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Mesothelioma Diagnosis

Receiving a diagnosis of mesothelioma is devastating, but you have good 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, that is the house, to be built. 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 come from an oncologist, an expert in studying and treating cancer. Because of how rare this type of cancer is, it is especially beneficial to see a medical oncologist or thoracic surgeon that has experience with mesothelioma patients.

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The First Steps in Diagnosing Mesothelioma

The first step in getting a mesothelioma diagnosis is to recognize the signs of this cancer. 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
  • Unexplained weight loss
  • Lumps on the chest

Early signs of mesothelioma are usually mild. Both doctors and patient often overlook them for this reason and because they are similar to 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 will do all the basic and routine examination steps that could actually 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 help 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 tumors:

  • A CT scan images the inside of the body using electromagnetic energy. A doctor can see most tumors this way.
  • 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 internal structures.
  • A PET scan is an imaging technique that detects areas of the body with high metabolic activity, which is often characteristic of cancerous cells.

You may need a combination of two or more imaging tests to be sure of tumor locations.

Tissue Biopsies

If an imaging scan does show something abnormal, the next step is to perform a biopsy. The image will show an oncologist the probable locations of cancerous tissues, cancer cells, and tumors.

The suspected areas can then be sampled by biopsy so that the tissue or fluid from a tumor can be tested to determine if it is cancerous or benign. There are several methods for performing a biopsy:

  • Fine-needle aspiration. This involves a thin, long, 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, inserted through an incision in the wall of the chest or back, or in the abdomen for peritoneal mesothelioma.
  • Endoscopy. An endoscope can also retrieve tissue from the lymph nodes in the throat to determine if the cancer cells have spread.
  • Open-surgical biopsy. Sometimes an oncologist needs more tissue than the less invasive procedures can provide. In this case the patient goes under general anesthesia and the doctor removes more tissue for testing.

Blood Tests and Early Detection

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

Unfortunately there is no quick blood test for mesothelioma. There are blood tests that 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 into 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, detects over 1,000 different proteins in the blood.

In trials with this test doctors were able to diagnose 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 accurately and earlier than ever before.

Staging Mesothelioma

After diagnosing mesothelioma, oncologists assign a cancer 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 latest and most advanced.

The most commonly used staging system for mesothelioma is called the TNM system. It describes how much the primary tumor has grown and how far it has spread from its original position.

Misdiagnosis and Second Opinions

Diagnosing mesothelioma is not exact. There is no single or simple test that can provide a definitive answer,  and misdiagnoses happen all too often. Initially a patient may get a diagnosis of something less serious and more common.

Often it is only when symptoms don’t resolve 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 uncertain about the accuracy of a diagnosis, you have every right to see another specialist for a second opinion.

What to Do Next

When you get a diagnosis of mesothelioma, it may feel like your world is falling apart. It is important that you have loved ones around you to support you and to help you make 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 educate yourself about cancer and mesothelioma. Let your oncologist give you resources to read, 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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