Mesothelioma Diagnosis

If you are experiencing mesothelioma symptoms, there are several tests and procedures for you to determine the cause. If you notice symptoms, contact a doctor immediately.

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Written by Jenna Campagna, RN

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How Is Mesothelioma Diagnosed?

Doctors diagnose mesothelioma through a number of imaging and blood tests, followed by a biopsy. Receiving a tissue biopsy is the most definitive way to provide a mesothelioma diagnosis.

People with a history of asbestos exposure are at risk of developing this cancer. However, not everyone who interacted with the mineral will be affected. The rate of occurrence is low, as only 3,000 new cases are diagnosed in the United States each year.

Patients experiencing symptoms of mesothelioma like coughing, chest pains or shortness of breath should see their doctor and explain the symptoms along with their asbestos exposure incidents. After seeing a physician, the mesothelioma testing process determines the causes of these symptoms.

How to Test for Mesothelioma

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Imaging Tests

Imaging tests are used to locate abnormalities and troublesome masses (such as fluid buildup) inside the body. An X-ray is almost always the first mesothelioma test conducted. If worrisome signs are discovered, the doctor likely will perform another test. The most common imaging tests are: a computed tomography (CT) scan; positron emission tomography (PET) scan; and magnetic resonance imaging (MRI) scan.

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Blood Marker Tests

According to the American Cancer Society, blood levels of specific substances (fibulin-3 and soluble mesothelin-related peptides) are higher in mesothelioma patients than they are in people without this cancer. While blood tests are not reliable on their own, they can provide insight into the potential of the disease’s presence and show how well vital organs are reacting to treatment.

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Biopsies

Once imaging and blood marker tests indicate the likelihood of someone having cancer, the doctor will refer the patient to a surgeon for a biopsy. A biopsy involves taking a tissue or fluid sample from a specific area, usually where doctors believe the cancer formed. These samples are examined under a microscope to determine if tumors are present, the specific cell type and how advanced the disease is at that time. It’s the only way to definitively issue a mesothelioma diagnosis.

Imaging Tests

Imaging tests are the first step in diagnosing mesothelioma. These tests help doctors discover the potential tumor’s location, size and severity. Each imaging test has its own purpose and helps doctors make an accurate diagnosis.

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X-Ray – An X-ray provides a two-dimensional image of the patient and can show fluid buildup.

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CT scan – CT scans are three-dimensional imaging tests that provide more detailed images of anomalies found by X-rays.

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PET scan – PET scans involve radioactive sugar inserted into the blood for cancerous cells to absorb. A special camera then sends a picture of the radioactive energy within the body back to the medical team and provides real-time footage of cancerous cells. This imaging scan is also useful in staging as it shows whether the tumor has spread to lymph nodes or other areas of the body.

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MRI scan – MRI scans create detailed images of soft tissue to find the exact location of a tumor or the extent of its spreading in the body.

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Echocardiogram – An echocardiogram is an ultrasound of the heart. Doctors may use this imaging scan if they suspect a patient has pericardial mesothelioma, which is a cancer along the membrane surrounding the heart.

Blood Tests and Biomarkers

Blood and biomarker tests measure a person’s blood levels. While these tests are not usually used in a mesothelioma diagnosis, they can help monitor the efficacy of treatment.

The levels of fibulin-3, cancerous antigen 125, osteopontin and soluble mesothelin-related peptides (SMRP) are commonly higher in mesothelioma patients than healthy people. Doctors compare the levels of these substances in people who have mesothelioma to that of baseline levels, information which could impact future treatment.

Some physicians use the Mesomark test, which is a blood test used to monitor a patient’s SMRP level. When the SMRP level is higher than the baseline level or has not decreased since the last Mesomark test, it's likely that treatment for the patient has not worked. However, if the SMRP level decreased since the most recent mesothelioma test, then doctors likely will continue with the treatment used to that point.

