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Mesothelioma Diagnosis

Imaging Techniques | Pathology Tests | Pulmonary Function Tests

The early detection of mesothelioma is critical to the patient’s outlook and in determining applicable treatment options. However, mesothelioma is often difficult to diagnose for a variety of reasons. Because mesothelioma is a rare disease, many doctors are not familiar with it. In addition, the non-specific nature of mesothelioma symptoms can be indicators of other medical conditions. The extended length of time between asbestos exposure and a patient’s symptomatic responses, between 10-70 years, further hinders immediate detection of mesothelioma. Despite these difficulties, there are many procedures available for the accurate diagnosis of mesothelioma.

Initial Evaluation of Mesothelioma Symptoms

The initial patient evaluations are critical in identifying patients at risk for developing mesothelioma. To establish risk factors and the presence of symptoms, your physician will complete a medical history that includes questions to help determine the timeframe and environment in which you may have been exposed to asbestos. Communication between the patient and doctor is important so that the earliest possible detection of mesothelioma can be made. Make certain that you have shared all relevant information regarding previous work history and possible asbestos exposure with your physician.

In addition to constructing a medical profile and detailed medical history, a complete physical examination will be performed. During a physical exam your doctor may look for the following:

Breath Sounds: by listening to the chest cavity as the patient inhales and exhales, the doctor may note an absence of breath sounds, or note these sounds may be muted. The absence of, or muted nature of, these breath sounds may be an indication of fluid in the chest cavity, or of pleural effusions.

The doctor may listen to the chest cavity while having the patient make vowel sounds - comparing the sound resonance in the right and left chest cavities. Muted, or dull, sounds between the cavities could be an indicator of a buildup of fluid.

By tapping on the chest area a doctor may notice a dull, solid thumping sound, rather than a hollow resonance. This may also indicate the presence of fluid, or a mass, in the chest cavity.

A physical examination will also check for enlarged lymph nodes.

There are often very few signs during an initial physical exam that would identify the presence of mesothelioma. On the basis of patient symptoms, medical history, the presence of specific risk factors (work environment, asbestos exposure), and a complete physical examination, the doctor can use one or more of the methods described below to determine if the disease is present.

Doctors use a variety of diagnostic procedures to determine if a patient has mesothelioma. Comparing results from imaging scans, tissue biopsies, pulmonary function tests, and other diagnostic techniques, the presence of mesothelioma can be identified.

Diagnostic Tests for Mesothelioma: Imaging Techniques

There are many available technologies that allow doctors to view, or image, organs and tissue that might show the presence of fluid or tumors

Chest X-Ray: A chest x-ray may show an unusual thickening of the pleura, lowering of the lung fissures (spaces between the lobes of the lungs), an accumulation of fluid in the lungs (pleural effusion), and/or an irregular mass in the chest cavity.
Computed Tomography (CT) Scan: A computed tomography (CT) scan uses x-rays and computers to give more sophisticated and detailed pictures of the insides of our body than conventional x-rays. A rotating x-ray beam is used to take a series of pictures of the body from different angles. A computer combines the series of pictures to produce a detailed cross-sectional image of a specific part of the body. The CT scan allows a radiologist to see distinct aspects of the lungs and pleura.
Magnetic Resonance Imaging (MRI): Magnetic Resonance Imaging (MRI) uses a strong magnetic field and radiowaves to scan the body. There is no radiation involved. This imaging method produces a series of cross-sectional pictures. MRI scans are useful for viewing soft tissues in the body and can show the extent of mesothelioma. New MRI techniques, where surface imaging techniques are combined with quick breath-holding sequences and gadolinium contrast medium, give images which detect tumor growth in the pleura and thoracic wall better than the previous methods. MRI images tend to be quite clear and are superior to routine x-ray images.
Positron Emission Tomography (PET) Scan: Positron Emission Tomography (PET) scans use a camera that produces powerful images of the body’s biological functions. Because cancers and other disease processes metabolize sugars at a higher rate than normal tissues or organs, the PET scan uses tracers to indicate where there is abnormal metabolic activity and can pinpoint the regions of active disease. PET scans can also identify extremely small cancerous cells, indicate benign or malignant cells, and help determine whether treatment therapies are working.

Mesothelioma is diagnosed by pathological examination, where tissue is removed and put under the microscope. A pathologist then makes a definitive diagnosis and issues a pathology report.

Diagnostic Tests for Mesothelioma: Pathology Tests

Thoracoscopy: A tissue sample of a pleural or pericardial tumor can be obtained using a relatively new technique called thoracoscopy. A thoracoscope (telescope-like instrument connected to a video camera) is inserted through a small incision into the chest. The doctor can see the tumor through the thoracoscope and can use special forceps to take a tissue biopsy.
Laparoscopy: A laparoscopy can be used to see and obtain a biopsy of a peritoneal tumor. In this procedure, a flexible tube is attached to a video camera that is inserted into the abdominal cavity via small incisions. Fluid can also be collected during thoracoscopy or laparoscopy.
Bronchoscopy: A bronchoscopy may be performed if pleural mesothelioma is suspected. In this process, the doctor inserts a flexible lighted tube down the trachea, and into the bronchi to check for masses in the airway. At that time, small samples of abnormal-appearing tissue may also be removed for testing.
Mediastinoscopy: Lymph nodes are collections of immune system cells that help the body fight infection. By examining the lymph nodes, the doctor can determine if the cancer has spread. During a mediastinoscopy, a patient has a lighted tube inserted under the sternum (chest bone) at the neck level and then moved down into the chest. The surgeon can see the lymph nodes and take tissue samples to check for cancer. This procedure can also help the physician determine if you have lung cancer or mesothelioma.

The last set of tests in diagnosing mesothelioma are the pulmonary function tests.

Diagnostic Tests for Mesothelioma: Pulmonary Function Tests

Pulmonary Function Tests (PFTs): PFTs encompass a wide variety of tests that evaluate the entire respiratory system. The tests are useful in the assessment and diagnosis of pulmonary disease and aid in determining a course of treatment. PFTs can be a simple peak flow measurement, or complex body plethysmography and ventilation/perfusion scans which are performed in hospitals and clinics. PFTs can also be useful in monitoring patient response to treatment.

Although Mesothelioma can often be difficult to initially detect, the above medical procedures and diagnostic tests can lead to a clear diagnosis. Early medical diagnosis is one of the primary variables affecting long-term prognosis.

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