Mesothelioma Diagnosis
There is no single established path to a mesothelioma diagnosis. However, the process often involves multiple procedures, each performed by a different medical professional. Most people receive their official diagnosis within two to three months from the onset of their symptoms.
A Typical Diagnosis
In most cases, doctors begin with oral and physical exams to learn more about your condition – and acknowledge any potential asbestos exposure. They may then move on to imaging tests that can identify any abnormalities. If the tests reveal a suspicious mass that looks like mesothelioma, they will request a biopsy to confirm the mesothelioma diagnosis.
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During the diagnostic process, you will work with several different doctors. It’s common for patients to visit a general practitioner, pulmonologist, radiologist, surgeon, pathologist and/or an oncologist during this period. Some people also visit an asbestos-related disease specialist for a second opinion or to get additional details about their diagnosis.
The First Diagnostic Appointment
Most patients make their first diagnostic appointment with their general physician several months after they first notice something wrong with their health.
This initial consultation often includes:
- A medical history
- An occupational history
- A basic physical exam
- A discussion of current symptoms
If you are preparing for your first diagnostic appointment:
- Assemble all necessary documents, including insurance cards and ID.
- Make a mental note to discuss any asbestos exposure you may have experienced, including length, time and location of exposure.
- Plan to spend between 30 minutes and one hour at the doctor’s office.
Unfortunately, it’s rare for someone to receive a mesothelioma diagnosis at their first consultation. Because the presenting symptoms can imply a number of diseases, your primary physician may order additional tests to identify the underlying cause. The most common diagnostic tests are imaging scans or biopsies, although some physicians may suggest pulmonary function tests as well.
Imaging Tests for Mesothelioma diagnosis
Oncologists use imaging tests to visually identify potential tumors. All modern forms of diagnostic imaging can play a role in mesothelioma diagnosis, including:
| X-rays Produce basic images of dense areas within the body (such as tumors) | CT scans Use electromagnetic imagery to create detailed images of internal structures |
| MRI Generates images of highly active internal structures using magnets and radio waves | PET scans Highlight areas of the body that have abnormally high, potentially cancerous metabolic activity |
Fast Fact In a study of 31 mesothelioma patients, PET-CT scans correctly diagnosed 20 cases, incorrectly diagnosed nine cases, and could not determine two cases. MRI imaging correctly diagnosed both of the undetermined cases in a follow-up scan.
CT scans are most doctors’ first choice, while the “gold standard” for mesothelioma diagnosis is a combination CT-PET. However, many mesothelioma diagnoses are made incidentally, when doctors use other types of scans to identify an unknown condition.
If you are scheduled for a mesothelioma diagnosis imaging scan:
- Assemble the same personal documents you collected for your first diagnostic appointment.
- Plan for a one-hour to two-hour appointment.
- Adhere to any pre-scan guidelines provided by your doctor (such as fasting from food and/or water).
- Research relaxation techniques if you are nervous about being in an enclosed scanning machine.
- Plan to hear the results from your doctor within one to two weeks of the appointment.
If a scan reveals a mass on the parts of the body where mesothelioma typically develops (the pleura, pericardium or peritoneum), a doctor may order a biopsy to confirm specific information about the growth.
Biopsies for Mesothelioma diagnosis
Biopsies are small fluid or tissue samples that go to a laboratory for microscopic evaluation. These tests can reveal whether a growth is malignant, where in the body the cancer originated, and what type of cells are involved. Doctors can retrieve biopsy samples in several different ways:
| Fine Needle Aspiration Extracts cells through a thin, hollow needle and a syringe | Thoracoscopy Takes samples with a camera-equipped tube that is inserted through the chest wall |
| Mediastinoscopies Mediastinoscopies are similar to thoracoscopies, except the tube is inserted through an incision in the neck. | Incisional/Core Incisional/core biopsies are similar to fine-needle biopsies, but use a wider needle to obtain larger samples. |
| Excisional Biopsy Excisional biopsies remove the whole tumor from the body and test selected samples from the mass. |
Thoracoscopies are considered the most accurate biopsies for mesothelioma diagnosis. This method allows for visualization of the pleural cavity as well as high-quality biopsy samples; it can result in accurate mesothelioma diagnosis for up to 98 percent of patients.
Blood Tests for Mesothelioma diagnosis
In recent years, researchers have spent a considerable amount of time developing mesothelioma blood tests. These tests analyze your blood for proteins and other biomarkers that are prevalent in mesothelioma patients. The FDA-approved MESOMARK assay tests the blood for soluble mesothelin-related peptide, while other tests screen for osteopontin or human megakaryocyte potentiation factor.
Preliminary studies suggest that these blood tests have the potential to play a role in the diagnostic process, but they are not yet fully reliable enough to stand on their own.
Capabilities of Mesothelioma diagnosis Blood Tests
| TEST: | SENSITIVITY1 | SPECIFICITY2 |
|---|---|---|
| MESOMARK | 68% | 92% |
| SOMAMER PANEL | 90% | 95% |
| HUMAN MPF ELISA KIT | 64% | 95% |
1. (the percentage of mesothelioma patients correctly diagnosed by the test). 2. the percentage of healthy people in which the test correctly ruled out a mesothelioma diagnosis):
As researchers continue to refine these tests for mesothelioma diagnosis purposes, they can still play a role in the evaluation of a mesothelioma patient’s progression.
After a Mesothelioma Diagnosis
Early mesothelioma diagnosis and prompt treatment are extremely important in extending your life expectancy. There are several steps that you can take, including developing a plan for treatment and finding a local mesothelioma expert. For medical guidance after a mesothelioma diagnosis, reach out to The Mesothelioma Center’s free Doctor Match program.
View Article Sources
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- American Cancer Society: Overview of Biopsy Types. (24 March 2010). Retrieved fromhttp://www.cancer.org/treatment/understandingyourdiagnosis/examsandtestdescriptions/testingbiopsyandcytologyspecimensforcancer/testing-biopsy-and-cytology-specimens-for-cancer-biopsy-types
- Boutin, C., & Rey, F. (1993). Thoracoscopy in pleural malignant mesothelioma: A prospective study of 188 consecutive patients. Part 1: Diagnosis. Cancer; 72 (2). Retrieved fromhttp://onlinelibrary.wiley.com/doi/10.1002/1097-0142%2819930715%2972:2%3C389::AID-CNCR2820720213%3E3.0.CO;2-V/abstract
- Fujirebio Diagnostics – MESOMARK: A potential test for malignant pleural mesothelioma. (2005). Retrieved fromhttp://fdi.com/mesomark/usa/documents/FDI%20MesoAbst2h.pdf
- Ostroff, R. M., Mehan, M. R., Steward, A., Ayers, D., Brody, E. N., Williams, S. A., …& Pass, H. I. (2012). PLOS ONE: Early detection of malignant pleural mesothelioma in asbestos-exposed individuals with a noninvasive proteomics-based surveillance tool. PLOS One. Retrieved fromhttp://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0046091
- Hollevoet, K., Nackaerts, K., Thimpont, J., Germonpre, P., Bosquee, L., De Vuyst, P. D., …& Van Meerbeeck, J. P. (2009). Diagnostic performance of soluble mesothelin and megakaryocyte potentiating factor in mesothelioma. American Journal of Respiratory and Critical Care Medicine; 181 (620-625). Retrieved fromhttp://ajrccm.atsjournals.org/content/181/6/620.full.pdf
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