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Stage 2 Mesothelioma

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Stage 2 mesothelioma means cancer cells may not have spread far, but they are entering nearby lymph nodes. Stage 2 prognosis may still be favorable, and there are plenty of treatments available to extend life expectancy. The 2-year survival rate for patients at this stage is around 38%.

Dr. Jacques Fontaine describes mesothelioma surgery and who are the best candidates for this type of treatment.
Dr. Jacques Fontaine describes mesothelioma surgery and who are the best candidates for this type of treatment.
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Characteristics of Stage 2 Mesothelioma

Once mesothelioma cells have spread to hilar lymph nodes, the case is considered stage 2 or higher, even if the main tumor growths are still very small.

Hilar lymph nodes, also known as N1 lymph nodes, are located at the root of the lung.

There are two important characteristics of stage 2 pleural mesothelioma:

  • Tumors have developed in the membrane lining the chest cavity and surrounding the lungs
  • Cancer cells have spread into 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. In stage 2, tumors may or may not have grown into the breathing muscle under the lungs (the diaphragm) or into the lung tissue.

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.

Stage 2 pleural and peritoneal mesothelioma patients can benefit from multimodal therapy that combines surgery, chemotherapy and radiation therapy. They must be healthy enough to endure an aggressive treatment plan.

Multimodal therapy currently is the gold standard for mesothelioma treatment. It has helped some patients live years beyond the average prognosis.

Early-stage patients with stage 1 or stage 2 mesothelioma often have a number of promising experimental therapies available to them as well.

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.

If symptoms do arise, they are easily mistaken as signs of a less serious condition, such as flu, pneumonia or bronchitis.

Symptoms can be caused by tumor growth or a buildup of fluid in the pleura (known as pleural effusion), which constricts the lung or causes pain. This is more common with stage 3 or 4 disease than with stage 2 mesothelioma.

Why Is Stage 2 Mesothelioma Difficult to Diagnose?

Mesothelioma 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 stage 3 or 4.

Most mesothelioma cases are diagnosed after the cancer has already advanced beyond stage 2, though sometimes this is not the case.

Some stage 2 cases are discovered through cancer screening. More often they are found by chance when a doctor checks 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 rate 5-year survival rate
Stage 2 38% 11%

Researchers calculate what percentage of stage 2 patients survived at least two years and at least five years. This is based on the statistics from thousands of patients diagnosed in recent years.

These survival rates reveal the seriousness of this diagnosis. However, because every patient is different and treatment technology has changed since these statistics were collected, these survival rates cannot predict the outcome for an individual patient.

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

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

Your lymph nodes are a series of filters that keep germs out of your bloodstream. Once cancer cells reach the lymphatic system, they can spread into the bloodstream and throughout the body.

Is Stage 2 Mesothelioma Curable?

Unfortunately, no stage of mesothelioma is considered 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 carries a better prognosis than more advanced stages of the cancer.

Patients with stage 2 peritoneal mesothelioma may be eligible for surgery and heated intraperitoneal chemotherapy, which 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 in hopes of finding a way to control and ultimately defeat mesothelioma. The goal is to help patients manage the cancer as a chronic disease rather than a terminal illness.

Their efforts have allowed some mesothelioma survivors to outlive the average life expectancy for mesothelioma by years.

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Stage 2 Mesothelioma Treatments

Stage 2 mesothelioma is treated with surgery, chemotherapy and radiation therapy.

Even with lymph node involvement, there are effective treatment options available to early-stage mesothelioma patients. Clinical trials offer experimental treatments such as immunotherapy.


There are two main surgical options for removing pleural mesothelioma tumors. The difference comes down to whether or not surgeons have to remove one of the patient’s lungs to eliminate all detectable the cancer.

Each patient’s medical team must create a treatment plan based on the patient’s overall health and how far the cancer has spread.


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

Doctors may use drugs to shrink tumors before surgery or kill remaining cancer cells after surgery. Patients not eligible for surgery may benefit from chemotherapy as a stand-alone treatment.

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 down to an earlier stage of development in order 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

Radiation can be used to shrink tumors before surgery or prevent local recurrence after surgery. Radiation therapy also can be used palliatively, to alleviate symptoms and improve quality of life.

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Clinical Trials

Patients can access cutting-edge treatments through clinical trials. These trials test immunotherapy, gene therapy and novel combinations of chemotherapy drugs.

Patients often have to be relatively healthy to volunteer for these research studies. Many people diagnosed with stage 2 mesothelioma qualify for clinical trials.

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Registered Nurse and Patient Advocate

Karen Selby joined in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the regional director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators.

Walter Pacheco, Managing Editor at
Edited by
Dr. Jacques Fontaine
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12 Cited Article Sources

The sources on all content featured in The Mesothelioma Center at include medical and scientific studies, peer-reviewed studies and other research documents from reputable organizations.

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Last Modified August 26, 2020

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