Malignant Mesothelioma - Diagnosis, Treatment and Support
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| Malignant Mesothelioma, Diagnosis, Treatment and Support |
Mesothelioma Diagnosis | Detection, Tests & Next Steps
Symptoms and test results may strongly suggest that a person has mesothelioma, but the actual diagnosis is made by removing cells from an abnormal area and looking at them under a microscope. This is known as a biopsy. It can be done in different ways, depending on the situation.
2-Removing fluid for testing
If there is a buildup of fluid in part of the body that might be due to mesothelioma, a sample of this fluid can be removed by inserting a thin, hollow needle through the skin and into the fluid. Numbing medicine is used on the skin before the needle is inserted.This may be done in a doctor’s office or in the hospital.Sometimes ultrasound (or an echocardiogram) is used to guide the needle. These tests use sound waves to see inside the body.
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This procedure has different names depending on where the fluid is:
A-Thoracentesis : removes fluid from the chest.
B-Paracentesis : removes fluid from the abdomen.
C-Pericardiocentesis : removes fluid from the sac around the heart.
The fluid is then tested for its chemical makeup and is looked at under a microscope to see if it contains cancer cells. If cancer cells are found, special tests might be done to see if the cancer is a mesothelioma, a lung cancer, or another type of cancer.
Even if no cancer cells are found in the fluid, a person might still have cancer. In many cases, doctors need to get an actual sample of the mesothelium (the pleura, peritoneum, or pericardium) to determine if a person has mesothelioma.
3-Needle biopsies
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| Malignant Mesothelioma, Diagnosis, Treatment and Support |
Suspected tumors in the chest are sometimes sampled by needle biopsy. A long, hollow needle is passed through the skin in the chest between the ribs and into the pleura. Imaging tests such as CT scans are used to guide the needle into the tumor so that small samples can be removed to be looked at under the microscope. This is often done using just numbing medicine.
Needle biopsy can also be used to get samples of the lymph nodes in the space between the lungs to see if the cancer has spread there (see “Endobronchial ultrasound needle biopsy”).
Needle biopsies do not require a surgical incision or overnight hospital stay. But the downside is that sometimes the samples removed are not big enough to make an accurate diagnosis. This is especially true for mesothelioma. A more invasive biopsy method may be needed.
There is a slight chance that the needle could put a small hole in the lung during the biopsy. This can cause air to build up in the space between the lung and the chest wall (known as a pneumothorax). A small pneumothorax might not cause any symptoms. It may only be seen on an x-ray done after the biopsy, and it will often go away on its own. But a larger pneumothorax can make part of a lung collapse and might need to be treated. The treatment is placement of a small tube (a catheter) through the skin and into the space between the lungs. The tube is used to suck the air out in order to reexpand the lung and is left in place for a short time.
4-Endoscopic biopsies
Endoscopic biopsy is commonly used to diagnose mesothelioma. An endoscope is a thin, tube-like instrument used to look inside the body. It has a light and a lens (or tiny video camera) on the end for viewing and often has a tool to remove tissue samples. Endoscopes have different names depending on the part of the body where they’re used.
A-Thoracoscopy: This procedure uses an endoscope called a thoracoscope to look at areas inside the chest. It can be used to look at the pleura and take tissue samples for biopsies.
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| Malignant Mesothelioma, Diagnosis, Treatment and Support |
Thoracoscopy is done in the operating room while you are under general anesthesia (in a deep sleep). The doctor inserts the thoracoscope through one or more small cuts made in the chest wall to look at the space between the lungs and the chest wall. This lets the doctor see possible areas of cancer and remove small pieces of tissue to look at under the microscope. The doctor can also sample lymph nodes and fluid and see if a tumor is growing into nearby tissues or organs.
B-Laparoscopy: For this test, the doctor uses an endoscope called a laparoscope to look inside the abdomen and biopsy any peritoneal tumors. This is done in the operating room while you are under general anesthesia (in a deep sleep). The laparoscope is inserted into the abdomen through small cuts on the front of the abdomen.
A small cut is made in the front of the neck above the breastbone (sternum) and a thin, hollow, lighted tube (called a mediastinoscope) is inserted behind the sternum. Special instruments can be passed through this tube to take tissue samples from the lymph nodes along the windpipe and the major bronchial tube areas.
Lung cancers often spread to lymph nodes, but mesotheliomas do this less often. Testing the lymph nodes can help show whether a cancer is still localized or if it has started to spread, which might affect treatment options. It can also sometimes help tell lung cancers from mesotheliomas.Patients with mesothelioma don’t need to have bronchoscopy to see if tumors are in their airways (because that isn’t where tumors from mesothelioma are found). Instead, bronchoscopy may be used to biopsy lymph
C-Endobronchial ultrasound needle biopsy: For this test, a bronchoscope (a long, thin,flexible, fiber-optic tube) with an ultrasound device at its tip is passed down the throat and into the windpipe. The ultrasound lets the doctor see the nearby lymph nodes. A hollow needle is then passed down the bronchoscope and through the airway wall into the nodes to take biopsy samples. This procedure may be done with either general anesthesia (where you are asleep), or with numbing medicine (local anesthesia) and light sedation. nodes near the lungs (instead of using mediastinoscopy).
5-Open surgical biopsy
Sometimes, endoscopic biopsies aren’t enough to make a diagnosis, so more invasive procedures are needed. By making an incision in the chest (thoracotomy) or an incision in the abdomen (laparotomy) the surgeon can remove a larger sample of tumor or, sometimes, remove the entire tumor.