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Mesothelioma Diagnosis

Getting a diagnosis for mesothelioma is crucial for patients to begin treating this terrible disease. The earlier the diagnosis is given, the better chance the patient has of getting treatment 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 an important step forward.

Diagnosis begins with a general doctor, but ultimately must be given by an oncologist, an expert in studying and treating cancer. Because of the rarity of this type of cancer, it is especially beneficial to see a specialty oncologist, someone who works mostly with mesothelioma patients. With imaging tests, biopsies, and possibly blood tests, you can get the diagnosis that will allow you to plan your next steps.

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The First Steps

The first step towards a mesothelioma diagnosis is recognizing the signs of the disease, the level of risk and asbestos exposure, or both. Some of symptoms of mesothelioma include:

  • Chest Pains
  • Shortness of Breath
  • Painful Coughs
  • Abdominal Pain and Swelling
  • Unexplained Weight Loss
  • Lumps on the Chest

These signs are often overlooked as symptoms of mesothelioma because they are characteristic of other conditions. If you experience these symptoms and especially if they persist and if you know or suspect you have been exposed to asbestos, it is crucial that you ask about mesothelioma.

Once you recognize that you may have some symptoms of this type of cancer, a visit to your general doctor is the next step. A primary care doctor can refer you if necessary to the next expert. This initial step is important because your doctor will do all the basic and routine examination steps that could actually rule out mesothelioma. Your primary doctor can also rule out other conditions that are more common and less serious. If your doctor cannot make a conclusive diagnosis or all other conditions are ruled out, an oncologist will be the next professional you will see to make an official diagnosis.

Imaging Tests for Mesothelioma

An early strategy for diagnosing mesothelioma is to image the chest cavity or abdomen. X-rays image dense tissues and can rule out pneumonia. CT, PET, and MRI scans give more detailed pictures to help physicians and oncologists determine if you have any tissue abnormalities that look like they could be tumors.

A CT scan images the inside of the body using electromagnetic energy. A doctor can see most tumors using this type of scan. A similar type of image can be produced with an MRI, or a magnetic resonance image. This uses magnets and electromagnetic energy to create a picture of your internal structures. A PET scan is an imaging technique that detects areas of the body with high metabolic activity, often characteristic of cancerous cells. A combination of two or more imaging tests are often used to be sure of tumor locations.

Tissue Biopsies

If an imaging scan does show something unusual the next step is to biopsy that tissue. The imaging techniques show an oncologist where the cancerous tissues, cancer cells, and tumors are. Those areas can then be sampled so that the tissue or fluid from a tumor can be tested to confirm that it is in fact cancerous, or malignant as opposed to benign. There are several ways in which a biopsy can be done:

  • Fine-needle aspiration. Often just called a needle biopsy, this procedure uses a thin, long, hollow needle inserted into one of the imaged tumors. The needle then withdraws a small amount of tissue or fluid for examination.
  • Thoracoscopy. A thoracoscopy involves a long flexible tube, called an endoscope, inserted through an incision in the wall of the chest or back, or in the abdomen in the case of peritoneal mesothelioma.
  • Endoscopy. This procedure uses an endoscope to retrieve tissue from the lymph nodes in the throat to determine if the cancer cells have spread.
  • Open-surgical biopsy. Sometimes an oncologist may need more tissue than the less invasive procedures can provide. In this case the patient goes under general anesthesia and the doctor removes a large portion of, or an entire tumor for testing.

Blood Tests and Early Detection

Currently, a combination of imaging and biopsies is the best and most accurate way to diagnose mesothelioma. Pathologists look at the tissue samples from biopsies under a microscope to determine the types of cells and if they are cancerous.

Blood tests can be done as well, but these are not considered conclusive. For example, someone with mesothelioma is likely to have higher levels of certain proteins in the blood called osteopontin and soluble mesothelin-related peptides. However, there could be other explanations for elevated levels.

The latest research into diagnosing mesothelioma has focused on blood tests that could give a patient a better, earlier diagnosis. One such test, called the SOMAmer test, can detect over 1,000 different proteins in the blood. In trials with this test doctors were able to diagnose 90 percent of patients known to have mesothelioma and could rule the disease out in 95 percent of people known not to have it. In other words, this test has big potential to diagnose patients accurately and earlier than ever before.

Staging Mesothelioma

Once you have a diagnosis of mesothelioma your doctor will want to stage it. This means looking at various factors to determine how advanced the cancer is. This helps your medical team plan for your treatment and helps you make better choices about treatment. Mesothelioma can be staged as one, two, three, or four, with one being the earliest stage and four the latest and most advanced.

The staging system most often used for mesothelioma is called TNM. To use it doctors look at how much the original, or primary tumor has spread, the extent to which cancerous cells have spread to the lymph nodes, and how much the cancer has metastasized, or spread to other organs beyond the mesothelium and lymph nodes.

Misdiagnoses and Second Opinions

Diagnosing mesothelioma is not perfect or clear cut. There is no single or simple test that can give a yes or no answer. Misdiagnoses happen all too often. Initially a patient may be diagnosed with something less serious and more common, but when it doesn’t resolve a cancer diagnosis may be given. Sometimes this results in a misdiagnosis of another type of cancer, like lung cancer. Part of the reason for this is that early-stage mesothelioma is difficult to diagnose and it mimics other types of cancers.

For instance, when examining the cells from a biopsy, it can be very challenging to see the difference between mesothelioma cells and those represented by other types of cancer. As the disease advances, though, it becomes clearer that it is mesothelioma. It is important that if you are not comfortable with a diagnosis that you have received that you see another specialist for a second opinion.

What to Do Next

If you do get a diagnosis for mesothelioma, it can feel like your world is crashing down around you. It is important that you have loved ones around you to support you and that you can rely on as you make the very difficult decisions about what to do next. Your next step may be a second opinion, or if you are satisfied with the diagnosis, a discussion with your oncologist of treatment options.

Make sure you take the time to educate yourself about this disease. Let your oncologist give you resources to read, so that you can make informed decisions. Ask all the 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

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.

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