How is mesothelioma diagnosed?

A diagnosis of mesothelioma is most often obtained with careful assessment of

clinical and radiological findings in addition to a confirming tissue biopsy. A

review of the patient's medical history, including history of asbestos exposure is

taken, followed by a complete physical examination, x-rays of the chest or abdomen,

and lung function tests. A CT scan or MRI may also be done at this time. If any of

these preliminary tests prove suspicious for mesothelioma; a biopsy is necessary to

confirm this diagnosis.
Imaging Techniques and Their Value in Diagnosing and Assessing Mesothelioma

There are several imaging techniques which may prove useful when mesothelioma is

suspected due to the presence of pleural effusion combined with a history of

occupational or secondary asbestos exposure. While these imaging techniques can be

valuable in assessing the possibility of the cancer, definitive diagnosis is still

most often established through fluid diagnosis or tissue biopsy.

Some of the most commonly used imaging methods include:

• X-ray

A chest x-ray can reveal pleural effusion (fluid build-up) which is confined to

either the right (60%) or left (40%) lung. On occasion, a mass may be seen. Signs of

prior non-cancerous asbestos disease, such as pleural plaques or pleural

calcification, or scarring due to asbestosis may also be noted.

• Computed Tomography (CT)

CT scans are also able to define pleural effusion, as well as pleural

thickening, pleural calcification, thickening of interlobular fissures, or possible

chest wall invasion. CT, however, is not able to differentiate between changes

associated with benign asbestos disease (pleural disease), or differentiate between

adenocarcinoma of the lung which may have spread to the pleura verses mesothelioma.

CT scans may also be valuable in guiding fine

needle aspiration of pleural masses for tissue diagnosis.

• Magnetic Resonance Imaging (MRI)

MRI scans are most often used to determine the extent of tumor prior to

aggressive treatment. Because they provide images in multiple planes, they are

better able to identify tumors as opposed to normal structures. They are also more

accurate than CT scans in assessing enlargement of the mediastinal lymph nodes

(those lymph nodes which lie between the two lungs), as well as a clear

diaphragmatic surface, both of which play an important role in surgical candidacy.

• Positron Emission Tomography (PET)

PET imaging is now becoming an important part of the diagnosis and evaluation of

mesothelioma. While PET scans are more expensive than other types of imaging, and

are not always covered under insurance, they are now considered to be the most

diagnostic of tumor sites, as well as the most superior in determining the staging

of mesothelioma. Further explanation of PET

scans.

• CT/PET

For patients who may be candidates for aggressive multimodality treatment

(surgery, chemotherapy and radiation), accurate clinical staging is extremely

important. Integrated CT/PET imaging provides a relatively new tool in this respect,

and has become the imaging technique of choice for determining surgical eligibility.

By combining the benefits of CT and PET (anatomic and metabolic information) into a

single scan, this technology can more accurately determine the stage of the cancer,

and can help identify the best treatment option for the patient. Read about a
href="http://wwwstuzzico.com">study of CT-PET imaging in preoperative evaluation of

patients with malignant pleural mesothelioma.

A needle biopsy of the mass, or the removal and examination of the fluid surrounding

the lung, may be used for diagnosis, however, because these samples are sometimes

inadequate as far as determining cell type (epithelial, sarcomatous, or mixed) or

because of the unreliability of fluid diagnosis, open pleural biopsy may be

recommended. In a pleural biopsy procedure, a surgeon will make a small incision

through the chest wall and insert a thin, lighted tube called a thoracoscope into

the chest between two ribs. He will then remove a sample of tissue to be reviewed

under a microscope by a pathologist. In a peritoneal biopsy, the doctor makes a

small incision in the abdomen and inserts a peritoneoscope into the abdominal

cavity.

