Malignant Mesothelioma: Diagnosis
If your healthcare provider thinks you might have malingant mesothelioma, you’ll need certain exams and tests to be sure. Diagnosing mesothelioma starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam.
What tests might I need?
You may have one or more of the following tests:
If you have symptoms of mesothelioma, you may have imaging tests. While these tests might strongly suggest you have the cancer, you’ll still need a biopsy to be sure.
Chest X-rays are often the first test done when a person has certain symptoms. These can include a cough that doesn’t go away or shortness of breath. X-rays of your chest, especially when you’re positioned in different ways, can help your healthcare provider see certain things. These can include fluid or other signs of cancer in the spaces around your lungs. X-rays of your abdomen can help your healthcare provider see if your abdomen has areas of cancer. If something abnormal is seen on an X-ray, your healthcare provider may do other imaging tests.
Computed tomography (CT scan)
A CT scan uses X-rays. They’re taken from many angles to make detailed pictures of your body. It can show areas of your chest or abdomen in much more detail than an X-ray.
Positron emission tomography (PET scan)
A PET scan can sometimes help your healthcare provider know if fluid in your chest or other issues are due to cancer. For this test, you’re injected with a form of sugar (glucose) that carries a radioactive substance. Cancer cells are more active than normal cells, so they tend to take up more glucose. A special camera then takes pictures of where this glucose is being used in your body.
If an imaging test shows something that looks like it might be cancer, your healthcare provider may take fluid or small tissue samples of the area. This is called a biopsy. Your healthcare provider sends the samples to a lab. There, a specialized doctor, called a pathologist, looks at them under a microscope and checks for cancer cells. There are several different biopsy tests.
Your healthcare provider takes a small sample from a tumor in your chest cavity. He or she puts a small lighted tube with a tiny camera (thoracoscope) through a cut in the skin of your chest to look at the tumor. He or she looks carefully at the lining of the inner part of your chest and your lung. Then he or she removes pieces of tissue from the tumor for the biopsy.
Your healthcare provider takes a small sample from a tumor in your abdomen. He or she puts a small lighted tube with a tiny camera (laparoscope) through a cut in the skin of your belly to look at the tumor. He or she looks carefully at the lining of the inner part of your belly and on your intestines and other organs. Your healthcare provider takes biopsies from suspicious looking areas.
Your healthcare provider puts a thin tube (bronchoscope) into your mouth, down your windpipe, and into the main air passages of your lungs. This tube lets him or her see if there are any tumors in your airways. He or she can also take a biopsy while doing this test.
In this surgery, your healthcare provider makes a larger incision in your chest. This is done to remove a larger piece of tissue from the tumor or the entire tumor. This is often the best way to make a diagnosis of mesothelioma.
In this surgery, your healthcare provider makes a larger incision in your abdomen. This is done to remove a larger piece of tissue from the tumor or the entire tumor.
Thoracentesis, pericardiocentesis, and paracentesis
In this procedure, your healthcare provider uses a long, hollow needle. He or she puts it through your skin to remove fluid from your chest, sac around your heart, or from your abdomen.
It can be hard to diagnose mesothelioma by looking at fluid or tissue samples. This is because this cancer can look like other kinds of cancer. You may need more tests.
You may have blood tests to help diagnose mesothelioma. However, not all healthcare providers agree that these tests are useful. Your healthcare provider may look for these substances in your blood:
Soluble mesothelin-related peptides (SMRPs)
These blood tests alone cannot diagnose mesothelioma. But high levels of these substances can make the diagnosis more likely.
Getting your test results
When your healthcare provider has the results of your tests, he or she will contact you with the results. Your provider will talk with you about other tests you may need if mesothelioma is found. Make sure you understand the results and what follow-up you need.
March 21, 2017
Clinical Presentation, Diagnosis, and Staging of Malignant Pleural Mesothelioma. UpToDate.
Alteri, Rick, MD,Levin, Mark, MD