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Mesothelioma Diagnosis

Receiving a diagnosis of mesothelioma is devastating, but you have options for treating and managing this disease. Diagnosis is an involved process that doesn’t necessarily have clear cut answers. It depends on examining a sample of tissue usually obtained by surgery. Diagnosis by looking at cells suspended from fluid is not sufficient. Special studies called immunohistochemistry are needed for an accurate diagnosis of actual tissue.

Diagnosis is the foundation that allows for the treatment of this disease. The earlier doctors can provide a diagnosis, the better chance the patient has of getting medical care that can really help. If you believe you have been exposed to asbestos, especially over a long period of time, such as through your workplace, being examined and either getting the diagnosis of mesothelioma, or ruling it out, is important.

Your regular doctor may suspect you have cancer, but ultimately the diagnosis must be given by an oncologist, an expert in studying and treating cancer. Because this type of cancer is so rare, it is especially beneficial to see a medical oncologist or thoracic surgeon with experience with mesothelioma patients.

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The First Steps in a Mesothelioma Diagnosis

The first step in getting an accurate diagnosis is to know and recognize the signs of mesothelioma. You should also be aware of any asbestos exposure in your past. Some of the symptoms of mesothelioma include:

  • Chest pains
  • Shortness of breath
  • Painful coughs
  • Abdominal pain and swelling
  • Lumps on the chest
  • Unexplained weight loss

Early signs of mesothelioma are mild. Both doctors and patients often overlook early symptoms, especially since they are similar to those of more common conditions. If you have these symptoms, and especially if they persist and if you know or suspect you have been exposed to asbestos, ask your doctor about mesothelioma.

This initial step is important because your doctor may rule out mesothelioma. Your doctor can also rule out other conditions that are more common and less serious. If your doctor cannot make a conclusive diagnosis or rules out other conditions, you will see an oncologist next.

Imaging Tests for Mesothelioma

Following a physical exam, your doctor will likely order imaging scans. X-rays can rule out pneumonia and other illnesses by imaging dense tissues.

CT, PET, and MRI scans provide detailed pictures of soft tissues. They help oncologists determine if you have any tissue abnormalities that look like they could be cancerous:

  • A CT scan images the inside of the body using electromagnetic energy. A doctor can see most tumors with it.
  • A similar type of image can be produced with an MRI, or a magnetic resonance image. It uses magnets and electromagnetic energy to create an image of internal structures.
  • A PET scan detects areas of the body with high metabolic activity, an important characteristic of many cancerous cells.

Your doctors may need to use a combination of two or more imaging tests to be sure of the presence of tumors and their locations.

Tissue Biopsies

If an imaging scan does show abnormal tissue or suspicious growths, the next step is to perform a biopsy. The image will show an oncologist locations where tissue may be cancerous, but it cannot confirm tumors.

The suspected areas can be sampled through a biopsy to test the tissue or fluid from an abnormality and determine if it is cancerous or benign. There are several methods for performing a biopsy:

  • Fine-needle aspiration. This procedure uses a long, thin needle inserted into one of the imaged tumors. It withdraws a small amount of tissue or fluid for examination.
  • Thoracoscopy. This involves a long flexible tube, called an endoscope, that is inserted through an incision in the wall of the chest, back, or abdomen.
  • Endoscopy. An endoscope can also remove tissue from the lymph nodes in the throat to determine if the cancer cells have spread here.
  • Open-surgical biopsy. Sometimes an oncologist needs more tissue than the less invasive procedures can provide. The patient goes under general anesthesia and the doctor surgically removes tissue for testing.

Blood Tests and Early Detection

Currently, a combination of imaging and biopsy gives specialists the most accurate way to diagnose mesothelioma. Pathologists look at tissue samples from biopsies under a microscope to identify cells and determine if they are malignant.

There is no definitive blood test for mesothelioma. Some blood tests can be useful, but not conclusive. For example, someone with mesothelioma is likely to have higher levels of certain proteins in the blood called osteopontin and mesothelin. But, there could be other explanations for elevated levels.

The latest research on diagnosing mesothelioma has focused on blood tests that may give a patient a more accurate and earlier diagnosis. One new test, called the SOMAmer test, can detect over 1,000 different proteins in the blood.

