Mesothelioma Stage 2

Summary

Stage 2 mesothelioma is the second earliest stage of asbestos-caused cancer. Tumors that first developed in the mesothelium (organ linings) have metastasized slightly into the deeper lung tissues or into the diaphragm. Stage 2 mesothelioma patients still have important treatment options that can control and stop the disease from spreading further.

Overview of Stage 2 Mesothelioma

  • Second least advanced stage of the 4 mesothelioma stages
  • Pleural mesothelioma is the only disease form with official stages, but similar staging criteria can be applied to peritoneal and pericardial mesotheliomas
  • In stage 2, the tumor is no longer localized as it has spread slightly beyond the primary location
  • Stage 2 diagnosis is rare as most cases are diagnosed at stage 3
  • Patients may not display symptoms at stage 2 mesothelioma
  • Stage 2 mesothelioma has a better prognosis compared to late-stage mesothelioma
  • Doctors treat stage 2 mesothelioma with a combination of surgery, chemotherapy and radiation therapy

What is Stage 2 Mesothelioma?

Stage 2 mesothelioma is the second least advanced stage of 4 mesothelioma stages and is considered an early stage in the disease. It refers a level of disease progression whereby the tumors are still contained in one area of the chest but have slightly metastasized outside the pleura—the tissue lining of the lungs.

The point where tumors first start to develop in the protective tissue linings, such as the pleura, peritoneum or pericardium, is called the primary location. In stage 1, the tumors have not spread beyond this initial point of origin. However, by stage 2, the tumors have started to grow outside the mesothelium and into the next layer of deeper organ tissues. When tumors spread outside their primary location, it’s called metastasis. Different factors affect the rate of metastasis as some mesothelioma cell types spread more quickly than others.

To diagnose stage 2 mesothelioma, doctors use imaging scans like X-rays, CT scans, PET scans and MRIs to look inside the patient. Images show doctors exactly how much metastasis is involved so that they can appropriately determine their patient’s disease stage. With stage 2 patients, doctors can see from the images that tumors have spread slightly beyond the primary location. With this information, they know where and how to surgically remove the mesothelioma.

Stage 2 Mesothelioma Prognosis and Life Expectancy

The general mesothelioma prognosis (disease outlook) is poor. However, the stage 2 mesothelioma prognosis is relatively good. The average life expectancy of mesothelioma patients is 12-21 months. Stage 2 pleural mesothelioma patients are at the upper end of this range.

The average life expectancy for stage 2 mesothelioma 19 months. Patients can improve their prognosis with curative surgeries, chemotherapy and radiation therapy.

MJN Brief

Most stage 2 mesothelioma patients are deemed good candidates for curative surgery because the disease is still early enough that doctors have a high likelihood of removing the mesothelioma (resectable cancer). According to various studies, stage 2 mesothelioma patients survive an average of 2 years after curative surgery.

Stage 2 Mesothelioma Symptoms

Early-stage mesothelioma is generally asymptomatic—meaning patients display no signs or symptoms of the disease. The asymptomatic nature of stage 2 mesothelioma makes it extremely difficult to detect and diagnose at such an early stage. Therefore, a stage 2 mesothelioma diagnosis is rare.

However, some patients do notice early symptoms, which can lead to a stage 2 diagnosis.

If you have been diagnosed with stage 2 pleural mesothelioma, there are signs or symptoms you may be experiencing:

  • Dry, persistent cough
  • Chest pain
  • Fluid buildup in the chest (pleural effusions)
  • Shortness of breath
  • Fever
  • Weight loss

When patients do report any of the above symptoms, it’s highly likely doctors will misdiagnose it as a respiratory condition like pneumonia, bronchitis, emphysema or chronic obstructive pulmonary disorder (COPD). It’s unlikely doctors will suspect malignancy (cancer) at this point because metastasis is so limited in stage 2 mesothelioma.

However, in some cases, doctors may order chest x-rays thinking their patient has a condition like COPD or pneumonia. If the chest x-rays reveal pleural effusions or abnormal tissue masses, then doctors may suspect cancer. Pleural effusions are a strong indicator of pleural mesothelioma because 90% of patients exhibit this sign.

