Diagnosing and Staging Mesothelioma


The earlier mesothelioma is accurately diagnosed, the more effective treatments can be.

Mesothelioma has a long latency period and it can take decades for symptoms to develop after someone is first exposed to asbestos.

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.

How Mesothelioma is Diagnosed

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.

Imaging Scans

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.

Pet Scan

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.

MRI

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.

CT Scan

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.

X-Ray

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

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.

Needle Biopsy

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.

Pleural Biopsy

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 radiologist's 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.

Thoracentesis

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.

Paracentesis

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.

Surgical Biopsy

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.

Thoracoscopy

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.

Thoracotomy

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.

Laparoscopy

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.

Laparotomy

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.

Mediastinoscopy

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.

Mesothelioma Symptoms

The symptoms most commonly associated with mesothelioma often mimic those of other less threatening upper respiratory illnesses. Mesothelioma is often confused with pneumonia in its early stages. Most people experience symptoms for about 2-6 months before seeking medical attention. Some people do not even experience any symptoms; the tumors are accidentally found through a routine x-ray or exam.

Patients with pleural mesothelioma often suffer from pain in the side of the chest or the lower back. Other symptoms include shortness of breath, difficulty swallowing, chest pains, weakness, coughing blood and sensory loss.

Peritoneal mesothelioma can cause pain in the abdomen, due to the swallowing of asbestos fibers. Symptoms include weight loss, nausea, vomiting, hernia, or swelling of the abdomen.

A person with any of these symptoms who has been exposed to asbestos in the past should see a doctor right away. It is important to tell your doctor all of your symptoms, as they can be the key to your diagnosis. It is also imperative to tell your doctor about any past exposure to asbestos.

It is extremely difficult to pinpoint mesothelioma because its symptoms are so common to other illnesses and are seemingly non-threatening. Mesothelioma is often confused with pneumonia in its early stages. Most people experience symptoms for about 2-6 months before seeking medical attention. Some people do not even experience any symptoms; the tumors are accidentally found through a routine x-ray or exam.

Patients with pleural mesothelioma often suffer from pain in the side of the chest or the lower back. Other symptoms include shortness of breath, difficulty swallowing, chest pains, weakness, coughing blood, and sensory loss.

Peritoneal mesothelioma can cause pain in the abdomen, due to the swallowing of asbestos fibers. Symptoms include weight loss, nausea, vomiting, hernia, or swelling of the abdomen.

If you are experiencing any of these symptoms and have come in contact with asbestos in the past, you should consult your doctor immediately. It is important to tell your doctor all of your symptoms, no matter how trivial, because they can be the key to your diagnosis. It is also imperative to tell your doctor about any exposure to asbestos.

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Jennifer Lucarelli Partner Jennifer Lucarelli

Staging Mesothelioma

How is Mesothelioma Staged?

When an individual is diagnosed with pleural mesothelioma, it is important to know what stage the cancer has progressed to as early diagnosis generally results in a more favorable prognosis. In order to find out how far the cancer has spread and what treatment options may be available, doctors will commonly use a staging system.

There are three primary staging systems that doctors use today. While each system varies slightly in terms of what is specifically being measured each one uses four stages to classify how far the disease has progressed.

Butchart Staging System

The Butchart system is the most common staging system used by doctors to diagnose mesothelioma patients. This system measures the extent of the primary tumor, and classifies the mesothelioma into one of four stages.

Stage I

In Stage I, mesothelioma exists in either the right or left pleura. The lung, pericardium, or diaphragm on the same side may also be involved.

Stage II

In Stage II, mesothelioma may be present in the heart or both sides of the pleura and invades the chest wall or involves the esophagus. Lymph node involvement in the chest may also be present.

Stage III

In Stage III, additional lymph nodes beyond the chest may be involved and the mesothelioma has penetrated moved through the diaphragm and invaded the peritoneum.

Stage IV

In Stage IV, the cancer has metastasized to other organs and the bloodstream.

TNM Staging System

The TNM Staging System recently developed by the American Joint Committee on Cancer, is similar to the other staging systems. T stands for tumor and evaluates size and whether or not it is localized. N stands for Node and evaluates lymph node involvement. M stands for Metastasis and measures progression of the disease throughout the body.

Stage I

As in the Butchart System, the mesothelioma is in either the right or left pleura. There is no sign of lymph node involvement but there may be indications of movement into the lining of the lung, pericardium or diaphragm.

Stage II

Mesothelioma may have spread into the lung, pericardium, or diaphragm on the same side, and may involve the lymph nodes on that same side.

Stage III

Mesothelioma has progressed into the chest wall muscle or other organs in the chest on the same side and may also have spread to the lymph nodes.

Stage IV

Mesothelioma has spread into the lymph nodes on the opposite side of the chest. It may also involve the pleura or lung on the opposite side, or have entered the peritoneum, or abdominal organs. In this stage there is also evidence of distant metastases to other organs.

Brigham Staging System

The Brigham Staging System defines whether or not surgery is a viable treatment option for a mesothelioma patient and whether or not there is lymph node involvement. It is similar to both the Butchart Staging System and the TNM Staging System in that it defines the progression of mesothelioma in four stages.

Stage I

The Brigham Staging System helps doctors determine what types of treatment options are available to a mesothelioma patient and like the previous two systems, uses a four tier classification system.

Stage II

Surgery is still a possible treatment option in Stage II as the mesothelioma remains localized. Lymph node involvement is detected.

Stage III

Surgical intervention is no longer an option. The mesothelioma has spread into the chest wall, heart, or through the diaphragm into the peritoneum. Lymph node involvement may or may not be present.

Stage IV

When diagnosed in Stage IV, a patient's prognosis is the least favorable. Mesothelioma has metastasized to other organs and the cancer is pervasive in the body

These staging systems provide doctors with information that allows them to accurately determine a patient's prognosis and assess therapeutic treatment options.


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