Mesothelioma Diagnosis: Important Detection Steps & Tests
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| Mesothelioma Diagnosis |
Mesothelioma Diagnosis: Understand the Diagnostic Process
Mesothelioma is most often diagnosed after a person goes to a doctor because of symptoms they are having. If there is a reason to suspect you might have mesothelioma, your doctor will examine you and use one or more tests to find out. Symptoms might suggest that the problem could be mesothelioma, but tests will be needed to confirm the diagnosis.
1-Medical history and physical exam
If you have any signs or symptoms that suggest you might have mesothelioma, your doctor will want to get your medical history to learn about your symptoms and possible risk factors, especially asbestos exposure.
A physical exam can provide information about possible signs of mesothelioma and other health problems. Pleural mesothelioma can cause fluid to build up around the lungs in the chest (called a pleural effusion). In cases of peritoneal mesothelioma, fluid can build up in the abdomen (called ascites). In pericardial mesothelioma, fluid builds up in the sac around the heart (called a pericardial effusion). Rarely, mesothelioma can develop in the groin and look like a hernia. All of these might be found during a physical exam, such as when the doctor listens to these areas with a stethoscope or taps on the chest or abdomen.
If mesothelioma is a possibility, tests will be needed to make sure. These might include imaging tests, blood tests, and other procedures.
2-Imaging tests
Imaging tests use x-rays, radioactive particles, sound waves, or magnetic fields to create pictures of the inside of your body. Imaging tests might be done for a number of reasons, such as:
A-To look at suspicious areas that might be cancer
B-To learn how far cancer has spread
C-To help determine if treatment is working
3-Chest x-ray
This is often the first test done if someone has symptoms such as a constant cough or shortness of breath. Findings that might suggest mesothelioma include an abnormal thickening of the pleura, calcium deposits on the pleura, fluid in the space between the lungs and the chest wall, or changes in the lungs themselves as a result of asbestos exposure.
4-Computed tomography (CT) scan
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| Mesothelioma Diagnosis |
The CT scan uses x-rays to make detailed cross-sectional images of your body. Instead of taking one picture, like a regular x-ray, a CT scanner takes many pictures as it rotates around you while you are lying on a narrow table. A computer then combines these into images of slices of the body.
CT scans are often used to help look for mesothelioma and to determine the exact location of the cancer. They can also help determine the stage (extent) of the cancer. For example, they can show if the cancer has spread to other organs. This can help determine if surgery might be a treatment option. Finally, CT scans can also be used to learn if treatment such as chemotherapy is shrinking or slowing the growth of the cancer.
A CT scanner has been described as a large donut, with a narrow table that slides in and out of the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.
Before the test, you might have to drink a liquid called oral contrast. This helps outline the intestine so that certain areas are not mistaken for tumors. You might also need an IV (intravenous) line through which a different kind of contrast is injected. This helps better outline structures in your body. The injection can cause some flushing (redness and warm feeling). Some people are allergic and get hives or, rarely, more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have any allergies (especially to iodine or shellfish) or have ever had a reaction to any contrast material used for x-rays.
5-Echocardiogram
This test uses sound waves to look at the heart. It may be done if your doctor suspects that you have fluid around your heart (a pericardial effusion). This test can also tell how well the heart is working. For the most common version of this test, you lie on a table while a technician moves an instrument called a transducer over the skin on your chest. A gel is often put on the skin first.
6-Positron emission tomography (PET) scan
For a PET scan, a radioactive substance (usually a type of sugar related to glucose, known as FDG) is injected into the blood. The amount of radioactivity used is very low. Because cancer cells grow quickly, they absorb more of the sugar than most other cells. After waiting about an hour, you lie on a table in the PET scanner for about 30 minutes while a special camera creates a picture of areas of radioactivity in the body.
The picture from a PET scan is not as detailed as a CT or MRI scan, but it can provide helpful information about whether abnormal areas seen on these tests are likely to be cancerous or not. For example, it can give the doctor a better idea of whether a thickening of the pleura or peritoneum seen on a CT scan is more likely cancer or merely scar tissue. If you have been diagnosed with mesothelioma, your doctor may use this test to see if the cancer has spread to lymph nodes or other parts of the body. A PET scan can also be useful if your doctor thinks the cancer may have spread but doesn’t know where.
Some machines can do both a PET and CT scan at the same time (PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT.
7-Magnetic resonance imaging (MRI) scan
Like CT scans, MRI scans make detailed images of the body’s soft tissues. But MRI scans use radio waves and strong magnets instead of x-rays. A contrast material called gadolinium is often injected into a vein before the scan to better show details. This contrast is different than the one used for CT scans, so being allergic to one doesn’t mean you are allergic to the other.
MRI scans can sometimes help show the exact location and extent of a tumor since they provide very detailed images of soft tissues. For mesotheliomas, they may be useful in looking at the diaphragm (the thin band of muscle below the lungs that helps us breathe), a possible site of cancer spread.
MRI scans take longer than CT scans – often up to an hour. You may have to lie inside a narrow tube, which can upset people with a fear of enclosed spaces. Special, more open MRI machines may be an option in some cases. The MRI machine makes buzzing and clicking noises that you might find disturbing. Some places will give you earplugs to help block this out.
8-Blood tests
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| Mesothelioma Diagnosis |
Blood levels of certain substances are often higher in people with mesothelioma:
A-Osteopontin
B-Soluble mesothelin-related peptides (SMRPs), detected with the MesoMark® test Mesothelioma can’t be diagnosed with these blood tests alone, but high levels of these substances can make the diagnosis more likely. These tests are not routinely used in most doctors’ offices because of their limited value.
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