Mesothelioma Diagnosis

The First Step in a Mesothelioma Diagnosis: See Your Doctor

The first step in getting an accurate diagnosis is to be able to recognize the signs of mesothelioma and to see your doctor about your concerns. Some of the symptoms of mesothelioma include:[1]

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

Early signs of mesothelioma are usually mild. Doctors and patients often overlook them, especially since they are similar to signs 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 be able to rule out mesothelioma.[2] 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, your next step is to see an oncologist.

Imaging Tests for Mesothelioma

Medical providers use several imaging studies to help diagnose the cause of your symptoms.[3]

X-rays are often the first test done to evaluate symptoms related to mesothelioma. This can show a pleural effusion (fluid inside your lungs) or obvious abnormalities of the heart or lung structures. It’s also helpful to rule out common health conditions that are not mesothelioma.

CT scans (computed tomography) use radiation to further evaluate the lungs or abdomen in better detail. This can usually give your provider useful information to explain your symptoms and to determine a plan for obtaining a diagnosis.

MRIs (magnetic resonance imaging) use magnetic fields and radio waves instead of radiation to provide different images than CT scans. MRI scans can provide additional information such as invasion of tumors into other structures that cannot be seen on a CT scan.

PET/ CT scans are specialized tests usually only ordered by an oncologist or surgeon. These scans highlight areas of higher metabolic activity which is seen in most cancer cells. This is usually used to help determine the stage of the cancer or for surgical treatment planning.

You may need more than one imaging test to be sure of the presence of tumors and their locations.

Tissue Biopsies

If an imaging scan does show abnormal tissue, the next step is a biopsy. This is a removal of tissue and cells that a pathologist examines under a microscope to look for malignancy. There are several methods for performing a biopsy:[4]

• 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. This is usually done at a hospital, but you are able to go home the same day.
• Thoracoscopy: This is minimally invasive surgical procedure that involves a camera to look inside your chest cavity. This allows the surgeon to evaluate areas of abnormality and take biopsies that help confirm a diagnosis. This is also called a surgical biopsy.
• ADD Laparoscopy: This also is a minimally invasive surgical procedure but includes entering the abdominal cavity. The surgeon is able to look inside with a camera and obtain biopsies to help gather more tissue for a diagnosis or determine if the cancer has spread to other organs.
• Endoscopy: An endoscope is a nonsurgical procedure that uses a long tube and camera to look inside the digestive tract. During the procedure, biopsies can be taken to help confirm a diagnosis.

Blood Tests for Mesothelioma

Right now, a combination of imaging scans and biopsy tests give specialists the most accurate way to diagnose mesothelioma.

Unfortunately, there is no definitive blood test for mesothelioma. They can be useful as part of a comprehensive diagnosis, but they are not conclusive. Some of the blood tests used currently include:

• The SOMAmer test: This test can detect over 1,000 different proteins in the blood, and is the most accurate blood test to date. Trials proved doctors could use it to diagnose 90% of patients already known to have mesothelioma and to rule out mesothelioma in 95% of people known not to have it.[5]
• MESOMARK: MESOMARK is already approved by the U.S. Food and Drug Administration and can detect mesothelin, a protein associated with mesothelioma.[6]
• Human MPF: Blood tests that detect megakaryocyte potentiation factor, or MPF, can show markers for mesothelioma.[7]

Staging Mesothelioma

The final step in diagnosing mesothelioma is to assign a stage to the cancer.[8] This is a description of how advanced mesothelioma is in an individual patient. Various factors to determine how advanced the cancer is:

• The size of the original tumor
• The extent of the spread of the tumor to nearby tissues
• The spread of the cancer to lymph nodes
• The spread of cancer to distant tissues or organs

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.

Do I Need a Second Opinion?

If you are uncomfortable with your diagnosis, treatment options, or prognosis, you should seek a second opinion from another specialist. Diagnosing mesothelioma is imperfect. There is no single test that can provide a definitive answer and misdiagnosis happens. It is typical for patients to get a misdiagnosis of something more common and less serious, like bronchitis or irritable bowel syndrome.

Often it is only after symptoms persist and treatments for other conditions don’t work that doctors consider the possibility of 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 doctor for a second opinion.

What to Do Next

Getting a diagnosis of mesothelioma can feel devastating and overwhelming. Have loved ones around you to support you and to help with difficult decisions. There are a few things you should do after getting your diagnosis:

• Get a second opinion if you feel you need one. See a mesothelioma specialist to confirm a diagnosis made by a general oncologist.
• Ask your specialist or diagnosing oncologist about the stage of your cancer and prognosis so you know what to expect.
• Select a treatment team and discuss your options.
• Rely on family to support you and the guidance of your doctors to make decisions about treatment.

Learning about and understanding your treatment options can help during the process of diagnosis and deciding on what treatments to choose from. 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.

If you do not have a support system available to you, or would like assistance, please call us at 1-800-692-8608 or fill out our form for your Free Resources. We’re standing by to offer you any assistance you need.

Page Medically Reviewed and Edited by
Luis Argote-Greene, M.D.

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.

Connect with Mesothelioma Doctor Luis Argote-Greene, M.D.