All patients should report details of their history of asbestos exposure to their doctor. With asbestos being the only cause of mesothelioma, knowing about your history of working or living around this toxin is extremely helpful in identifying mesothelioma sooner.

Stage 2 Mesothelioma Treatment Options

Because doctors consider stage 2 mesothelioma an early stage of the disease, patients have important treatment options that can provide the best chance at survival. Because the tumor has no significant metastasis to distant sites, doctors will completely remove the tumor and take measures to prevent recurrence—when the mesothelioma comes back after treatment. Stage 2 mesothelioma patients have the possibility of achieving remission, which is when doctors can no longer detect any signs of mesothelioma.

Mesothelioma specialists are doctors who have spent decades researching and treating mesothelioma. Because they know that it’s such a highly complex cancer, doctors are careful to never apply a one-size-fits-all solution.

All stage 2 mesothelioma patients are put on individualized treatment plans, which may include the following options:

Extrapleural Pneumonectomy

One of two surgery options for stage 2 pleural mesothelioma patients, the extrapleural pneumonectomy (EPP) is considered a radical procedure. During the EPP, the surgeon removes the affected lung, the pleura (lining of the lung and/or chest wall), the pericardium (heart lining), part of the diaphragm, and nearby lymph nodes in between the two lungs.

While many patients can still live a high quality of life with one lung, there is a debate in the medical community over the radical nature of this procedure. Many specialists feel that it’s unnecessary to remove the lung and that this surgery can pose a high risk of complications to the patient. The EPP has been highly refined over the years and is still considered by many specialists to be the correct choice for certain patients.

Pleurectomy With Decortication

The second of two stage-2 pleural mesothelioma surgeries, the pleurectomy with decortication (P/D) is called a lung-saving surgery. During the P/D, the surgeon leaves the lung and only removes the diseased pleura and any surrounding tumors. Because stage 2 pleural mesothelioma patients may have slight metastasis into the lung, surgeons also remove part of the lung tissue as needed. By removing the diseased pleura and surrounding tissues, doctors prevent further metastasis to distant sites.

Ultimately, the choice between the EPP vs. P/D is up to you and your medical team. It’s a decision that should be based on your unique case and what will give you the greatest chance at long-term survival after the surgery.

Chemotherapy and Radiation Therapy

All stage 2 mesothelioma patients undergo radiation therapy and/or chemotherapy in conjunction with their surgery. As anti-cancer therapies, chemo and radiation are important treatments to stop the spread of mesothelioma from any cells left behind after surgery. Chemotherapy and radiation can be administered before surgery (neoadjuvant therapy) or after surgery (adjuvant therapy).

One approach with excellent survival rates is called SMART—surgery for mesothelioma after radiation therapy. By administering radiation therapy before the EPP surgery, doctors can prevent seeding, which is when mesothelioma cells move around during surgery. SMART ultimately helps improve remission rates by minimizing the chance of recurrence.

Stage 2 Mesothelioma Specialists

It’s vital for stage 2 mesothelioma patients to seek consultation from a mesothelioma specialist. A specialist is a doctor whose focus is on researching and treating mesothelioma. Unlike, general oncologists, specialists see hundreds of cases of mesothelioma and have the expertise to develop individualized treatment plans for each patient.

If you’ve been diagnosed with stage 2 pleural mesothelioma, then you may be eligible to receive legal compensation. As victims of asbestos exposure, mesothelioma patients can file claims against negligent companies. Successful claims can provide you with compensation to cover your treatment costs and other expenses associated with your diagnosis.

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Sources
  1. American Cancer Society, “Malignant Mesothelioma Stages” Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/staging.html. Accessed on January 2, 2018.
  2. General Thoracic and Cardiovascular Surgery, “Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma.” Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153961/. Accessed on January 2, 2018.
  3. Medscape, “Surgery for Malignant Pleural Mesothelioma.” Retrieved from: https://www.medscape.com/viewarticle/724140. Accessed on January 2, 2018.

Last modified: February 14, 2018