Characteristics of Stage 2 Mesothelioma

Stage 2 mesothelioma means the cancer has begun spreading outside the original location. The spread includes nearby lymph nodes.

Pleural mesothelioma is at stage 2 or higher when there is hilar lymph node involvement. These lymph nodes, also known as N1 lymph nodes, are located at the root of the lung.

Peritoneal mesothelioma has no formal staging system. Doctors often define it as stage 2 if there is local tumor growth and some lymph node involvement.

Two important characteristics of stage 2 pleural mesothelioma:

  • Tumors developed in the membrane lining the chest cavity and surrounding the lungs.
  • Cancer cells have spread into nearby lymph nodes.
Stage 2 mesothelioma tumor progression
Stage 2 mesothelioma spreads locally and develops in nearby lymph nodes.

Tumor cells in the hilar lymph nodes is the main difference between stage 2 and stage 1 disease.

In stage 1, cancer cells have not yet reached lymph nodes. Tumors in stage 2 may or may not have grown into the the diaphragm or into the lung tissue.

Multimodal therapy can benefit stage 2 pleural and peritoneal mesothelioma patients.

This treatment combines surgery, chemotherapy and radiation therapy. Patients must be healthy enough to endure an aggressive treatment plan.

Clinical trials provide promising therapies for stage 1 or stage 2 mesothelioma patients.

Stage 2 Mesothelioma Facts
  • Two-year survival rate is about 38%.
  • Typically causes no major symptoms.
  • Tumor-removing surgery recommended for eligible patients.
  • Surgery is usually supported by chemotherapy and radiation therapy.

Stage 2 Mesothelioma Symptoms

In most cases, mesothelioma symptoms do not directly present themselves in stage 2. When people do notice symptoms they are typically minor and may include:

  • Chronic coughing
  • Slight breathing issues
  • Minor chest pain

Less commonly, some people with stage 2 disease may experience a fever.

Symptoms may be mistaken as signs of a less serious illness, such as flu, pneumonia or bronchitis.

Tumor growth or a buildup of fluid in the pleura may cause symptoms. These two issues constrict the lung and cause pain. This is more common with stage 3 or stage 4 disease.

Why Is Stage 2 Mesothelioma Difficult to Diagnose?

Stage 2 mesothelioma is tough to diagnose because it has a long latency period. Decades pass between initial asbestos exposure and cancer development. Once it begins to develop, it can grow quickly without causing symptoms until stages 3 or 4.

Doctors diagnose mesothelioma cases after the cancer has already spread beyond stage 2. But this is not always the case.

Cancer screenings identify some stage 2 cases. More often, doctors find cases when checking a patient’s chest for an unrelated reason.

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Life Expectancy for Stage 2 Mesothelioma

Each patient’s life expectancy depends on many factors. Their overall health and the specific cell type of their cancer play important roles.

Pleural Mesothelioma Stage 2 Survival Rates

2-year survival rate5-year survival rate
Stage 238%11%

“People now being diagnosed with MPM may have a better outlook than these numbers show,” the American Cancer Society explains. “Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.”

Survival rates reveal the seriousness of this diagnosis. But they cannot predict the outcome for an individual patient. That’s because every patient’s case is different.

Patients with stage 2 peritoneal mesothelioma tend to have better survival rates than patients with pleural disease.

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Is Stage 2 Mesothelioma Curable?

Unfortunately, no stage of mesothelioma is curable. But therapies can control the cancer to help people live longer with mesothelioma.

Pleural mesothelioma is an aggressive disease. Most patients do not survive longer than two years after diagnosis. Stage 2 mesothelioma has a better prognosis than more advanced stages of the cancer.

Patients with stage 2 peritoneal mesothelioma may be eligible for surgery. They may also qualify for heated intraperitoneal chemotherapy. This treatment is also known as HIPEC. About 50% of peritoneal patients who receive HIPEC will be alive five years after diagnosis.

Doctors and researchers are testing new drugs and treatment approaches. Their goal is to help patients manage the cancer as a chronic disease, rather than a terminal illness.

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Stage 2 Mesothelioma Treatments

Stage 2 mesothelioma treatment options include surgery, chemotherapy and radiation therapy. Doctors also use multimodal therapy, which is a combination of treatments.

A 2022 study on stages 1 and 2 pleural mesothelioma patients found multimodal therapy safe and effective at improving survival. Participants underwent induction chemotherapy, surgery, postoperative radiation therapy and chemotherapy.

Researchers reported a median overall survival of 32.1 months. That figure surpassed the average 12-month survival.

Clinical trials also offer experimental treatments such as immunotherapy.


Extrapleural pneumonectomy and pleurectomy with decortication are the two main surgical options.

A patient’s overall health and cancer spread determine which option doctors choose.


The chemotherapy combination of Alimta and cisplatin or carboplatin is the most common treatment for pleural mesothelioma.

For patients with stage 2 peritoneal mesothelioma, chemotherapy can be circulated throughout the abdominal cavity during surgery to remove visible tumors.

While experimental, chemotherapy has been used to shrink tumors to an earlier stage of development to operate on a patient.

In a 2020 report published in General Thoracic and Cardiovascular Surgery, a stage 3 patient who responded well to chemotherapy was downstaged to stage 2 and subsequently qualified for aggressive surgery. The patient was alive at 30-month follow-up and undergoing another round of chemotherapy to combat a recurrence.

Radiation Therapy

Doctors may use radiation to shrink tumors before surgery. They can also use it to prevent local recurrence after surgery. Radiation therapy can ease symptoms and improve quality of life.

Clinical Trials

Many people diagnosed with stage 2 mesothelioma qualify for clinical trials. These trials test gene therapy and novel combinations of chemotherapy drugs. Patients often have to be healthy enough to volunteer for these research studies.