In trials with this test, doctors diagnosed 90 percent of patients who were already known to have mesothelioma. They were able to rule out the disease in 95 percent of people known not to have it. In other words, this test has the potential to diagnose patients more accurately and earlier than ever before.

Staging Mesothelioma

After diagnosing mesothelioma, oncologists assign a patient a stage. They look at various factors to determine how advanced the cancer is. Staging helps specialists plan for your treatment and helps you make more informed choices about treatment. Mesothelioma can be staged as one, two, three, or four, with one being the earliest stage and four the most advanced.

The most commonly used staging system for mesothelioma is the TNM system. It describes how much the primary tumor has grown and how far it has spread from its original location to other areas of the body.

Misdiagnosis and a Second Opinion

Diagnosing mesothelioma is imperfect. There is no single test that can provide a definitive answer. Because of this, misdiagnoses happen all too often. Initially a patient may get a diagnosis of something less serious and more common.

Often it is only after symptoms persist and treatments for other conditions don’t work that doctors consider the possibility of diagnosing cancer. Sometimes this results in a misdiagnosis of another type of cancer, like lung cancer. Early-stage mesothelioma is difficult to diagnose and it mimics other types of cancers.

If you feel uncomfortable about a diagnosis, you have every right to see another specialist for a second opinion.

What to Do Next

Getting a diagnosis of mesothelioma can feel like your world is falling apart. Have loved ones around you to support you and to help with difficult decisions. Your next step may be a second opinion, or if you are satisfied with the diagnosis, a discussion with your oncologist about treatment options.

Take the time to learn more about cancer and mesothelioma. Let your oncologist give you resources so that you can make informed decisions. Ask any questions you have before starting on a treatment plan so you feel comfortable with the next steps. Involve your loved ones so you have support and help making important decisions.

Page Edited by Dave Foster

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Dave has been a mesothelioma Patient Advocate for over 10 years. He consistently attends all major national and international mesothelioma meetings. In doing so, he is able to stay on top of the latest treatments, clinical trials, and research results. He also personally meets with mesothelioma patients and their families and connects them with the best medical specialists and legal representatives available. Connect with Patient Advocate Dave Foster

Page Medically Reviewed and Edited by
Luis Argote-Greene, MD

Luis Marcelo Argote-Greene, MD
Luis Argote-Greene is an internationally recognized thoracic surgeon. He has trained and worked with some of the most prominently known thoracic surgeons in the United States and Mexico, including pioneering mesothelioma surgeon Dr. David Sugarbaker. He is professionally affiliated with University Hospitals (UH). His areas of interest and expertise are mesothelioma, mediastinal Tumors, thoracic malignancies, lung Cancer, lung transplantation, esophageal Cancer, experimental surgery, and lung volume reduction. Dr. Argote-Greene has also done pioneering work with video-assisted thoracoscopic surgery (VATS), as well as robotic assisted minimally invasive surgery. He has taught the procedures to other surgeons both nationally and internationally.
Sources
  1. Mayo Clinic. (n.d.). Mesothelioma - Diagnosis and Treatment.
    Retrieved from: https://www.mayoclinic.org/diseases-conditions/mesothelioma/symptoms-causes/syc-20375022
  2. American Cancer Society. (2018, November 16). Tests for Malignant Mesothelioma.
    Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/how-diagnosed.html
  3. American Cancer Society. (2018, November 16). Malignant Mesothelioma Stages.
    Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/staging.html
  4. American Cancer Society. (2015, March 30). Types of Biopsies Used to Look for Cancer.
    Retrieved from: https://www.cancer.org/treatment/understanding-your-diagnosis/tests/testing-biopsy-and-cytology-specimens-for-cancer/biopsy-types.html
  5. Ostroff, R.M., Mehan, M.R, Stewart, A., Ayers, D., Brody, E.N, Williams, S.A., Levin, S., Black, B., Harbut, M., Carbone, M., Goparaju, C, & Pass, H.I. (2012). Early Detection of Malignant Pleural Mesothelioma in Asbestos-Exposed Individuals with a Noninvasive Proteomics-Based Surveillance Tool. PLoS One, 7(10): e46091.
    Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463527/

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