If there is a reason to suspect you may have a mesothelioma, a qualified medical professional will review your medical history, perform a physical examination and use a variety of diagnostic tests and methods to confirm the presence of the disease.
Medical History and Physical Examination
A complete medical history (interview) is taken to check for risk factors and symptoms. This interview includes questions to determine where asbestos exposure may have occurred as well as the duration and amount of asbestos exposure that the patient was subjected to.
A physical exam will provide information about signs of mesothelioma and other health problems. Patients with pleural mesotheliomas (mesotheliomas of the chest) often have pleural effusion (fluid in their chest cavity) caused by the cancer. Ascites (fluid in the abdominal cavity) in cases of peritoneal mesothelioma, and pericardial effusion (fluid in the pericardium) in cases of pericardial mesothelioma can also be detected during a physical exam. If other symptoms are present such as shortness of breath, pain and weakness they will also be evaluated.
Pet scans, X-rays, CT scans and MRI's are useful diagnostic imaging tools for diagnosing mesothelioma and evaluating the stage that the cancer has progressed to. Each test provides doctors with a different view / type of information to help them in making their diagnosis.
A PET scan (Positron Emission Tomography scan) provides doctors with a three-dimensional image of an area as well as information about the function of affected tissue in that area. It is a nuclear medicine imaging technique used by doctors to stage mesothelioma as it can detect how far the disease has advanced. A PET scan will produce an image of the metastasizing or malignant mesothelioma cancer if other surrounding tissue is affected.
A magnetic resonance image or MRI or is frequently used by mesothelioma doctors to diagnose mesothelioma and assist with staging the disease. An MRI uses magnetic fields rather than x-rays to create images of areas of the body that are suspected to show cancer.
Computed tomography scans, also known as CT scans, use a rotating x-ray beam to create multi-angled views of the body. This enables doctors to have a detailed cross-sectional image of the area of the body that is suspected of showing cancer. At times, a harmless dye may be injected into the veins to highlight certain details on the CT scan.
Patients that have mesothelioma often show signs of irregular thickening of the pleura, fluid in the pleural space, pleural calcifications (mineral deposits), and spaces between the lobes of the lungs. These characteristics of mesothelioma can be identified through the use of X-rays.
Biopsies are frequently used by doctors to make a conclusive mesothelioma diagnosis. The two primary types of biopsy procedures are needle biopsies and surgical biopsies. A biopsy is an important diagnostic procedure recommended by doctors for patients with a history of prior asbestos exposure that are presenting with signs and symptoms of mesothelioma. Fine needle aspiration is the less invasive type of biopsy that can be performed. More invasive surgical biopsies are recommended if results from a needle biopsy are inconclusive or if a needle biopsy is not recommended for medical reasons.
A fine needle biopsy is a less invasive procedure. It is also sometimes referred to as a closed biopsy. The most common closed biopsy procedure that is typically performed is a pleural biopsy. Thoracentesis and paracentesis are other types of closed biopsy procedures.
The symptom of pleural effusion is common in mesothelioma patients. If a patient presents with this symptom their doctor will likely recommend a pleural biopsy. This test, which can be performed in a radiologists office, is considered a minimally invasive procedure to obtain a fluid and tissue sample from the chest area and the pleural membrane. Once obtained it is send to the lab for examination. The procedure itself has few risks associated with it and can be performed on an outpatient basis.
Patients presenting with excessive fluid buildup in the chest area may be required to undergo a thoracentesis. This procedure, also considered a “closed needle” procedure, is designed to obtain a fluid sample from the pleural space (to see if pleural mesothelioma is present) as well as remove excess fluid so that the patient will be more comfortable.
Peritoneal patients often experience the symptom of excess fluid buildup in the abdominal area. If excess abdominal fluid exists, a paracentesis may be recommended. It is essentially the same procedure as the thoracentesis described above except the purpose is to drain excess fluid from the abdominal region rather than the chest. It can make the patient more comfortable and allow doctors to obtain a fluid sample to assist in making a cancer diagnosis.
When less invasive needle biopsies produce inconclusive results or if it is determined that it would be unsafe to perform them, a surgical biopsy may be recommended. It is a more invasive procedure and generally requires hospitalization.
A diagnostic procedure that doctors use to help detect the presence of pleural mesothelioma is called a thoracoscopy. This procedure uses a thoracoscope (telescope-like instrument connected to a video camera) that is inserted into the chest after a small incision is made. Through the thoracoscope a doctor can view the tumor and take a tissue biopsy using special forceps.
If a tumor has been detected in the chest area and the doctor suspects that the patient may have pleural mesothelioma, a thoracotomy may be ordered. A thoracotomy is considered open surgery. In this procedure, a surgeon makes an incision in the chest wall. This allows them to perform an examination around the lungs and to obtain a tissue sample from a tumor. In some instances the tumor will be removed in its entirety.
Similar to thoracoscopy, a laparoscopy allows surgeons to examine organs in the abdominal region and perform a biopsy of abnormal tissue using video assisted technology.
A laparotomy is also an open surgery, and is similar to a thoracotomy. This surgery, however, is performed in patients suspected of having peritoneal mesothelioma. It allows the surgeon to open the abdominal cavity, examine the tumor and surrounding tissue, obtain a biopsy sample and, if necessary, remove the tumor all together.
This procedure allows doctors to examine the lymph nodes in a suspected area and remove samples to test for cancer. Lung cancer is known to spread to lymph nodes, but is not characteristic with mesothelioma. A Mediastinoscopy can help doctors distinguish lung cancer from mesothelioma and help determine if the cancer is localized or if it has begun to spread to other areas of the body.