Stage 2 Pleural Mesothelioma

Quick Summary

Stage 2 pleural mesothelioma develops when the cancer spreads locally and symptoms become more obvious. Patients with stage 2 mesothelioma still have a similar prognosis to stage 1. Treatments include radiation, chemotherapy, and surgery.

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What is Stage 2 Pleural Mesothelioma?

Stage 2 malignant pleural mesothelioma means that the cancer has spread from its origin point. Tumors have grown to other areas of the lung tissue, lining of the lung, diaphragm or pericardium.

However, the cancer is still located on one side of the chest and the patient often has few symptoms. If the patient has symptoms, they are usually vague symptoms like cough, chest pain or weight loss. The doctor may not even suspect that there is cancer in the chest unless symptoms persist.

Without treatment, the cancer can progress into more advanced mesothelioma stages. These later stages limit treatment options and overall survival.

Stage 2 Symptoms

In stage 1 mesothelioma, many patients hardly notice their symptoms since the cancer is in such an early stage. This can also be true of stage 2 patients, which accounts for why some people go undiagnosed for so long.

Symptoms you may notice in stage 2 mesothelioma include:

  • Lumps in chest
  • Pain when breathing
  • Shortness of breath
  • Unexplained weight loss

During stage 2 mesothelioma, symptoms are still relatively manageable without treatment. But even at this stage, doctors recommend palliative treatments to diminish the severity of symptoms, ease pain, and make patients more comfortable.

Doctors often prescribe palliative treatment alongside curative treatment. Palliative care can also make it easier to cope with the side effects of treatment.

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Doctors use symptoms to make early judgments, but only imaging scans can reveal tumors. Those tumors must further be tested through biopsy and pathology tests to identify it as mesothelioma.

With all these steps complete, doctors can confirm a mesothelioma diagnosis and properly stage your disease.

The TNM Staging System

There are several systems for staging mesothelioma. One of the most agreed upon is the TNM system. This acronym stands for “tumor, node, and metastasis.” This system is used by the American Cancer Society (ACS).

Each facet of this ranking system gets a different rating based on the tumor’s location and the degree to which it has spread. This not only helps doctors determine your stage but your treatment, too.

Here is a quick breakdown of the TNM system:

  • (T) Tumor: Your doctor looks at the size of your tumors. They also examine the nearby tissues the tumors have spread to.
  • (N) Node: Mesothelioma spreads through the lymph system. When it reaches the lymph nodes, the cancer gets trapped. Doctors use this to measure how far your disease has traveled. Stage 2 patients have no lymph node involvement.
  • (M) Metastasis: Doctors look for mesothelioma in distant organs. Stage 2 patients also have no signs of metastasis.

The node and metastasis groups are rated as N0 and M0 in stage 1 and 2 mesothelioma. This means your cancer hasn’t yet begun to spread beyond its origin.

The tumor group in the TNM system has ratings from T0 (no sign of tumor at the origin) to T4 (the tumor is inoperable). Stage 2 patients receive a rating of T2. This means the tumor is in the lining of the chest wall, diaphragm, and lung. It has also grown into either the lung or diaphragm.

A lung removal surgery called an extrapleural pneumonectomy (EPP) or a lung-sparing surgery called a pleurectomy with decortication (P/D) can remove these tumors from the chest cavity.

Did you know?

Patients who are properly staged get more benefits from surgery. Studies have shown that mesothelioma surgery is more effective when your doctor knows your full background. Your doctor should be aware of any cancer in nearby lymph nodes and the pathological makeup of your tumors. This is why it’s important to see a specialist.


Surgery is the best aggressive treatment for stage 2 pleural mesothelioma.

Many people have an EPP or a P/D to get rid of as many tumors as possible. The type of surgery may depend on your doctor's opinion or your specific condition.

Surgery is often followed by chemotherapy and radiation therapy. These mesothelioma treatments will hopefully kill off any leftover mesothelioma cells in the body.

Newer treatments are becoming available through clinical trials. Immunotherapy for pleural mesothelioma was approved after being studied in these trials for years.

Immunotherapy trains the body to destroy cancer cells within the pleura (lung lining), abdominal cavity, and beyond.

Consult with a doctor who can help develop the right treatment plan to improve your survival time.


The chances of survival for people with stage 2 mesothelioma are better than most patients.

The median life expectancy for those with stage 2 disease is 19 months. This means that half of all people will live shorter than 19 months and half of all patients will live longer than 19 months.

Stage 2 patients also need to consider their cell type in mesothelioma prognosis. Cell type can be more important in your prognosis than your stage.

Most stage 2 patients have epithelioid cancer cells. This cell type has the best prognosis. Biphasic and sarcomatoid cell types spread faster. Patients with non-epithelioid cell types may advance in stage faster than other stage 2 patients.

Did you know?

The late Dr. David Sugarbaker led a study of 636 mesothelioma patients to find factors that led to long-term survival in mesothelioma patients. The study, published online in 2011, specifically analyzed patients who underwent an EPP. Results indicated that more than 100 stage 2 patients survived between 36.4 and 169.8 months, or between 3 and 14 years.

Some doctors hesitate to operate on patients with biphasic or sarcomatoid cell types. But stage 2 patients may still be good candidates for surgery. If your doctor says, ‘no’ to surgery, consider getting a second opinion.

The patients in the study mentioned above each had a good initial prognosis. Still, the results show that it’s possible to outlive your prognosis.

“The treatment of [pleural mesothelioma] is positioned for a major advance,” said the authors of the 2011 study.

Finding Treatment for a Longer Life

Some consider stage 2 mesothelioma as the first advanced stage because tumors have started to grow past their origin. Yet, stage 2 patients still have so many treatment options. From standard chemotherapy combinations to aggressive surgeries, there is something for you.

Points to consider about stage 2 mesothelioma:

  • Survival rates are improving every day.
  • Surgical treatment is the best way to improve your outlook.
  • Finding a specialist is the key to a longer life.

If you have been diagnosed with stage 2 mesothelioma, the time to act is now. Many patients diagnosed at this stage have reached remission. They accomplished this with a little luck and the best mesothelioma specialists they could find. There are people who can help you find a specialist in the VA and get you financial compensation for your disease. Get help from a VA claims agent now.

Veterans Support Team
Todd Gersten, MD PhotoReviewed by:Todd Gersten, MD

Double Board-Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Todd Gersten, MD is a double board-certified medical oncologist and hematologist specializing in general adult oncology and hematologic disease. He is a physician partner with the Florida Cancer Specialists and practices in Wellington, Florida.

Dr. Todd Gersten is an independently paid medical reviewer.

Christopher Dryfoos PhotoWritten by:

Contributing Author

Christopher Dryfoos is a journalist and member of the American Medical Writers Association (AMWA). As the grandson of the U.S. Navy’s first forensic pathologist, he aims to help veterans with mesothelioma access needed care.

View Sources


American Cancer Society. “Early Detection, Diagnosis, and Staging.” Retrieved from: Accessed on August 23rd, 2017.

European Journal of Cardiothoracic Surgery. “Predictors of long-term survival following radical surgery for malignant Pleural Mesothelioma.” Retrieved from: Accessed on August 23rd, 2017.

Sugarbaker, David J. European Journal of Cardiothoracic Surgery. “Clinical and pathological features of three-year survivors of malignant Pleural Mesothelioma following extrapleural pneumonectomy.” 2011. Retrieved from: Accessed on August 23rd, 2017.

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