Stage II Mesothelioma

Where Mesothelioma is Located in Stage II

At stage II, the cancer has not spread far from its origin, and treatments to remove it from the body are more effective. Symptoms could be mild and resemble less serious pulmonary diseases. Prognosis is not as good as in stage I, but it’s better than in late-stage cancer.

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  • Cancer is not too far from initial site.

  • Small tumors begin spreading to thin tissue beneath the lung.

  • Surgical options are effective and can extend survival.

Stage II is a designation of an early stage of cancer that responds well to surgery and traditional treatment. This stage has the second-best prognosis of all the stages.

In this stage, small tumors are growing on the lining of one lung and starting to spread to the underlying lung tissue or the diaphragm. The lymph nodes are free of cancer cells. The cancer remains localized within the chest.

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Symptoms of stage II may be mild and often resemble those of less serious lung illnesses like pneumonia. Shortness of breath, coughing, difficulty breathing and chest pain are sometimes felt at stage II. Pleural mesothelioma originates in the pleural lining, which is composed of two layers: One layer covers the lungs and one layer covers the chest wall. Symptoms are caused by the tumors that form on the pleural lining. Symptoms are also caused by the accumulation of fluid in the space between the two layers of the lining; this is called pleural effusion.

At stage II, tumors growing on the layers of the pleural lining thicken, and the space between the layers begins to disappear. A patient may feel chest pain or have difficulty breathing as a result of tumor growth or trapped pleural fluid.

  • Fever
  • Weight loss
  • Shortness of breath
  • Difficulty breathing
  • Cough or chest pain


A treatment plan using curative surgery, chemotherapy and radiation therapy has produced the best survival rates for people with stage II mesothelioma. Multimodal therapy is recommended to stage II patients who are in good enough health to handle the aggressive treatment approach.

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Extrapleural Pneumonectomy

At stage II, tumor spreading to the lung tissue or diaphragm may call for an extrapleural pneumonectomy surgery. During this surgery, the affected lung and its lining are removed. Half of the diaphragm, nearby lymph nodes and the heart lining may also be removed.

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Chemotherapy is most often given after surgery. Clinical trials are investigating the value of circulating chemotherapy drugs throughout the pleural space during surgery. This procedure is known as heated chemotherapy and is more commonly given to people with peritoneal mesothelioma.

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Radiation Therapy

Radiation therapy is most often given after surgery to reduce the risk of the cancer returning. New research suggests that applying radiation therapy before surgery might drastically improve survival rates for many patients. Radiation therapy has also helped to manage recurring mesothelioma tumors over extended periods of time. If the cancer returns, your doctor might recommend radiation therapy to keep the tumor under control.

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HIPEC for Peritoneal Mesothelioma

People with stage II peritoneal mesothelioma may greatly improve their long-term survival by opting for cytoreduction with HIPEC, an aggressive treatment option that combines surgery with heated chemotherapy.

For this procedure, doctors first perform surgery to remove as much visible tumor growth as possible, and then bathe the abdominal cavity with high-dose chemotherapy that is heated to improve its ability to kill cancer. A 2009 study involving more than 400 peritoneal patients treated with HIPEC reported a median survival of more than four years, with one patient surviving 19 years after the procedure.

Chemotherapy Drugs for Stage II

For the majority of people with stage II mesothelioma, doctors recommend first-line chemotherapy with the drugs cisplatin and pemetrexed. A key study found this treatment combination offers a median survival of 12.1 months, compared to only 9.3 months with cisplatin alone.

However, cisplatin-based regimens won't work for people with impaired kidney function or several other serious health conditions unrelated to mesothelioma. If you have one of these conditions, your doctor may suggest a cisplatin alternative to be given with pemetrexed.

Other first-line chemotherapy regimens for mesothelioma include:

  • Carboplatin and pemetrexed
  • Gemcitabine and cisplatin
  • Pemetrexed alone
  • Vinorelbine alone

Clinical trials have shown that carboplatin and pemetrexed appears equivalent to the standard cisplatin-pemetrexed regimen. Doctors also may recommend this combination to people with poor overall health that have trouble performing daily activities.

Complementary and Alternative Therapies

In addition to traditional cancer treatments, many long-term mesothelioma survivors used alternative and complementary therapies. Certain complementary therapies may help reduce symptoms or ease the side effects of cancer treatments, and some are even clinically proven to improve survival rates when combined with traditional cancer treatments.


Diagnosed with Stage II Mesothelioma? Consider the Following:

  • Few people are diagnosed as early as stage II. You may qualify for an aggressive treatment approach that could greatly improve survival.

