How is Mesothelioma Diagnosed?

Mesothelioma is often difficult to diagnose and the process of diagnosis can be fairly lengthy. For one thing, mesothelioma is a relatively rare disease. Most doctors have limited experience with mesothelioma. Your doctor may not immediately consider mesothelioma as a possible diagnosis, or may have trouble telling the difference between malignant mesothelioma and lung cancer.

In addition, many symptoms of mesothelioma are similar to those of less serious ailments. Most people with mesothelioma initially go to the doctor complaining of shortness of breath, pain in the chest or abdomen, and persistent fatigue, which could be caused by any number of diseases. All too often, the patient has been suffering from these symptoms for many weeks or months before they are diagnosed. This makes it especially important to inform your doctor of any possible asbestos exposure, so that he or she will know that you are at risk for mesothelioma.

Mesothelioma and Asbestos Exposure

Once your doctor has determined that you may be suffering from mesothelioma, he or she will want to take a complete medical history to check for possible risk factors. The doctor will probably begin by reviewing your occupational history, particularly any history of asbestos exposure.

If you are not sure, or if you cannot recall ever having been exposed to asbestos, it is okay to tell your doctors that you do not know or cannot recall having been exposed, but do not automatically say "No." You should be aware that many exposures are "occult" which in this context means unknown or entirely forgotten.

Asbestos is present in many different products, and exposure to asbestos can take place in many different circumstances and situations. Some of these exposures are far removed from the typical occupational settings and work environments. For example, bystanders that are in and around construction sites, present during renovations, in places such as homes and commercial buildings, through family members, and in neighborhoods near asbestos mines and factories. Again, this information is very important to your diagnosis, since asbestos is the primary risk factor for malignant mesothelioma.

Diagnostic Tests

After examining your medical history, the doctor will perform a complete physical exam to check for signs of disease. This will probably include x-rays of the chest and abdomen. Your doctor may also perform additional radiological tests such as a CT scan, MRI, or PET scan.

If there is a large amount of fluid in the chest or abdomen, the doctor may remove some of the fluid with a syringe to check for abnormal cells by cytology. A pathologist will examine the fluid under a microscope to check for malignant cells.

If the cytology is positive, or the imaging tests indicate that mesothelioma is likely, the doctor will order a biopsy to confirm the diagnosis. The doctor will remove a sample of tissue from the chest or abdomen. This tissue will be examined by a pathologist, who will issue a pathology report with a final diagnosis.

The doctor may also perform a thorascopy or bronchoscopy to test for pleural mesothelioma. Either of these techniques may be used to view the inside of the chest directly as well as to gather tissue samples for a biopsy. If the cancer appears to be a peritoneal mesothelioma, the doctor may perform a laparoscopy to obtain tissue from the abdomen. The earlier you begin the process of diagnosis, the better. Mesothelioma is easier to treat if it is detected in the early stages. Thus, if you have ever been exposed to asbestos on the job, in your household, or in your neighborhood, and you are suffering from any of the symptoms of mesothelioma, be sure to see your doctor as soon as possible.

Biopsy To Diagnose Mesothelioma

A biopsy is a diagnostic test in which your doctor removes cells or tissue from your body for examination by a pathologist, a doctor with specialized training in diagnosing diseases using microscopes. Your doctor will probably order a biopsy to confirm a diagnosis of mesothelioma or other cancer.

If your doctor suspects mesothelioma, he or she will remove a sample of tissue from your chest or abdomen for testing at a pathology lab. This biopsy tissue will then be sent to your pathologist, who will issue a pathology report with a final diagnosis.

The biopsy may be done in different ways, depending on where the cancer is located. If the cancer appears to be a pleural mesothelioma, your doctor may order a core needle biopsy (CNB) or a fine needle aspiration (FNA) biopsy. He or she will use a CT machine or other imaging test such as an endoscopic ultrasound (EUS) to locate the abnormal tissue, and then insert a biopsy needle through the chest wall into the suspect lung tissue.

If your doctor is unable to get a large enough tissue sample through a needle biopsy, he or she may also make a surgical incision to remove tissue from the chest or abdomen. This is known as an incisional biopsy.