Stage 1 & Stage 2 Mesothelioma

During the early stages of mesothelioma, the cancer is contained in or near the point of origin. Patients are rarely diagnosed at this point, but for those fortunate enough to be diagnosed early, several treatment options are available to improve prognosis and extend survival.

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This page features: 11 cited research articles

Patients diagnosed with mesothelioma at stages 1 or 2 — also expressed with Roman numerals as stage I and II — have a more favorable prognosis than late-stage patients.

This is mainly because there is less of the cancer present in its early stages. Therefore, surgery, radiation and chemotherapy can all be more effective at controlling the disease and prolonging life.

In stage 1 pleural mesothelioma, tiny tumors develop along the lining of one lung. Stage 2 develops when the tumors start spreading to the underlying lung tissue or the diaphragm. The lungs and lymph nodes do not contain cancer cells at these early stages.

Diagram shoing the early stages of mesothelioma

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Stage 1 is the only mesothelioma stage divided into two categories: 1a and 1b. This distinguishes the layer of the pleural lining where tumors begin to form. Tumors on the parietal pleura, which is the outer layer closest to the chest wall, are given a stage 1a diagnosis. When tumors also involve the visceral pleura, which is the outermost layer of the lung, a diagnosis of stage 1b is given.

A 2017 review of 1a and 1b patient survival found no significant difference between these tumor stages, compelling researchers to consider revising stage 1 into a single category without subcategories. Mesothelioma Guide

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Treatment Options for Early Stages

Compared to patients in other stages of mesothelioma, patients diagnosed in the early stages have the most treatment options available. A multimodal approach combining surgery, chemotherapy and radiation therapy is recommended for stage 1 and 2 patients in sufficiently good health to handle the aggressive treatment plan. Patients who undergo multimodal therapy may live years beyond the average mesothelioma prognosis.


The two most common surgery options for mesothelioma patients are a pleurectomy/decortication (P/D) procedure and an extrapleural pneumonectomy (EPP). The recommended surgery will depend on the extent of disease spread, overall health of the patient and the physician’s medical opinion.

Learn more about mesothelioma surgeries

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


Chemotherapy is usually given after a patient recovers from surgery to kill any remaining cancer cells thatare suspected to be present. Some treatment plans use chemotherapy to shrink tumors before surgery. Many chemotherapy drugs can result in side effects such as fatigue, hair loss and nausea.

Learn more about chemotherapy

Radiation Therapy

Doctors traditionally use radiation therapy after surgery to prevent local recurrence. New research suggests applying radiation therapy before surgery might significantly improve survival rates for certain patients. Radiation therapy has also helped 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.

Learn more about radiation therapy

Clinical Trials

Eligibility varies for mesothelioma clinical trials, but many early stage patients qualify because the cancer hasn’t negatively impacted their overall health as when it is found at more advanced stages. These voluntary research studies test chemotherapy drug combinations, immunotherapy treatments, genetic therapies and treatment combinations not yet approved by the U.S. Food and Drug Administration for mainstream use.

Learn more about mesothelioma clinical trials

Early Stages of Peritoneal Mesothelioma

There is no definitive staging system for peritoneal mesothelioma, but patients diagnosed before the tumors spread outside the lining of the abdomen have a better outlook.

Peritoneal mesothelioma patients in the early stages of the cancer may benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, also known as HIPEC. This multimodal treatment combines the process of heating chemotherapy drugs and delivering them to the abdomen directly following surgery.

Learn more about peritoneal mesothelioma

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Common Symptoms of Early Stages

Mesothelioma is rarely diagnosed in the early stages of development because symptoms seldom arise that would prompt someone to get medical attention. The cancer has an unusually long latency period, meaning it can take decades after initial asbestos exposure before the cancer even beings to develop. Stage 1 cases, in particular, often are discovered accidentally.

Symptoms for stage 1 and 2 are mild and resemble less serious lung conditions such as pneumonia. Stage 1 patients may not experience any symptoms, while those diagnosed with stage 2 may feel chest pain or have difficulty breathing as a result of tumor growth or trapped pleural fluid.

Other early symptoms include:

  • Shortness of breath
  • Chronic cough
  • Weight loss
  • Fever
  • Body aches

Life Expectancy for Early Stage Mesothelioma

The survival difference between the first two stages isn’t as significant as the variances between stages 2, 3 and 4. Early stage patients who undergo surgery may live longer than three years, according to the research of mesothelioma specialists Dr. Raja Flores and Dr. Valerie Rusch.

Mesothelioma is considered a heterogeneous disease, meaning no two cases are alike. Certain patients respond better to treatment and will far surpass the average survival statistics.

Catching the cancer early is a major factor that helps people with stage 1 or 2 live much longer than people with late-stage mesothelioma.

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Michelle Whitmer, Content Writer at

Joining the team in February 2008 as a writer and editor, Michelle Whitmer has translated medical jargon into patient-friendly information at for more than eight years. Michelle is a registered yoga teacher, a member of the Academy of Integrative Health & Medicine, and was quoted by The New York Times on the risks of asbestos exposure.

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  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. and 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. 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
  4. 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.
  5. Rusch, V. et al. (2001, April 19). A Phase II Trial of Surgical Resection and Adjuvant High-dose Hemithoracic Radiation for Malignant Pleural Mesothelioma. Retrieved from
  6. 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
  7. 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
  8. 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
  9. 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
  10. Yan, T., Cao, C. & Munkholm-Larsen, S. (2010, February 15). A Pharmacological Review on Intraperitoneal Chemotherapy for Peritoneal Malignancy. World Journal of Gastrointestinal Oncology. Retrieved from
  11. 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
  12. National Comprehensive Cancer Network. (2014). NCCN Guidelines for Patients: Malignant Pleural Mesothelioma. Retrieved from
  13. Tannapfel, A. (2011). Malignant Mesothelioma: Recent Results in Cancer Research. Springer: Berlin.
  14. Rusch, V. (2017). Update on the mesothelioma staging system. Journal of Thoracic Oncology; 12(1):S30-S31. doi: 10.1016/j.jtho.2016.11.031
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