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A person often sees a health care provider when they are having physical health symptoms that are worrisome. A health care provider will conduct an examination and testing to determine the cause of the symptoms.

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Mesothelioma Diagnosis
Mesothelioma Diagnosis

Tests for Malignant Mesothelioma

A person often sees a health care provider when they are having physical health symptoms that are worrisome. A health care provider will conduct an examination and testing to determine the cause of the symptoms. The results of a health care providers examination and testing will determine if your symptoms suggest mesothelioma.

A medical history conducted by your health care provider will collect information about symptoms and possible risk factors leading to the exposure of asbestos. A buildup of fluids around the chest area can be pleural mesothelioma, a buildup of fluids in the abdomen can be peritoneal mesothelioma, and a buildup of fluids in the sac around the heart can be pericardia mesothelioma. A physical exam using a stethoscope can determine the symptoms of any of these forms.

Since mesothelioma is hard to diagnose, more tests will be required such as blood tests, imaging tests, and biopsies if the results show that this cancer is present.

Mesothelioma Imaging Tests

Imaging Tests

Images are taken of the inside of your body using x-rays, sound waves, radioactive particles, or magnetic fields. These tests are done to indicate:

  • See if and/or how far the cancer has spread
  • To figure out if treatment is working
  • Look if cancer has returned after treatment
  • Look for cancer is located in skeptical areas
Stage 2 Mesothelioma Facts
Malignant Mesothelioma
Pleural Mesothelioma Diagnosis

Chest X-Ray

If there are problems in the lung, this is typically the first test that is done. Asbestos exposure could have caused complications such as calcium deposits on the pleura, changes in the lungs, thickening of the pleura, or fluid in the space between the lungs and the wall. All of these complications could signify mesothelioma.

How many Types of Mesothelioma

Types of Mesothelioma

Pleural mesothelioma arises in the membrane which surrounds the lung, called the pleura. Pleural mesothelioma is the most common form of this deadly cancer.

Peritoneal mesothelioma develops in the lining of the abdominal cavity, called the peritoneum. Peritoneal mesothelioma is less common but is more often found in women than in men.

Pericardial mesothelioma originates in the pericardium, which lines the heart.

Computed Tomography (CT) Scan
CT Scan

Computed Tomography (CT) Scan

Doctors will use CT scans to locate the specific locations of the cancer by making detailed images of the body using x-rays. It can also show if the cancer has spread to other organs and the extent of it. CT scans can also show if surgery is an option and if the chemotherapy is working by shrinking the tumors.
Mesothelioma Diagnosis

Echocardiogram

If a doctor believes that there is fluid around the heart, they will order an echocardiogram; which is an ultrasound of the heart. This machine can also detect how well a heart is working.

Mesothelioma Diagnosis

Position Emission Tomography scan (PET)

In a PET scan, a camera creates a picture of radioactivity in the body after it detects the radioactive sugar that is inserted into the blood stream. The cancer cells adsorb the sugar at a much faster rate than normal cells which is why they grow quicker. There is also a very low amount of radioactivity used.

This machine is used for patients who are suspected of having mesothelioma to determine if the cancer has spread to the lymph nodes or other parts of the body. This provides doctors with a better understanding that if the cancer is causing the thickening of the peritoneum or pleura, or if it is just scar tissue. If a doctor is unsure where or how much the cancer has spread, a PET scan can help as well.

PET/CT Scan: Doctors can do a CT and PET scan at the same time to compare high radioactivity and more detailed pictures of that area.

Stage 2 Mesothelioma Facts
Magnetic resonance imaging (MRI) scan
What is Magnetic resonance imaging?

Magnetic resonance imaging (MRI) scan

Instead of X-rays, an MRI scan utilizes magnets and radio waves to show thorough images of soft tissues in the body. To show a clearer image, gadolinium, a contrast material is injected into the vein before the MRI.

The detailed images allow doctors to locate the exact level and location of the tumor, which can help detect mesothelioma when looking at the diaphragm for any signs of cancer.

Blood Tests

For individuals with mesothelioma, certain blood levels that contain substances are often higher than normal

  • Flbulin-3
  • Soluble mesothelin-related peptides

MRI’s are not commonly used because of their restricted value; therefore, additional research is still needed. High levels of these substances can make the mesothelioma diagnoses more possible, but it cannot be diagnosed with just a blood test.

What are Tests of fluid and tissue?

Tests of fluid and tissue samples

A biopsy is what is preformed to diagnosed if a patient has mesothelioma. This procedure can be done several different ways, but the most common way is removing cells from an abnormal area and examining them under a microscope.

Tests of fluid and tissue samples
Stages of Pleural Mesothelioma

Pleural Mesothelioma Stages

A doctor will also determine the stage of mesothelioma as part of the diagnostic process, which determines the origin in the lining of the lungs and describes how far it has spread from that point. This information is significant to doctors when determining potential treatment availabilities. Standard treatment options are more commonly available to patients with stage 1 or stage 2 compared to patients with the later 3 and 4 stages.

The following are the pleural mesothelioma stages:

Stage
1

Within Stage 1, the mesothelioma tumor is generally in one location, and the cancerous cells have not dispersed to lymph nodes or other body organs and tissues. In general, surgical treatment may be an option for eliminating the cancerous growth.

 

Stage
2

Within Stage 2, the mesothelioma tumor is larger and has probably intruded on surrounding organs, such as the lung or even diaphragm. Lymph nodes could additionally be included. In this case, surgical reapportion might still be feasible, however much more difficult depending on the scope of the growth.

