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The symptoms of pleural mesothelioma are similar to many other illnesses. In most cases, a patient will experience shortness of breath, coughing and chest pains, which can easily be mistaken for more common disorders. Many even delay a visit to their doctor because they believe the symptoms are signs of a minor illness.
Approximately 25 percent of people that have pleural mesothelioma symptoms experience them for six months or more before they are diagnosed. This is unfortunate because pleural mesothelioma generally reaches the advanced stages of development before any symptoms appear and any delay in detection can have an effect on treatment options. Anyone who has been exposed to asbestos should thus be evaluated by a physician specializing in asbestos-related illnesses on a regular basis.
When someone visits their doctor with mesothelioma symptoms, the doctor will ask several questions regarding their past and present medical history. It is important to mention any possible exposure to hazardous substances such as asbestos and other toxins. Pleural mesothelioma can initially be misdiagnosed because physicians want to consider more common disorders before looking at less likely possibilities.
A doctor visit will include a physical exam to look for signs of mesothelioma or other disorders. Pleural effusion, which is fluid in the chest cavity, can often be a sign of pleural mesothelioma and may be detected during a physical exam.
As part of a diagnostic work-up, the doctor may order blood tests. These are performed to determine a patient’s general state of health rather than to detect mesothelioma. An elevated level of a protein in the blood called osteopontin will rouse suspicion of mesothelioma. However, a blood test cannot officially determine whether or not a patient has mesothelioma. More extensive imaging tests and biopsies are needed to determine an exact diagnosis.
Several imaging tests, including X-rays, computerized tomography (CT) scans and magnetic resonance imaging (MRI) scans can be used to diagnose cancer. While a patient is being checked out, doctors will often perform more than one kind of imaging test.
Doctors will typically order a second set of pictures using a contrast dye to create a better picture. The patient will then be given a radiocontrast agent (a dye) through an intravenous line (IV). An allergic reaction to the contrast solution can include hives or more serious reactions such as breathing difficulties and low blood pressure. Allergic reactions are relatively rare and a patient will be questioned about possible allergies before the test.
Occasionally, a contrast material may be injected during an MRI. MRI scans are not painful, but some people find them uncomfortable since the majority of the body is placed inside a large tube that contains the scanning equipment. There are some MRI machines that are not enclosed, but these are not readily available in all locations. MRI machines also make a loud noise, but many places give patients earphones to block out the noise.
If someone has abnormal fluid in the chest cavity, a fluid sample or biopsy can help determine if they have pleural mesothelioma. The doctor will take a fluid sample by inserting a needle into the chest cavity. The sample will later be examined under a microscope to see if it contains cancerous cells. If the sample contains cancerous cells, more tests will be performed to determine whether the cancer is pleural mesothelioma, lung cancer or another form of cancer.
If suspicious spots are shown on an imaging test, the next step will likely be a biopsy to take a tissue sample. Tissue samples can be collected in different ways depending on the location of the tissue and the size of the mass. A thoracoscopy, often used for inspecting the pleural cavity, allows physicians to obtain a tissue sample of a tumor located in the chest. A small incision is made in the chest and a thorascope (a tube-like instrument with a video camera), is inserted to look at any suspicious spots.
Another procedure used to diagnose pleural mesothelioma is the bronchoscopy. For this test, a flexible tube is inserted into the mouth, moved through the trachea, and directed into the bronchi to look for masses in the airway. A sample will then be taken of abnormal tissue.
If physicians suspect a patient has cancer that has spread to other locations, he or she may perform a procedure called a mediastinoscopy. For this test, an incision is made under the sternum (chest bone) and a thin tube is inserted to examine the lymph nodes. The lymph nodes are small clusters of specialized cells that help the body fight infection. It is common for lung cancer to invade the lymph nodes, but it is less common for pleural mesothelioma. This test can especially be useful in distinguishing lung cancer from pleural mesothelioma.
If the imaging tests show large abnormal masses, the doctor may recommend surgery and suggest a biopsy be taken.
Once tissue and/or fluid samples are obtained, a pathologist will examine them under a microscope. Because pleural mesothelioma cells can look like other types of cancer cells, a more powerful electron microscope is sometimes used to help distinguish the cells. Special laboratory tests of the cells are often needed to make a diagnosis of pleural mesothelioma. Immunohistochemistry testing examines proteins on the surfaces of cells and can determine if a tumor mass is pleural mesothelioma or lung cancer.
If a doctor determines a patient has pleural mesothelioma, the next step is to determine how far the disease has progressed. Determining the stage of the cancer will help doctors recommend the various treatment options available.
If you would like to understand more about diagnosing and treating mesothelioma, please feel free to call 1-800-381-1772 or fill out the form on this page to speak with a Patient Advocate who can further explain your options and mail you additional information.