Mesothelioma Biopsies

A biopsy involves the extraction and examination of tissue or fluid from the body. It’s the final step in the diagnostic process.

By examining the biopsy sample, doctors can analyze the cells and determine if any are cancerous. This is the only way doctors can make a conclusive mesothelioma diagnosis.

The histological makeup of the cancer can also be determined by examining the microscopic structure of the tissue. Certain cellular makeups respond differently to different treatment plans. There are also different types of biopsies, such as surgical biopsies or needle biopsies.

Surgical Biopsies

Doctors use surgical biopsies to extract tissue from a patient. The tissue sample is sent to a pathologist to examine for the presence of mesothelioma. This procedure is done using traditional surgical methods, needle biopsy or camera-assisted surgery. The various biopsy procedures include:

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Thoracotomy

This procedure is a traditional biopsy of the chest cavity, which is useful for diagnosing pleural mesothelioma. Surgeons can also get a firsthand look at the disease.

Thoracotomy – This procedure is a traditional biopsy of the chest cavity, which is useful for diagnosing pleural mesothelioma. Surgeons can also get a firsthand look at the disease.

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Mediastinoscopy

A mediastinoscopy examines the mediastinum, which is the space in the middle of the chest behind the breastbone and between the lungs. This procedure can be used to determine the severity of a patient’s pleural mesothelioma, as evidence of tumors in the mediastinum would support a late-stage diagnosis.

Mediastinoscopy – A mediastinoscopy examines the mediastinum, which is the space in the middle of the chest behind the breastbone and between the lungs. This procedure can be used to determine the severity of a patient’s pleural mesothelioma, as evidence of tumors in the mediastinum would support a late-stage diagnosis.

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Thoracoscopy

A thoracoscopy is an alternative, less-invasive chest biopsy for diagnosing pleural mesothelioma. This method uses a camera.

Thoracoscopy – A thoracoscopy is an alternative, less-invasive chest biopsy for diagnosing pleural mesothelioma. This method uses a camera.

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Laparotomy

This procedure is a traditional biopsy of the abdominal cavity, which is useful for diagnosing peritoneal mesothelioma. This biopsy procedure also allows surgeons a firsthand look at the disease.

Laparotomy – This procedure is a traditional biopsy of the abdominal cavity, which is useful for diagnosing peritoneal mesothelioma. This biopsy procedure also allows surgeons a firsthand look at the disease.

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Laparoscopy

A laparoscopy is an alternative, less-invasive abdominal biopsy for diagnosing peritoneal mesothelioma. The biopsy method also uses a camera.

Laparoscopy – A laparoscopy is an alternative, less-invasive abdominal biopsy for diagnosing peritoneal mesothelioma. The biopsy method also uses a camera.

Non-Surgical Biopsies

Non-surgical biopsies take fluid samples from the lungs, abdomen or heart. Doctors use a needle to extract the fluid and examine it for the presence of mesothelioma cells. If cancer exists, the fluid may also determine the type of cancer.

This method is less invasive than surgical biopsies, but it is not as conclusive and does not allow doctors a firsthand look at the tumor. It’s also difficult to get a lot of cells to examine from fluid.

Histopathology and Cytology Reports

After a patient undergoes a biopsy, the next step is finding out if cancer is present and, if so, the type. This process is part of pathology, and it has two options that depend on the type of sample extracted. Histology and cytology reports help doctors study the tissue (histopathology) or fluid (cytology) obtained from the biopsy.

Misdiagnosis

Due to mesothelioma’s rarity, many doctors have not encountered the cancer and can’t accurately diagnose mesothelioma. This results in a high percentage of misdiagnosis when compared to other cancers.

Mesothelioma is commonly misdiagnosed because the symptoms are typical to illnesses such as the common cold, flu and pneumonia. To prevent misdiagnosis, patients should seek a second opinion from a doctor or contact a mesothelioma specialist.

