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Pleural Mesothelioma Diagnosis

Diagnosing pleural mesothelioma is difficult for most doctors because the disease is so rare. Getting a second opinion from a team of mesothelioma specialists is the best way to confirm the cancer type and stage. Diagnostic accuracy is vital to an effective treatment plan.

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The diagnostic process for pleural mesothelioma cancer usually begins when a doctor sees something unusual on a chest X-ray or CT scan.

The patient may have come in complaining of chest pain or breathing difficulty that won’t go away. In some cases, the patient has no cancer symptoms yet, and the tumor is caught by accident during a scan for an unrelated issue.

Either way, most doctors will not suspect pleural mesothelioma unless the patient informs them about a history of asbestos exposure. This usually means working around asbestos products for many years.

Living with someone who brought asbestos dust home on their work clothes is another risk factor.

Danger of Misdiagnosis

A misdiagnosis wastes precious time. It may also lead to a pleural mesothelioma patient receiving the wrong treatments. If a patient’s doctor is not familiar with asbestos-related diseases, the patient should be proactive about seeking a mesothelioma specialist.

All too often, the diagnostic process for pleural mesothelioma drags on for months because doctors assume the patient has a more common illness such as pneumonia. Doctors may also misdiagnose the patient with the wrong type of cancer, the wrong mesothelioma cell type or the wrong cancer stage.

The diagnostic process usually involves an oncologist, pulmonologist, radiologist, pathologist and surgeon. Cancer centers with mesothelioma treatment programs have mesothelioma experts in all these subspecialties.

The diagnostic process for pleural mesothelioma cancer usually begins when a doctor sees something unusual on a chest X-ray or CT scan.

The patient may have come in complaining of chest pain or breathing difficulty that won’t go away. In some cases, the patient has no cancer symptoms yet, and the tumor is caught by accident during a scan for an unrelated issue.

Either way, most doctors will not suspect pleural mesothelioma unless the patient informs them about a history of asbestos exposure. This usually means working around asbestos products for many years.

Living with someone who brought asbestos dust home on their work clothes is another risk factor.

Danger of Misdiagnosis

A misdiagnosis wastes precious time. It may also lead to a pleural mesothelioma patient receiving the wrong treatments. If a patient’s doctor is not familiar with asbestos-related diseases, the patient should be proactive about seeking a mesothelioma specialist.

All too often, the diagnostic process for pleural mesothelioma drags on for months because doctors assume the patient has a more common illness such as pneumonia. Doctors may also misdiagnose the patient with the wrong type of cancer, the wrong mesothelioma cell type or the wrong cancer stage.

The diagnostic process usually involves an oncologist, pulmonologist, radiologist, pathologist and surgeon. Cancer centers with mesothelioma treatment programs have mesothelioma experts in all these subspecialties.

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Testing for Pleural Mesothelioma

Pleural mesothelioma tests usually include imaging scans and a biopsy. A PET-CT scan can reveal whether cells are cancerous and how far they have spread. But a pathologist must analyze a biopsy sample to confirm what type of cancer is present.

Imaging Tests

Imaging tests used to diagnose pleural mesothelioma include X-rays, CT scans, MRI scans and PET scans. Combination PET-CT scans are particularly useful:

Biopsies

A biopsy is a test done on a small sample of cells from a tumor. A pathologist examines this sample in a laboratory to determine whether the tumor is pleural mesothelioma and, if so, what the cell type is. The sample may be extracted as a solid bit of tissue or as a liquid sample from fluid buildup in the chest.

Retrieving a biopsy sample involves a minor surgical procedure. Biopsy procedures for pleural mesothelioma include:

 
Dr. Farid Gharagozloo describes the diagnostic process for pleural mesothelioma.

Specialists consider thoracoscopy the most accurate biopsy method for pleural mesothelioma. It allows doctors to look around the pleural cavity and retrieve high-quality tissue samples.

To examine the biopsy sample, a pathologist looks at it under a microscope and applies different immunohistochemical stains. This process is important for differentiating pleural mesothelioma from lung cancer. A 2015 review detailed several important chemical markers for mesothelioma.

Blood Tests

Researchers are trying to develop blood tests for mesothelioma, including one based on SOMAmer proteomic technology. These tests search for biomarkers (proteins and other molecules) that indicate mesothelioma cells are in the body. But these blood tests are not yet reliable enough to replace biopsies.

Researchers are also exploring the potential of breath tests that can detect mesothelioma biomarkers, as reported in a 2017 study.