 

Stage
3

Within Stage 3, mesothelioma cancer has infested a region or perhaps location. Cancer has progressively spread throughout one side of the chest, within the chest wall, esophagus, and additional lymph nodes. Surgical treatment is typically not an option as curative therapy, however various other treatment options may be attempted. 

 

Stage
4

Within Stage 4, the mesothelioma has dispersed to numerous locations, such as various other organs and tissues throughout the body. Surgical treatment is no longer an alternative, and most treatments at this stage concentrate on minimizing discomfort and pain.

 

Mesothelioma Prognosis

Removing fluid for testing

If there is a noticeable accumulation of fluid, a doctor will numb the skin and then insert a needle into the fluid and drain it out. The needle is very thin and hollow and sometimes an ultrasound is utilized to help guide the needle.

Depending on where the fluid is located, the procedure has different names

If cancer cells are found within the fluid that is tested, special test are then done to see which type of cancer it could potentially be. A patient could potentially still have cancer even if no cancer cells appear in the fluid. In most cases, an actual sample of mesothelioma has to be drawn to ensure the individual has it.

Removing fluid for testing
Needle Biopsies
Needle Biopsies Risks

Needle Biopsies

During a needle biopsy, a long, thin needle is inserted into the pleura, which is in between the ribs; and tiny pieces of the tumor are taken out. A CT scan is sometimes used to assist with directing the needle to help remove the tumor. This biopsy can also be applied when getting samples of the lymph nodes to determine if the cancer has spread there.

Unfortunately, in some cases, the sample that is withdrawn is not enough to make a correct diagnosis, which is very common in mesothelioma. However, a biopsy does not require an overnight hospital stay or a surgical cut.

Needle biopsy risk: When preforming the biopsy, there is a risk that the needle could puncture the lung and make a hole, causing air build up between the lung and the chest wall. This is known as pneumothorax. A small pneumothorax may not show any symptoms and will typically go heal on its own. A larger pneumothorax may cause part of the lung to collapse and will require treatment to heal. To fix, a catheter is inserted into the space between the lungs and sucks the air out to re-expand the lungs.

Mesothelioma Diagnosis

Endoscopic biopsies

This is a common biopsy used to detect mesothelioma by using an endoscope to look inside the body. The device had a little video camera as well as a light to look inside the body and remove tissue samples. There are different names for the endoscopes depending on the part of the body.

Thoracoscopy– An endoscope called a thoracosope is utilized to look inside the chest to examine the pleura and remove tissue samples for biopsies.
It is performed in an operation room, and as the patient is asleep under general anesthesia, the doctor will insert the scope into the chest to examine the space between the lungs and the chest wall. The doctor then will remove tiny samples of tissue for testing. They will also remove lymph nodes and fluid if need be. Also, during this procedure, a doctor can see if there is a growing tumor by any organs or tissues.

Laparoscopy- An endoscope called a laparoscope is utilized to look inside the stomach for any possible tumors. The scope is put into the front of the abdomen as the patient is under general anesthesia.

Mediastinoscopy– An endoscope called a mediastinoscopy is utilized to look in the area between the lungs if an imagining test shows that there is cancer has spread to the lymph nodes there. This is also done while the patient is under general anesthesia

A small incision is made from the neck to the sternum and a mediastinoscopy is inserted in front of the wind pipe and behind the sternum to examine the area. Small devices are then inserted down the tube to remove tissue samples from the lymph nodes by the bronchial tubes.

Testing the lymph nodes is highly important to determine if the cancer has spread or not; which may alter treatment options for the patient. It also helps determine if the cancer is in fact mesothelioma, or if it is a different lung cancer. A bronchoscopy is not necessary for individuals with mesothelioma since it does not spread inside the breathing tubes. In some cases, a bronchoscopy could potentially be used to biopsy lymph nodes near the lungs in place of a mediastinoscopy.

Endobronchial ultrasound needle biopsy: A bronchoscope with an ultrasound at the tip is utilized for this test. It is inserted down the throat and into the windpipe and a needle is placed down the tube to take biopsy samples of the lymph nodes in the airway wall. The ultrasound at the tip allows doctors to see the lymph nodes nearby. While this procedure is being done the patient is either placed under general anesthesia or local anesthesia with numbing medicine.

Mesothelioma Prognosis

Open surgical biopsy

In some cases, more aggressive procedures are needed if the endoscopic biopsies are enough to make a judgement. A surgeon can remove a larger sample or the entire tumor by making an incision in the chest (thoracotomy) or abdomen (laparotomy) if needed.

Testing the samples in the lab

After the removal of the sample, a doctor will examine all biopsies and fluids under a microscope in a pathology lab to see if they contain cancer cells.

It is sometimes very difficult to diagnose mesothelioma with only a tissue from a small biopsy or from small fluid samples. Mesothelioma can look a lot like other cancers under a microscope. To help determine mesothelioma from other cancers, such as lung cancer, additional special lab tests are done. Based on the patterns of the cells, the doctor can determine what type of mesothelioma the patient has. Most mesotheliomas are categorized as either sarcomatoid, biphasic, or epithelioid.

Pulmonary function tests

Pulmonary function tests will be performed if mesothelioma is diagnosed to see if the patient’s lungs are functioning regularly. If surgery is an option, this procedure is also very important since sometimes removing part or all of the lung is part of the process.

Open surgical biopsy