Mesothelioma Diagnosis

How Is Mesothelioma Diagnosed?

A biopsy is the only definitive means for identifying a correct mesothelioma diagnosis. A surgeon collects and analyzes the biopsy tissue under a microscope. They examine the biopsy to see if it contains cancerous mesothelioma cells that form tumors. The most common types of biopsies for diagnosing mesothelioma include pleural aspiration, thoracoscopy and image-guided biopsy. 

In addition to these biopsy procedures, doctors may also perform other tests such as a physical exams, blood tests, CT scans or pathology reports for patients suspected of having mesothelioma, especially if they have a history of asbestos exposure. But these other tests cannot offer positive confirmation.

Results from other medical tests, such as routine blood work or chest X-rays, often indicate the need for further cancer testing. These initial tests frequently lead to a mesothelioma biopsy and subsequent diagnosis. However, the diagnostic process is not the same for everyone, and the order of tests may vary.

“The lining of the lung becomes thickened, which begins to show on a CT scan or X-ray,” Sugarbaker said. “Even though the cytology report is negative, there can be cancer there. Therefore, a biopsy is the most definitive way in which patients will understand clearly that they either have or don’t have mesothelioma.”

Methods for Diagnosing Mesothelioma

Doctors diagnose mesothelioma using a variety of tests, including biopsies, physical exams, imaging tests and blood tests. A physical exam is usually the initial step in diagnosing mesothelioma, during which your physician will inquire about your medical history. 

If you have been exposed to asbestos in the past, your doctor will check for symptoms of mesothelioma, such as fluid buildup in the chest (pleural effusions) or in the abdomen (ascites). Following this examination, your physician will decide whether you require imaging scans or a biopsy.

Medical professionals use imaging tests to reveal the location and tumor size. While mesothelioma blood tests can’t provide an accurate initial diagnosis, they can inform doctors about the patient’s potential response to treatment. Cytology tests, which are types of biopsies that extract fluid and cancer cells with a needle, are dependable methods to accurately diagnose mesothelioma.

Physical Exams

If you are experiencing chest pain, difficulty swallowing, shortness of breath or lower back pain and have a history of asbestos exposure, you will want to have a physical exam with your doctor to begin the process of checking for mesothelioma. Your doctor may use specific tools to check your chest and abdomen for symptoms of the disease. It is also crucial to be frank and thorough with your physician, going over every symptom you experience as well as your medical history and asbestos exposure.

Imaging Tests

Radiologists use high-tech imaging tests, including PET scans, X-rays, echocardiograms, CT scans and MRIs, to locate and assess mesothelioma tumors. Some scans involve contrast dye. Most are generally quick and painless; MRIs can take 30 to 90 minutes.

Early screenings can be vital for the patient’s health as treatment outcomes can improve, survival rates increase and symptoms and complications can be alleviated by early intervention. Dr. David Sugarbaker, a pioneer of pleural mesothelioma research, told The Mesothelioma Center: “What we need to do as clinicians is find out what’s causing [possible mesothelioma symptoms].”

Some scans such as MRIs may cause anxiety in some patients. In such cases, health care providers may prescribe anti-anxiety medications to help patients relax during the scan.

“I did get used to the routine of going in for scans, but I still experienced scanxiety,’” said Tamron Little, who used positive thinking to overcome anxiety. “Think positive thoughts. I know this may seem cliché, but it works. Thinking positively will take your mind off the scan.”

Biopsies

The most accurate way to confirm the presence of mesothelioma is with a biopsy. This is a medical procedure to extract a sample of tissue that experts examine to detect signs of mesothelioma.

A biopsy is necessary and vital for accurately diagnosing mesothelioma. Only a biopsy can identify the specific mesothelioma cell type.

Pathology and Lab Tests

The most important pathology test and lab test used for any type of mesothelioma is the biopsy. Doctors may also order blood tests and other tests for biomarkers and immunohistochemical markers, to accurately diagnose mesothelioma.

It’s important to understand the pathology of the mesothelioma of a particular patient to implement proper treatment. Mesothelioma pathologists are experienced in correctly identifying the disease based on the physical characteristics of the tumors.

How Doctors Determine Stages of Mesothelioma Cancer

Doctors determine the stages of mesothelioma cancer using biopsies, imaging scans and other diagnostic tests. The pathology result of a patient’s biopsy is the best indicator of mesothelioma.

Staging represents what the clinicians will do when the patient comes in to determine where their mesothelioma is, what is involved in it and whether it’s gone anywhere else.

Dr. Andrea Wolf

Director of the New York Mesothelioma Program at Mount Sinai

The 4 stages of mesothelioma range from early stage (stages 1 and 2 or I and II) or late stage (stages 3 and 4 or III and IV). The higher the number, the more the cancer has spread from the original location, and the more difficult it may be to treat.

For staging pleural mesothelioma, the official system is called the TNM staging system, which identifies tumor size and location, lymph nodes and metastasis. There is no official staging system for peritoneal mesothelioma, but most doctors use a modified version of TNM until they develop one for peritoneal. No staging system exists for pericardial or testicular mesothelioma.

