Mesothelioma is a highly aggressive, malignant cancer related to exposure to asbestos. If affects the mesothelium, a lining of certain organs and body cavities such as the lungs (pleural mesothelioma), abdomen (peritoneal mesothelioma), heart (pericardial mesothelioma) and testicles (testicular mesothelioma ). Stage 2 mesothelioma is considered to be more treatable than later stages.
The Second Stage
Stage 2 mesothelioma is the second most-advanced. Pleural and peritoneal mesothelioma the most common types of mesothelioma that are diagnosed at stage 2 Stage 2 mesothelioma still remains in the local tissue area but has traveled to some local lymph nodes. At stage 2, mesothelioma is likely to be treated aggressively and most patients will undergo surgery.
Major Characteristics of Stage 2 Mesothelioma
- Cancer is localized to originating area but has penetrated surrounding tissue and has spread to local lymph nodes. Symptoms vary from patient to patient and may include persistent coughing, fever and chest, chest, or abdominal pain.
- Treatment will generally be performed in a multi-modal approach with surgery and one or more additional treatments.
What to Expect
- Symptoms of Stage 2 mesothelioma may be continue to be confused with other but may include frequent cough, chest or abdominal pain, shortness of breath, fever, aches or localized lumps. Symptoms are more severe and persistent
- Mesothelioma diagnosis will be confirmed through imaging studies, blood testing and biopsy. Patients are advised to get a second opinion after diagnosis from a mesothelioma specialist who is familiar with treatment of the rare disorder.
- Curative surgeries may be performed during stage 2 to remove tumor and a healthy portion of tissue but surgical procedures are generally more aggressive, requiring that more tissue is removed. Chemotherapy and/or radiation is also generally advised. Most treatments are intended to remove tumor and kill any remaining cancer cells so that cancer will not spread.
- Palliative surgical procedures may also be performed to relieve symptoms and increase comfort. These surgeries may be performed to remove fluid buildup which is causing pain, organ compression and other symptoms or may be intended to remove as much of the tumor as possible for the same reason.
- A second opinion will help to confirm the appropriateness of treatment and ensure that all options are considered.
Stage 2 Symptoms
Mesothelioma cancer may not develop until years have passed after asbestos exposure has occurred. This is known as a long “latency time” which often makes diagnosis more difficult. Symptoms may be similar to other disorders and due to its rarity, mesothelioma is not often the first disease considered.
Symptoms of Stage 2 Mesothelioma may be variable in severity but include:
- Difficulty breathing or shortness of breath
- Persistent, frequent cough
- Chest or abdominal pain
- Swelling of the abdomen
- Lethargy and weight loss
Diagnosis of Stage 2 Mesothelioma
A diagnosis of mesothelioma at stage 2 has a better prognosis or survival outlook than when diagnosed at later stages. The cancer has penetrated local tissues but has not spread beyond the local area and has spread to some lymph nodes. The rarity of mesothelioma and the long latency time, make identification of the disease difficult. Symptoms may also mimic those of other diseases and misdiagnosis is not rare. When other diagnosis have proven to be incorrect, a number of diagnostic tools may be used.
- Medical history – a complete medical history with patient interview is one of the most important diagnositic tools. It will determine family history and the patient’s exposure to asbestos.
- Imaging studies – X-ray, CT and PET scans will readily show development of tumor and penetration of cancer cells.
- Blood testing – may identify certain proteins that are released into the blood stream by mesothelioma cancer cells. Biopsy – tissue to remove a small portion of the tumor will be examined microscopically to confirm the presence and identify the specific type of cancer cells. Biopsy will generally be performed using thoracotomy or laparotomy, possibly with camera assistance to make the surgery less invasive.
Stage 2 Treatment Options
Stage 2 mesothelioma will usually require aggressive treatment methods. Though Stage 2 patients have a better prognosis, the cancer is still quite fatal and multiple treatments may be required to improve the patient’s prognosis.
