Mesothelioma is not easy to diagnose. Doctors will need all the information they can get to make the diagnosis. To begin with, the clinical history may be the most important clue, if the patient knows that he or she has been exposed to asbestos. Anyone with asbestos exposure and symptoms of lung disease, including shortness of breath, chest pain or cough should be evaluated for possible mesothelioma as well as asbestosis.The physical examination will give clues to the diagnosis of mesothelioma. There may be specific sounds the doctor will hear when listening to the patient’s breathing.
An ordinary chest X-ray will also help make the diagnosis of mesothelioma. A one-sided pleural effusion, fluid in the space between the chest and lungs, is common with mesothelioma. There are other changes that can be seen on plain X-ray.
The next step in making the diagnosis will usually be a CT scan of the chest. The scan may be able to delineate areas of cancerous infiltration, or specific areas of cancer.
Depending on what is seen on CT scan, and MRI or other type of scan may be useful, but this is not necessary for diagnosis. Other scans may be needed for staging, to see if the cancer has spread.
A biopsy, or sample of tissue, has to be obtained. This will be done in whatever manner is easiest for the patient. The sample will be analyzed, using chemical tests as well as stains to see the cells.
Putting all of this together will make the diagnosis of pleural mesothelioma possible. Abdominal mesothelioma is even harder to diagnose. Again, if a patient has known asbestos exposure and symptoms of abdominal pain or intestinal blockage, a doctor must think about mesothelioma.
A CT scan will probably be needed to make a preliminary diagnosis of abdominal mesothelioma. Biopsy again will be done in whatever manner is easiest for the patient.
Mesothelioma is almost always diagnosed because it has already spread and caused symptoms. It is very rarely diagnosed early. If a patient does not know of asbestos exposure, and has a tumor mass, the diagnosis will probably not be suspected until a biopsy is obtained.
Dr. Kaplan
