Malignant Mesothelioma: Tests After Diagnosis
After a diagnosis of mesothelioma, you’ll likely have other tests. These tests help your healthcare team learn more about your cancer. They can help show if the cancer has grown into nearby areas or spread to other parts of the body. The results help your healthcare providers decide the best ways to treat the cancer. For instance, tests can help tell whether or not surgery might be an option to treat it. If you have any questions about these or other tests, talk with your healthcare team.
The tests you may have can include:
Computed tomography (CT) scan
Magnetic resonance imaging (MRI)
Positron emission tomography (PET) scan (or PET/CT scan)
Mediastinoscopy or other staging surgeries
During a CT scan (or a CAT scan), X-rays are used to scan a part of the body to create detailed pictures. You may have this done on your chest or abdomen. When you have mesothelioma, these pictures help your healthcare provider see where the cancer is. They can also show if the cancer has spread to nearby organs or lymph nodes or to other parts of the body.
To have the test, you lie still on a table as it slowly slides through the center of the CT scanner. A computer uses the data from the X-rays to create many pictures of your chest. A CT scan is painless. You may be asked to hold your breath one or more times during the scan. In some cases, you get an IV drip with a contrast medium before the scan. This helps any tumors show up better. You may be asked not to eat anything in the time between drinking the contrast and the scan. The contrast will slowly pass through your system and exit through your bowel movements.
An MRI uses magnets, radio waves, and a computer to create detailed pictures of the inside of your body. An MRI is sometimes used to show the exact extent of the cancer. This can help tell if surgery might be an option.
MRIs are not painful. They can, though, take up to an hour to do. In some cases, you’ll be injected with a contrast dye before getting the scan. During the scan, you’ll need to lie still on a table that is moved into a long, narrow tube. Some people say the test makes them feel claustrophobic. If you have had problems with enclosed spaces in the past, tell your healthcare provider before the test. He or she may give you a sedative to help you stay calm during the test. If you have a sedative, you’ll need to allow for time after the test for its effect to wear off. Newer, more open MRI machines can sometimes be used instead. But the images may not be as sharp. The equipment also makes loud banging noises during the procedure. You can ask for earplugs if you think the noise will bother you.
Because the test uses powerful magnets, you won’t be allowed to have anything metal in the room. Even eyeglasses and ballpoint pens can become projectiles when the magnets are turned on. If you have any kind of metal implant, such as a heart valve or a joint pin, you may not be able to have an MRI. And the equipment can affect implants, such as a pacemaker.
A PET scan can give your healthcare provider a better idea of whether an abnormal area seen on a CT scan or other imaging test is a tumor or not. If you’ve already been diagnosed with cancer, your healthcare provider may use this test to look for spread of the cancer to lymph nodes or other parts of your body. A PET scan can also be helpful if your healthcare provider thinks the cancer may have spread, but doesn't know where. Because it scans your whole body, your healthcare provider may do a PET scan instead of doing multiple X-rays of different places on your body. The picture isn’t as detailed as a CT scan. But it can be used along with a CT scan to look for tumors.
For this test, you’re injected with a sugar that has a mildly radioactive substance. Cancer cells absorb more of this sugar than normal cells. The radioactive material shows up during the image from the scan. To have the scan, you’ll need to lie still on a table as it’s pushed into the PET scanner. This is a machine that takes pictures that show where the sugar is in your body. The entire process may take several hours. A PET scan is painless and noninvasive. But if you’re sensitive to the sugar, you may have side effects. These can include nausea, headache, or vomiting.
Mediastinoscopy and other staging surgeries
Imaging tests can help show the extent of your cancer. But they might not always show all of the cancer. Surgery is often the best way to treat this cancer if it can be done. But this is a major operation. So, it’s important to know ahead of time if all of the cancer can be removed.
If your healthcare provider thinks surgery might be an option, he or she might want to do a less invasive, staging surgery first to help be sure. This operation is done to look for areas of cancer that imaging tests might have missed, rather than to treat the cancer.
For instance, you may have a mediastinoscopy. For this procedure, your healthcare provider puts a thin tube through a cut in the skin above your breastbone. This tube is called a mediastinoscope. He or she moves the tube down into your chest to see organs and lymph nodes in the area. A staging laparoscopy might be done as well. In this test, your healthcare provider puts a small lighted tube with a tiny camera (laparoscope) through a cut in the skin of your belly. This is done to look at the lining of the inner part of your belly and the lining on your intestines and other organs.
Working with your healthcare provider
Your healthcare provider will talk with you about which tests you'll have. Make sure to get ready for the tests as instructed. Ask questions and talk about any concerns you have.
March 21, 2017
Clinical Presentation, Diagnosis, and Staging of Malignant Pleural Mesothelioma. UpToDate.
Alteri, Rick, MD,Levin, Mark, MD