Importance of Early Mesothelioma Detection

Early detection of mesothelioma is critical for improving patient outcomes and increasing treatment options. Asbestos exposure, the primary cause of mesothelioma, often occurs decades before symptoms manifest, making early diagnosis challenging. 

Prompt detection enables healthcare providers to initiate treatment sooner. Rapid treatment improves prognosis and extends survival. Pleural mesothelioma specialist Dr. Jeffrey Velotta told The Mesothelioma Center, “If we could diagnose patients a year earlier, we could start treatment earlier. Then we’d put them in a protective mode where we monitor, rather than manage, advanced tumor growth.”

There are many benefits to early mesothelioma detection, but according to the CDC, between 2017 and 2021, a total of 45.9% of mesothelioma diagnoses occurred in later stages of the disease. It’s essential to start discussions and cancer screening with your healthcare providers as soon as possible if you have known asbestos exposure. 

Early mesothelioma treatment, including surgery, chemotherapy and radiation therapy, offers better therapeutic responses and improved quality of life for patients. Early detection and better access to screening programs can lead to improved patient outcomes.

Why Is Diagnosing Mesothelioma Difficult?

Diagnosing mesothelioma is difficult because symptoms often mimic more common illnesses. Mesothelioma survivor Wendy M. Phillips told us “I went to the hospital with a swollen arm and was initially told I had a blood clot. Further testing revealed mesothelioma tumors were blocking my lymph nodes.”

The Patient Advocates at The Mesothelioma Center add, “Many patients we speak with have told us they were diagnosed after going to the hospital for what they thought was an unrelated symptom.” The decades-long latency period between asbestos exposure and the development of mesothelioma means 20 to 60 years may pass before symptoms arise. 

Getting a second opinion from a mesothelioma specialist is essential because many primary care physicians and oncologists have never encountered mesothelioma. Without knowledge of asbestos exposure, they may misdiagnose mesothelioma or not consider it as a possible diagnosis. 

Importance of Finding a Mesothelioma Specialist

Finding a mesothelioma specialist is important because primary care physicians and oncologists may not have experience in diagnosing mesothelioma or overlook it as a possible cause. Seeking a second opinion is critical because symptoms of mesothelioma can often mimic common illnesses, and an accurate diagnosis can be challenging. 

Peritoneal mesothelioma survivor Tamron Little informed us, “At first, I was under the care of an oncologist who said he knew nothing about mesothelioma. But I finally found the right mesothelioma specialist. I was presented with a roadblock and decided to go around it.” 

The experience of mesothelioma specialists in treating patients with asbestos-related cancer is invaluable. General health care providers may lack the necessary expertise to provide comprehensive care. Acquiring a second opinion from a specialized mesothelioma specialist could considerably impact treatment outcomes and potentially extend a patient’s life.

Most people who contact us about diagnosing mesothelioma are looking for a second opinion. We can connect them with mesothelioma specialists and arrange appointments and treatment if they do receive a confirmed mesothelioma diagnosis.

Dr. Snehal Smart

Patient Advocate at The Mesothelioma Center at Asbestos.com

What Should I Do After a Mesothelioma Diagnosis?

After you have a diagnosis of mesothelioma, you should consult your physician about treatment options. Treatments include chemotherapy, immunotherapy, radiation and surgery. Tumor Treating Fields is another treatment that patients can do at home. 

While treatment of the disease is encouraged, some patients choose alternatives or implement certain health modifications in their lives in addition to treatment. This includes integrative medicine like yoga or acupuncture. Patients with mesothelioma can also follow a fitness routine as well as a mesothelioma diet to assist with immune function.

Common Questions About Diagnosing Mesothelioma

Who should be tested for mesothelioma?

People who have experienced direct and long-term exposure to asbestos and their families are at the highest risk for developing mesothelioma. If you have a history of asbestos exposure and develop a persistent cough, shortness of breath or other mesothelioma symptoms, make an appointment with your primary care physician or seek a mesothelioma specialist.

How long does it take to get a mesothelioma diagnosis?

The average time from initial symptoms, such as shortness of breath or chest pain, to a mesothelioma diagnosis is approximately 3 months.

How will my diagnosis affect my treatment options and prognosis?

An accurate and early diagnosis will start you on the path to more effective treatment options, which may help improve your prognosis. A late diagnosis or misdiagnosis delays treatment, limits its effectiveness and reduces the chances of a favorable prognosis.

How do you prepare for a mesothelioma biopsy?

Stop taking any blood-thinning medication at least 5 days before a biopsy. Wear loose clothing to the appointment, and plan to have a designated driver take you home. Don’t eat or drink anything 6 hours before your appointment. Plan to spend several hours undergoing the biopsy. Some biopsies, such as thoracoscopy, require at least a 1-night stay in the hospital.

Why is it essential to get a second opinion?

Seeking a second opinion from a mesothelioma specialist is essential because they have expertise in diagnosing and treating the disease. A specialist may offer a more accurate diagnosis and recommend better treatment options than a general oncologist.

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