Misdiagnosis also occurs in two other ways. Pathologists with limited or no experience in distinguishing cancer types may mistake mesothelioma for a lung or abdominal cancer. Even if a patient has a history of asbestos exposure along with the symptoms of mesothelioma, their doctor may say the patient does not have mesothelioma.

Mesothelioma is often staged incorrectly, resulting in limited treatment options for patients. Patients should always consider getting a second opinion to double-check their diagnosis.

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Long-Term Survivor After Misdiagnosis

Multi-year survivor Alexis K. was almost diagnosed with a terminal prognosis until seeing additional specialists. They revealed that her mesothelioma diagnosis was treatable. She was initially staged at stage 4.

However, the team of doctors determined it was not stage 4 and that her case was unusual. This change opened up new treatment options. Since mesothelioma is such a unique illness, many doctors don’t have the experience needed to treat it.

“For me, having it diagnosed was just the first step, and getting a second opinion gave me new options as I entered treatment.”

— Alexis Kidd

Alexis received a mesothelioma diagnosis and followed up with a second opinion. She put herself in a better position by staying on top of her own health care and requiring confirmation from a specialist. Take control of your health care and get a second opinion from a specialist by using our free Doctor Match program.

Mesothelioma Diagnosis for Veterans – Getting a Second Opinion

Most veterans will see a general oncologist within the Veterans Affairs (VA) system first. Since these doctors aren’t experienced in distinguishing mesothelioma from other diseases, it is important that veterans using the VA get a second opinion from a mesothelioma specialist. A general oncologist may consider a veteran’s disease to be inoperable or suggest the wrong treatment because of a lack of experience with mesothelioma.

Many times, once a veteran sees a specialist, they learn they are eligible for more treatments than they previously thought. Additionally, there are three top mesothelioma treatment centers in the VA health system that rival the best treatment centers in the country. These centers are located at the Boston VA, Houston VA and Los Angeles VA.

Treatment After Mesothelioma Diagnosis

After doctors have confirmed a mesothelioma diagnosis, they create a treatment plan for the patient. This mesothelioma treatment plan is tailored to each patient. Surgery is usually used in patients with early-stage mesothelioma.

Even if a patient has late-stage mesothelioma, the surgeon may feel confident they can remove all of the cancer without any life-threatening complications. One major issue with surgery for late-stage mesothelioma patients is the tumor has likely spread beyond the point of origin and reached other vital organs. Attempting to remove tumors in this scenario would require removing the affected organs, which may not be possible.

Chemotherapy and radiation are frequently used for patients who can’t undergo surgery. They’re also used in collaboration with surgery. Multimodal treatment involves multiple types of treatment methods and has shown promising results.

In most cases where a mesothelioma patient survives beyond the expected prognosis, their treatment involves a combination of chemotherapy, radiation and surgery. Learn more about how you can beat the odds after your mesothelioma diagnosis in our free Mesothelioma Survivor’s Guide.

Common Questions About Mesothelioma Diagnosis

How does a doctor diagnose mesothelioma?

Doctors analyze imaging scans and tissue or fluid samples to diagnose mesothelioma. The first step is performing X-rays, CT scans, PET scans and MRI scans on patients. These imaging tests will show visual evidence of mesothelioma. A tissue biopsy will finalize whether or not a patient has this cancer.

What test shows mesothelioma?

Imaging tests show the presence of mesothelioma on scans. However, they’re not 100% conclusive. X-rays, CT scans and MRI scans can show masses that look like tumors, or fluid buildup caused by tumors. Testing a fluid or tissue sample provides scientific proof that cells are diseased.

How can a mesothelioma misdiagnosis occur?

Doctors may misdiagnose mesothelioma in numerous ways. The cancer is often mistaken for other, less serious health concerns, or even other types of cancer. A misdiagnosis can also occur by stage. The rarity of mesothelioma means few doctors have experience diagnosing it properly.

Last Edited: October 28, 2020.

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