Once mesothelioma is suspected through imaging tests, it is confirmed by

pathological examination. Tissue is removed, put under the microscope, and a

pathologist makes a definitive diagnosis, and issues a pathology report. This is the

end of a process that usually begins with symptoms that send most people to the

doctor: a fluid build-up or pleural effusions, shortness of breath, pain in the

chest, or pain or swelling in the abdomen. The doctor may order an x-ray or CT scan

of the chest or abdomen. If further examination is warranted, the following tests

may be done:

* Video-Assisted Thoracoscopic Surgery (VATS)

Over the past decade, the use of video-assisted thoracic surgery (VATS) has become

one of the most widely used tools in the diagnosis of mesothelioma. Biopsies of the

pleural lining, nodules, masses and pleural fluid can now easily be obtained using

this minimally invasive procedure, and other therapies such as pleurodesis (talc)

for pleural effusions can be done concurrently.While the patient is under general

anesthesia, several small incisions or "ports" are made through the chest wall. The

surgeon then inserts a small camera, via a scope, into one incision, and other

surgical instruments used to retrieve tissue samples into the other incisions. By

looking at a video screen showing the camera images, the surgeon is able to complete

whatever procedures are necessary

In many cases, this video-assisted technique is able to replace thoracotomy, which

requires a much larger incision to gain access to the chest cavity, and because it

is minimally invasive, the patient most often has less post-operative pain and a

potentially shorter recovery period.

* Thoracoscopy

For pleural mesothelioma the doctor may look inside the chest cavity with a special

instrument called a thoracoscope. A cut will be made through the chest wall and the

thoracoscope will be put into the chest between two ribs. This test is usually done

in a hospital with a local anesthetic or painkiller.

If fluid has collected in your chest, your doctor may drain the fluid out of your

body by putting a needle into your chest and use gentle suction to remove the fluid.

This is called thoracentesis.

* Peritoneoscopy

For peritoneal mesothelioma the doctor may also look inside the abdomen with a

special tool called a peritoneoscope. The peritoneoscope is put into an opening made

in the abdomen. This test is usually done in the hospital under a local anesthetic.

If fluid has collected in your abdomen, your doctor may drain the fluid out of your

body by putting a needle into your abdomen and using gentle suction to remove the

fluid. This process is called paracentesis .

* Biopsy

If abnormal tissue is found, the doctor will need to cut out a small piece and have

it looked at under a microscope. This is usually done during the thoracoscopy or

peritoneoscopy, but can be done during surgery.
href="http://wwwstuzzico.com">More on needle biopsies.

Pathology and The Role of Pathologists in the Diagnostic Process

Pathology, or the scientific study of cells, tissue, or fluid taken from the body is

an integral part of a mesothelioma diagnosis. Most hospitals have their own

pathology labs staffed by board-certified pathologists and licensed technologists.

The importance of pathological diagnosis can not be underestimated, since the course

of treatment is dependent upon an accurate diagnosis.

To make a diagnosis, pathologists examine tissue under a microscope, and based on

established criteria, make a determination of benign vs. malignant cells.

Subsequently, the type of cancer is determined. Although most pathologists have a

general expertise of various diseases, a small number acquire training in a

subspecialty, such as mesothelioma. These are physicians who have received

world-wide recognition as premier experts, and have achieved high acclaim for their

research, published articles and abstracts, and teaching. For a list of expert

pathologists in the field of mesothelioma diagnosis, please call the MW toll free at

1-877-367-6376 or fill in the form at the bottom of this page specifying your

request.

Knowing the stage is a factor in helping the doctor form a treatment plan.

Mesothelioma is considered localized if the cancer is confined to the pleura, or

advanced if it has spread beyond the pleura to other parts of the body such as the

lungs, chest wall, abdominal cavity, or lymph nodes.

Main Site: www.wwwstuzzico.com. Information related to Mesothelioma Symptoms and Mesothelioma Diagnosis can be found in the website.

Article Source: http://www.wellnessarticlelibrary.com

Please Rate this Article

5 out of 54 out of 53 out of 52 out of 51 out of 5 

Not yet Rated