  • Your overall health and lifestyle choices can impact survival. Take steps to improve or maintain good health. If you smoke, quitting will improve your lung function. Healthy lifestyle choices may also enhance your quality of life, such as improving your diet.

  • Be open to emotional support. Find a counselor or join the monthly online mesothelioma support group. It takes place on the second Wednesday of every month.

  • Helpful resources are available to anyone diagnosed with mesothelioma. Patient advocates are available to connect patients with resources.

  • Take time to relax and spend time with your family and friends. Travel, if possible, and make time for hobbies that bring you joy.

  • Remember that every case of mesothelioma is unique. Statistical averages cannot predict how long any person will live. People diagnosed at stage II respond better to treatment than most people diagnosed at a later stage. You could be one of the people who far outlive the average survival rate.


Stage II has the second-best prognosis of all the stages. Stage I and stage II patients who undergo curative surgery usually live longer than three years, according to research done by mesothelioma experts Dr. Raja Flores and Dr. Valeria Rusch.

Patients who qualify for surgery with a curative intent live longer than 22 months on average. About 28 percent of people diagnosed at stage II live longer than three years. Around 15 percent live beyond five years.

Stage 2 Prognosis Pie Chart

The survival difference between stage I and stage II isn't as significant as the difference between stage II and stages III and IV. Stage II is still considered an early stage cancer that responds much better to multimodal treatment than late-stage cancer. Additionally, mesothelioma is called a heterogeneous disease because every case is unique. Certain patients respond better to treatment and far surpass the average survival rates. Catching the cancer early is a major factor that helps people with stage II live much longer than people with late-stage mesothelioma.

Additional Resources

Karen Selby is a registered nurse and a Patient Advocate at The Mesothelioma Center. She worked in several subspecialties within nursing before joining in 2009.

  1. Cho, B.C.J., Feld, R., Leighl, N., Opitz, I., Anraku, M., Tsao, M., … & de Perrot, M. (2014). A feasibility study evaluating surgery for mesothelioma after radiation therapy: The “SMART” approach for resectable malignant pleural mesothelioma. Journal of Thoracic Oncology, 9(3): 397-402. doi: 10.1097/JTO.0000000000000078
  2. Flores, R.M., & Rusch, V.W. (2005). Staging of mesothelioma. In Pass, H.I., Vogelzang, N.J., & Carbone, M. (Eds.), Malignant Mesothelioma (pp.402-415). New York: Springer.
  3. Rice, D.C. (N/A). Staging of malignant pleural mesothelioma: A guide for patients. Retrieved from
  4. Rusch, V.W., & Giroux, D. (2012). Do we need a revised staging system for malignant pleural mesothelioma? Analysis of the IASLC database. Annals of Cardiothoracic Surgery, 1(4): 438-448. doi: 10.3978/j.issn.2225-319X.2012.11.10
  5. Rusch, V.W., & Venkatraman, E. (1999). Important prognostic factors in patients with malignant pleural mesothelioma, managed surgically. The Annals of Thoracic Surgery, 68(5): 1799-1804. doi: 10.1016/S0003-4975(99)01038-3
  6. Rusch, V.W., Giroux, D., Kennedy, C., Ruffini, E., Cangir, A.K., Rice, D., … & Meerbeeck, J.P. (2012). Initial analysis of the international association for the study of lung cancer mesothelioma database. Journal of Thoracic Oncology, 7(11): 1631-1639. doi: 10.1097/JTO.0b013e31826915f1
  7. Rusch, V.W., & Venkatraman, E. (1996). The importance of surgical staging in the treatment of malignant pleural mesothelioma. Journal of Cardiovascular Surgery, 111(4): 815-825. Retrieved from
  8. Schil, P.V., Carp, L., Hendriks, J., & Lauwers, P. (2008). Staging of malignant pleural mesothelioma. In Baldi, A. (Ed.), Mesothelioma from Bench Side to Clinic (357-366). New York: Nova Science Publishers, Inc.
  9. Yan, T., Cao, C. and Munkholm-Larsen, S. (2010, February 15). A Pharmacological Review on Intraperitoneal Chemotherapy for Peritoneal Malignancy. World Journal of Gastrointestinal Oncology. Retrieved from
  10. Vogelzang, N.J. et al. (2003). Phase III Study of Pemetrexed in Combination with Cisplatin Versus Cisplatin Alone in Patients with Malignant Pleural Mesothelioma. Retrieved from
  11. National Comprehensive Cancer Network. (2014). NCCN Guidelines for Patients: Malignant Pleural Mesothelioma. Retrieved from
  12. Tannapfel, A. (2011). Malignant Mesothelioma: Recent Results in Cancer Research. Springer: Berlin.

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