Diagnosing mesothelioma involves a series of steps that begin with your first visit to the doctor after you notice symptoms. The diagnostic process begins with a general practitioner and a routine physical exam as well as a discussion of medical history. The next steps include imaging the lungs and pleura to look for potential tumors and using biopsies in an attempt to confirm the presence of tumors and cancer cells.
A biopsy is an important step, not only in diagnosing this type of cancer, but also in staging it. When a diagnostician examines cells from the fluid or tissue near or within a suspected tumor, that professional may be able to determine both if the cells are cancerous and if so what type of cancer. Diagnosing mesothelioma is not always perfectly accurate, but a biopsy is the most definitive strategy that patients and doctors rely on for developing treatment plans.
What is a Biopsy?
A biopsy is the examination of either fluid or tissue, or both, removed from a patient for the purpose of diagnosing a condition, finding the presence of certain types of cells, finding the source or cause of an illness, and for determining the extend of an illness. When a biopsy is used for cancer, the purpose is to confirm the presence of cancerous cells, to find out the types of cancer cells, and to figure out how far the cancer has spread, if at all.
A tissue or fluid sample for a biopsy can be taken in a number of ways including with a needle, with open surgery, or with an endoscope, a tube that enters the body and guides the doctor to the right location. The sample is then examined under a microscope by a pathologist whose job is to diagnose and find out more information about the tissue, cells, and fluid.
The Importance of Biopsies in Diagnosis
A biopsy is just one part of a complete diagnosis for mesothelioma. It is important because it is the most accurate way to confirm that someone actually has this type of cancer. An imaging test can tell a doctor that a person most likely has cancer or that there is some type of tumor in the pleura or other area of the body, but it cannot confirm that the suspected tissues are malignant or a particular type of cancer. The biopsy is also important because it determines the extent of the cancer. All of these pieces of information help the patient and medical team create the best possible treatment plan.
Blind vs. Guided Biopsies
There are two basic categories of biopsies that can be taken for patients who may have mesothelioma. A blind biopsy is one that is taken without knowing exactly where the suspected tumor or cancerous tissues is. A guided biopsy is used when an imaging technique, like a CT scan helps the doctor better target the location of the tissue in question. This guided kind of biopsy has been proven to be more accurate in making mesothelioma diagnoses. In fact, those guided specifically by CT scans are the most effective types of biopsies for making accurate diagnoses.
Fluid and Needle Biopsies
Sometimes fluid builds up as a result of mesothelioma and testing some of it can be a useful part of the diagnosis. The name of the procedure depends on where the fluid is taken from. For instance, when pleural mesothelioma is suspected the fluid is taken from the chest and is called a thoracentesis. A paracentesis removes fluid from the abdomen to test for peritoneal mesothelioma and a pericardiocentesis removes fluid from the sac around the heart to test for pericardial mesothelioma.
A fluid biopsy is not very invasive. It can be done in a doctor’s office with local anesthetic. A small needle is inserted through the skin to the area of fluid buildup and a little bit of fluid is removed for testing. The fluid is then examined under a microscope to look for cancer cells. A needle can also be used to remove a small sample of tissue as well as fluid.
An endoscope is a thin, flexible tube that is used to look into different areas of the body. Using an endoscope to take a sample of tissue is an example of a guided endoscopy. The endoscope has a light and either a lens or a camera that allows the doctor to see deep into the body without making a large incision or conducting open surgery.
Because most cases of mesothelioma are pleural, the most common type of biopsy done to test for this kind of cancer is a thoracoscopy, a type of endoscopy. The endoscope is inserted into the chest to look at the pleura and suspected tumors and to remove a sample for biopsy. Although less invasive than open surgery, an endoscope biopsy like this still requires that the patient be under general anesthesia.
Less invasive and lower risk techniques for biopsies are always used first, but sometimes they are not enough to diagnose mesothelioma. A last resort type of biopsy is to conduct open surgery, surgery that involves a large incision and the removal of a significant amount of tissues. A thoracotomy is a procedure that involves an incision in the chest to remove part of a tumor or an entire tumor. A laparotomy is the same procedure through the abdomen for diagnosing peritoneal mesothelioma.
Incisional and Excisional Biopsies
Biopsies for mesothelioma are also sometimes classified as incisional or excisional. For an incisional biopsy, only a small amount of tissue is removed from a tumor. These are done when the tumor is more easily accessible. An excisional biopsy refers to the entire removal of a tumor. If it is possible, it is desirable to remove the entire mass, both for testing and as a part of treatment because it negates the need for a later surgical removal of the tumor.
There are many types of biopsies and the type that you may undergo as part of your mesothelioma diagnosis depends on individual factors. Your medical team will decide which biopsies are needed to help make the most accurate diagnosis and to set you on a path to treatment.
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