, although the TNM system is the most commonly used and updated. Researchers using the system identify the extent and size of existing tumors, whether cancer has spread to nearby lymph nodes, and whether it has metastasized to distant sites.
In the latest update, researchers describe stage 2 mesothelioma as T1-2N1. This means that the cancer is only in the pleura on one side of the chest (T1) or has spread locally to the lung itself or the diaphragm (T2). Stage N1 signals that the mesothelioma cells have spread to nearby lymph nodes on the same side of the body, but there is no distant spread. In a three-stage system, researchers agree that stage 2 mesothelioma indicates that the disease is still respectable.
Stage 2 Peritoneal Mesothelioma
Peritoneal mesothelioma, which develops in the lining of the abdominal cavity, does not have its own staging system due to its rarity. Instead, doctors rely on the broader features of stage 2 mesothelioma, including localized tumors and limited metastases, which may include lymph node involvement.
Doctors may also refer to the Peritoneal Cancer Index (PCI), which is another broad staging tool for abdominal cancer. The abdomen is divided into regions and scored to describe whether tumors are present and their size. Scores from all regions are totalled, which doctors can use to approximate the stage. According to the researchers, a score of 11 to 20 indicates stage 2 mesothelioma.
In stage 2 mesothelioma, doctors can still offer one of the most successful multimodal treatments for peritoneal mesothelioma: cytoreductive surgery and hyperthermia intraperitoneal chemotherapy (HIPEC). This combination therapy involves the mesothelioma specialist first removing all visible tumors, followed by an intense chemotherapy washout in the abdomen, hopefully eliminating any other mesothelioma cells present. Some clinical trials have shown that surgery with HIPEC improves the 5-year survival rate to at least 50%, with some studies showing a median survival of 92 months or more.
Because pericardial mesothelioma is rare, there is no widely accepted staging system for this form of cancer.
Mesothelioma Stage 2 Symptoms
Since there are some metastases that appear in stage 2, patients may experience more noticeable symptoms. However, the symptoms are non-specific and may not be very bothersome in this early stage, making it easy for patients to ignore potential signs of mesothelioma or face a misdiagnosis. Especially in its early stages, mesothelioma can be mistaken for a common illness like the flu.
Stage 2 Mesothelioma Symptoms
- persistent cough
- Chest pain
- Air failure
- Unexplained weight loss
Stage 2 Mesothelioma Prognosis
Early diagnosis of mesothelioma is the best chance for long-term survival. Patients with mesothelioma diagnosed at stage 2 have an average life expectancy of 19 months, which can potentially be extended with conventional and new treatments. A patient’s prognosis also varies depending on the type and cell type of mesothelioma, gender, age, general health, and 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, such as chemotherapy, and new treatments, such as immunotherapy.
Treatment Of Stage 2 Mesothelioma
When diagnosed at an early stage, mesothelioma patients usually have more treatment options. Since the cancer has limited spread, surgery to remove the tumor is often recommended along with other treatments such as chemotherapy and radiation therapy. In most cases, at this stage, treatment is curative, although some therapies may be used palliatively to help ease symptoms.
In the early stages, mesothelioma specialists often use aggressive surgeries to remove as many tumors as possible and delay the progression of the disease. Patients with pleural mesothelioma, for example, may undergo a pleural decortication or extra pleural pneumonectomy to remove the diseased membrane and visible tumors. Researchers have found that these surgeries can increase the 2-year survival rate from 19% with chemotherapy alone to 40%. However, it is important to note that these operations are more invasive and risky than other types of treatment.
Chemotherapy is considered the standard of care for mesothelioma and is often used in combination with other treatments. Many times, mesothelioma surgeries are followed by chemotherapy to kill any remaining cancer cells. A multimodal treatment plan has successfully prolonged survival in some patients, such as surgery and HIPEC, which achieved a median survival of 53 months in various clinical trials.
Researchers have found that chemotherapy alone is not always the most effective in prolonging life, with some clinical trials showing a median survival of 16 months for patients with pleural mesothelioma treated with standard Alimta and cisplatin. However, additional clinical trials have shown that systemic chemotherapy can prolong survival from about 12 months to 39 months for patients with recurrent mesothelioma who have previously been treated with radical surgery and chemotherapy.
Radiation is sometimes recommended along with surgery and chemotherapy in patients diagnosed at an early stage. 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 progresses to advanced stages and spreads to more distant organs of the body.
In Clinical Trials
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 non-surgical pleural mesothelioma to include immunotherapy. For decades, first-line treatment has been a combination of chemotherapy, but now includes triple therapy with the monoclonal antibody bevacizumab (Avastin).
Other types of immunotherapy have also shown success, such as personalized cancer vaccines. In early-phase clinical trials, researchers found that the treatment could extend survival by at least 24 months, with some patients surviving up to 55 and 60 months in the latest follow-up studies. With continued research into these new treatments, mesothelioma patients and their loved ones have more hope for extended survival.