Diagnosis of Mesothelioma

Before the Diagnosis

Identifying the presence of mesothelioma in the body is often very difficult. The symptoms that patients experience are not unique to mesothelioma and are similar to those of less serious ailments. The disease, often called “asbestos cancer” may not present symptoms until 20 or 30 years after initial tumor formation, causing a delay in diagnosis.

When doctors suspect mesothelioma a variety of imaging techniques can be used to advance their hypothesis. These techniques are effective in establishing the possibility of cancer, but a fluid diagnosis or tissue biopsy is needed for the most accurate result. Indeed, a tissue biopsy is considered the most definitive way to diagnose cancer.

To begin assessing a patient for mesothelioma the doctor will complete a routine survey of the patient’s medical history. A thorough physical examination and lung function test will also be administered. The doctor will then take a set of x-rays of the patient’s chest and possibly the abdomen. X-rays provide an internal picture which doctors can use to see fluid that may have built up in the lungs, also known as plueral effusion. Sometimes an x-ray can identify a mass or tumor.

Another form of imaging test the doctors may perform is a CT, or computed tomography. This scan takes detailed pictures of the internal organs by using x-ray combined with computer technology. Sometimes a contrast agent is used to assist in identifying diseased tissue. A contrast agent is a material the patient swallows of is injected with in order to make the tumor show up more clearly on the scan.

MRI, or magnetic resonance imaging, is a very detailed scan used to help show the difference between normal and diseased tissue. This type of scan uses a large magnet to produce images and is able to take pictures in several different planes. This technique provides etailed images of the patient’s soft tissue making it easier for doctors to determine if the tissue is diseased.

If the radiological tests indicate a likelihood of cancer, the doctor will perform some form of biopsy.

The least invasive of these is a needle biopsy, which is performed under local anesthetic. A needle is inserted into the chest cavity and tissue and fluid samples are collected. Due to the small size of the sample collected, this type of biopsy is usually only 25% to 60% accurate. Radiation therapy is used after a needle biopsy to prevent the spread of the tumor along the needle’s path.

An open biopsy, done under general anesthesia in a hospital, is the most accurate type of biopsy because it provides a much larger tissue sample to study. This is the preferred method of biopsy in mesothelioma cases but may also require a course of radiation treatment afterwards to prevent tumor seeding.

Questions to ask your doctor before a biopsy and other tests.

After the Diagnosis

When mesothelioma is positively identified the doctor determines the stage of the disease before deciding on a treatment plan. Staging in mesothelioma is simply categorizing the severity of the cancer and how much it has spread. Pleural mesothelioma is thought to be in an early stage if it has not spread beyond the pleura, or chest cavity lining. If the disease is more advanced it may have spread beyond the lining into the chest wall, lungs or other organs. The treatment plan depends largely on the stage of the disease as well as the type of mesothelioma (pleural, peritoneal or pericardial).

The staging system most commonly used in assessing mesothelioma is called TNM staging. This refers to the initial tumor, the surrounding lymph nodes and rate of metastasis. (T for tumor, N for nodes, and M for metastasis) However, there are several other systems used to determine stages such as the Butchart system and the Brigham system. Different doctors have their preferences for staging systems.

In most cases the same tests used in diagnosing mesothelioma are used to determine the stage of a patient’s disease. Each stage of the disease poses different problems and symptoms for patients. At earlier stages, patients may have no noticeable symptoms. In later stages, patients may suffer pleural effusion causing shortness of breath and some chest pain. In the most advanced stages of the disease patients may face acute stabbing pain in the diseased area and overall deterioration in health due to the spread of the disease into the bloodstream and other organs.

Questions to ask your doctor after a diganosis.

What Does This Mean?

Once a patient is positively diagnosed, a treatment plan must be discussed with an oncologist. (Oncologists are doctors that specialize in cancer treatment.) Together, the patient and doctor will determine how to proceed depending on the stage of the mesothelioma. Other factors that also play a part in determining treatment include the overall health of the patient, the patient’s age and the location of the cancer in the body.

Individuals with early stage mesothelioma will have three main options for treatment. Surgery can be performed to remove the tumor and surrounding diseased tissue or chemotherapy or radiation can be used. In most cases it is found to be more beneficial to use a combination of these three treatments. The “multimodality approach”, using more than one treatment method, is currently thought to be the best way to increase survival of those with malignant mesothelioma.

Treatment of mesothelioma