Staging Pleural Mesothelioma

Staging pleural mesothelioma means determining how far the cancer has spread. Cancer stage is a major factor in whether doctors recommend tumor-removing surgery. Staging pleural mesothelioma through minimally invasive techniques requires expert training and experience.

Imaging scans are valuable for staging, but they yield imperfect results. A 2012 study analyzed more than 3,000 pleural mesothelioma cases and reported the discrepancies in staging between diagnosis and surgery.

In about 80 percent of patients diagnosed with stage 1 cancer, surgeons found the cancer was actually more advanced. Around 65 percent of patients diagnosed with stage 2 pleural mesothelioma were similarly upstaged during surgery.

On the other hand, though, many doctors unfamiliar with pleural mesothelioma tend to assume the disease is untreatable, even when there is hope for life-extending surgery. Getting a second opinion from a mesothelioma expert is essential.

After a Mesothelioma Diagnosis

After a pleural mesothelioma diagnosis, you should go to a specialized cancer center to confirm the details of the diagnosis. From there, a mesothelioma treatment center will give you access to innovative treatment combinations and clinical trials.

Learn all you can about your type of mesothelioma and the treatment options that may help you live longer and increase your quality of life.

Ask your medical team about complementary therapies that can alleviate symptoms and side effects. Be sure to also tell them about other health conditions you have and prescription medications you are taking.

Explore financial assistance options for medical bills and the costs of traveling for treatment. Reach out to friends, family and health professionals to build a support network. Taking these steps will help you and your family cope with this diagnosis.


Dr. Snehal Smart

Snehal Smart

Snehal Smart is the Pleural Mesothelioma Center’s in-house medical doctor, serving as both an experienced Patient Advocate and an expert medical writer for the website. When she is not providing one-on-one assistance to patients, Dr. Snehal stays current on the latest medical research, reading peer-reviewed studies and interviewing oncologists to learn about advancements in diagnostic tools and cancer treatments.

Medically Reviewed By Dr. Joanne Getsy
Last Modified December 19, 2018

9 Cited Article Sources

  1. American Cancer Society. (2012, October 2). How is Malignant Mesothelioma Found Retrieved from http://www.cancer.org/cancer/malignantmesothelioma/overviewguide/malignant-mesothelioma-overview-diagnosed
  2. Brigham and Women’s Hospital. (2011, December 5). Malignant Pleural Mesothelioma. Retrieved from http://www.brighamandwomens.org/Departments_and_Services/surgery/services/thoracicsurgery/services/mesothelioma/Pleural_Mesothelioma.aspx
  3. European Lung Cancer Conference. (2012, April 18). Promising Developments in Early Diagnosis and Treatment of Pleural Mesothelioma. Retrieved from http://iaslc.org/assets/News-Releases/ELCC-Mesothelioma-PR-final.pdf
  4. Fujirebio Diagnostics, Inc. (n.d.). FAQ The MESOMARK Assay. Retrieved from http://www.fdi.com/mesomark/world/about/faqs.html
  5. Memorial Sloan-Kettering Cancer Center. (n.d.). Mesothelioma Diagnosis & Staging. Retrieved from http://www.mskcc.org/cancer-care/adult/mesothelioma/diagnosis-staging
  6. Neumann, V., Loseke, S., Nowak, D., Herth, F., and Tannapfel, A. (2013, May). Malignant Pleural Mesothelioma: Incidence, Etiology, Diagnosis, Treatment and Occupational Health. Deutsches Arzteblatt International. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659962/
  7. National Comprehensive Cancer Network. (2012). Malignant Pleural Mesothelioma NCCN Guidelines for Patients. Retrieved from http://www.nccn.org/patients/patient_guidelines/mpm/index.html#/12/
  8. Peake, M.D., Entwisle, J., & Gray, S. (2006). Malignant pleural mesothelioma: Clinical presentation, radiological evaluation and diagnosis. In K. O’Byrne & V. Rusch (Eds.), Malignant pleural mesothelioma (pp. 35-60). New York, NY: Oxford University Press.
  9. Weyant, M. and Flores, R. (2004). Imaging of Pleural and Chest Wall Tumors. Thoracic Surgery Clinics. Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&ved=0CIIBEBYwBw&url=http%3A%2F%2Ffiles.lacart-pa.webnode.com.br%2F200000080-9692b978aa%2F4%2520-%2520Imaging%2520of%2520pleural%2520and%2520chest%2520wall%2520tumors.pdf&ei=eQQ1UKrJO8Lc2AXxkYDYDw&usg=AFQjCNGmyNcUc6EukllKaIx7V6G1BVf2ww&cad=rja

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