Depending upon the type of mesothelioma, Stage 2 treatment options include a combination of:
- Pleurectomy with Decortication (P/D) – removal of the pleura. It is less invasive but not as successful as more aggressive surgeries.
- Extrapleural Pneumonectomy (EPP) – removal of the affected pleura and entire lung along with a section of the diaphragm. It is more invasive but has a greater chance of success.
- Thoracentesis – palliative surgery to remove fluid that has accumulated between lungs and pleura which may reduce symptoms. Thoracentesis is not an attempt at a cure – but only to relieve symptoms
- Pleurodesis – to obliterate pleural space by forcing adherence of membranes surrounding lungs, preventing fluid buildup in pleural space. It is not a curative surgery but if oerformance is possible, it may help to reduce and prevent worsening of symptoms.
- Perinectomy with debulking– to remove tumor and portion of abdominal cavity lining. Depending on how advance the tumor growth has become, this surgery may not be possible.
- Cytoreduction – the removal of the mesothelium lining the peritoneal cavity. It may also include removal of the omentum which is an additional lining of the abdominal cavity, along with other abdominal tissue as required
- Paracentesis – to drain and remove fluid buildup which may reduce swelling, pain and other symptoms. Paracenteses is not intended as a cure but is performed only to relieve symptoms.
Surgery is commonly performed alongside other treatments in Stage 2 mesothelioma.
Chemotherapy is treatment with medication to eradicate or kill cancer cells.
Traditional chemotherapy – medications that are targeted to rapidly dividing cells. These medications vary in the way that they work and will be chosen depending upon the specific type of cells that exist in the mesothelioma tumor. Chemotherapy may be performed as an IV infusion, given as an oral medication or may be used intra-abdominally in peritoneal mesothelioma. Chemotherapy is commonly used with other treatments in stage 2 mesothelioma.
Chemotherapy is often used during Stage 1 mesothelioma treatment in combination with other treatments such as radiation or surgery.
Newer medications – medications which target mutations or specific DNA within cancer cells may be used to activate the immune system. Targeted medications may also be used when cancer cells show certain genetic traits. Some of these newer treatments are available only as part of an investigational or clinical trial. Medications and treatments used in clinical trials are often not yet approved by the Food and Drug Administration but may offer hope to some mesothelioma patients
If newer treatments are appropriate, they are often given in combination with other procedures.
Focused waves or beams of energy may be used to kill cancer cells. Energy is focused on the tumor site but depending upon tumor location, may not be appropriate. If the tumor is located too closely to vital organs such as the heart, radiation may not be possible.
If appropriate, radiotherapy is most commonly used alongside other treatments.
Palliative treatments are not used to “cure” mesothelioma but are intended simply to provide relief of symptoms. Palliative treatments may include surgery, chemotherapy or radiation to reduce tumor size or fluid drainage to remove fluid accumulation. Medications to manage pain and other symptoms may also be considered palliative care.
Stage 2 mesothelioma patients are undergoing the beginnings of metastasis but aggressive treatment may offer some hope. In many cases, the prognosis for the patient shows an average of a 16 month life expectancy but aggressive treatment may improve a patient’s chance of living for a longer period of time. There are differing opinions as to which options offer the most hope and that is why it is important to seek a second opinion from a mesothelioma expert who is experienced at treating the particular type of mesothelioma involved.
Mesothelioma Staging Systems for Stage 2
Depending on the specific cancer location, one of several staging “systems” may be used including the
TNM system – based on the assignment of numbers for (T) tumor size, (L) lymph node involvement and (M) for metastases. In most cases, TNM results will be T=1, L=1, M=0.
Butchart System – identifies that tumor is larger in size has penetrated local tissues such as the esophagus, diaphragm or abdominal muscle and into local lymph nodes but has not spread beyond local area.
Brigham System – is older and identifies how far cancer has invaded local tissues beyond the mesothelium and whether it is likely to be removable by surgery.