How do medical professionals diagnose mesothelioma?
If you believe that you may have mesothelioma, a qualified medical professional will use a variety of diagnostic tests and methods to confirm the presence of the disease.
The first step that mesothelioma doctors will take in evaluating an asbestos related disease is to obtain a full medical history to determine the level and severity of mesothelioma risk factors and presenting mesothelioma symptoms. This interview will consider among other things, where asbestos exposure occurred, the length of exposure and the amount of asbestos that you were exposed to.
In addition, he/she will perform a medical exam to look for signs and symptoms of various types of mesothelioma. For example, if pleural mesothelioma is suspected the doctor will look for fluid in the chest, peritoneal mesothelioma often shows fluid in the abdomen and pericardial mesothelioma presents with fluid in the area of the heart.
Diagnostic image tests like x-rays, CT scans and MRI's are useful in obtaining more information about the cancer including how far it is progressed. Each method provides another piece of information for your doctor to assist him/her in making an accurate diagnosis. Chest x-rays are used to identify abnormalities in the lungs including unusual thickening, mineral deposits and fluid in the chest area. CT scans are capable of providing images of the same location from many different angles. MRI technology uses magnetic fields rather than x-ray to provide additional views.
- PET Scan - Positron Emission Tomography, more commonly referred to as a PET scan, is a nuclear medicine diagnostic technique. Nuclear medicine involves introducing a small amount of radioactive material into the body (in this case, intravenously) to help doctors determine if the body is functioning properly. PET scans in mesothelioma patients are often used in conjunction with CT scans. PET scans can be particularly helpful in determining if the cancer has metastasized beyond its point of origin.
- CT Scan - A Computer Tomography scan or CT scan, as it is more often referred to, is a commonly utilized method for locating the tumor in the body and determining the extent of the disease. Doctors will often prescribe a CT scan if mesothelioma is suspected because it offers more detail than a traditional X-ray. The CT scan provides cross-sectional imaging of the internal body structures that can be reconstructed on a computer monitor.
- MRI - A magnetic resonance image, more commonly referred to as an MRI, is a noninvasive method used for diagnosing mesothelioma within the body. The MRI uses a magnetic field and radio frequency pulses, transmitting them to a computer. Traditional MRI equipment consists of a cylinder within which the patient lies. The MRI poses no risk for patients, though some find the enclosed spaces uncomfortable. These patients may request a mild sedative to allow them to remain still and calm during the procedure.
- X-Ray - An x-ray is a commonly utilized mechanism not only for cancer diagnosis but for many different respiratory abnormalities, including bronchitis and pneumonia. Nevertheless, given that the symptoms of these respiratory disorders closely mimic those of malignant mesothelioma, often a chest x-ray is the first imaging technique used in a mesothelioma diagnosis. X-rays are particularly adept at identifying the proliferation of fluid within the pleural cavity, a symptom of mesothelioma known as a pleural effusion. If effusion is detected in the pleural cavity, doctors will often prescribe a surgical biopsy to test the fluid for malignant mesothelioma cells.
A biopsy is an important diagnostic procedure recommended by doctors for patients presenting with signs and symptoms of mesothelioma that have a history of asbestos exposure. Fine needle aspiration (FNA) is the less invasive type of biopsy that can be performed. FNA biopsy may be done on a pleural-based solid lesion, or cancer-associated fluid may be extracted through a syringe and then tested for the presence of malignant cells. Upon determining the presence of malignant cells, cancer specialists will determine the cellular classification of the malignancy and if mesothelioma is, in fact, present. However, it is not uncommon for there to be no cancer cells in the fluid or an insufficient number to make a definitive diagnosis even when cancer is present.
- Needle Biopsy- The needle biopsy is considered the less invasive biopsy procedure. Commonly, a more substantial biopsy of cancer tissue is generally recommended for patients in whom mesothelioma is suspected, such as a core biopsy. This may be done as a CT-guided biopsy from outside of the chest, or sometimes a small lung surgery such as a video-assisted thoracoscopic surgery (VATS), in which a surgeon uses small surgical tools with cameras and biopsy equipment to look inside the chest along the pleural surface (pleuroscopy) with a minimally invasive approach. It is often helpful and sometimes necessary for a surgeon to do a VATS and directly biopsy suspicious nodules in order to establish the diagnosis
- Surgical Biopsy - A surgical biopsy is a far more extensive procedure than needle biopsy. Nevertheless, these procedures are sometimes necessary to make a conclusive diagnosis of mesothelioma. Surgical biopsy can be particularly useful once a diagnosis has already been established. Once cancer is effectively staged, treatment recommendations can be made based on the best possible scenario for each individual patient’s circumstances.
National Cancer Institute - Mesothelioma: Questions and Answers