MESOTHELIOMA DIAGNOSIS
Mesothelioma can be a difficult disease to diagnose. Distinguishing mesothelioma from other types of cancer can be a challenge for doctors who do not see people with mesothelioma very often, and, because mesothelioma is a relatively rare disease, many pulmonologists, oncologists and pathologists rarely, if ever, treat a patient suffering from mesothelioma. Only a few years ago, this was an even greater problem than it is today, but diagnostic procedures are continually improving and it seems that information about the disease is more widespread today than it was even ten years ago. Still, many experts believe that a significant number of people suffering from mesothelioma are never diagnosed with the disease.
Typically, someone sees a doctor with complaints of either shortness of breath, chest or back pain, and sometimes weight loss. Very often, the cause of the shortness of breath is a pleural effusion, an accumulation of fluid in the pleural cavity of the chest. Sometimes, these can be termed massive in size and involve liters of fluid build-up. An effusion can occur in the abdomen in the case of someone with peritoneal mesothelioma. Symptoms related to the onset of peritoneal mesothelioma may also include stomach pain, swelling and bowel problems.
Doctors will usually start with a chest x-ray (or x-ray of the abdomen if peritoneal mesothelioma is suspected), and if the results are suspicious may then refer the patient for a CT-Scan. These imaging techniques are helpful in identifying an effusion or a tumor, but CT-Scans and x-rays alone can not determine whether a tumor is malignant or distinguish mesothelioma from other types of cancers. Adenocarcinoma of the lungs in particular can resemble mesothelioma in x-rays and CT-Scans because of the diffuse nature of the tumor (its tendency to spread across the chest rather than develop into more of a lump).
X-rays and CT-Scans may also show the presence of non-malignant asbestos-related disease such as pleural thickening, pleural calcifications or asbestosis. These may develop due to significant exposure to asbestos, and are regarded as clear markers that someone in fact did have significant exposure to asbestos in their lifetime.
If the radiology results from the imaging techniques are suspicious for a malignancy, a doctor will likely recommend that a biopsy of the pleura or peritoneum be performed. This can be done by needle biopsy involving the injection of a fine needle between the ribs in the back to remove some fluid and tissue. Often, however, this needle biopsy yields inadequate tissue for a definitive diagnosis.
Today, most doctors will opt to perform a video assisted thoracoscopy. This procedure involves a small incision in the chest through which the surgeon inserts a small tube and tiny camera. This can usually yield an adequate tissue specimen for a definitive diagnosis. This is a far less invasive procedure than a thoracotomy, which involves a much bigger incision, and, until recently, was performed far more regularly. The same procedure can be performed in the abdomen when peritoneal mesothelioma is suspected. This is called a laparoscopy.
Sometimes a bronchoscopy will be performed which involves inserting a tube with a tiny camera down the patient's throat through their trachea. A biopsy can be taken in this way as well.
If there is significant fluid build-up, a doctor may opt to perform a thoracentesis which means the draining of the fluid from the pleural cavity. Very often, a pleuradesis will be done as well to prevent fluid from accumulating in the pleural spaces again. This procedure actually involves fusing the pleura to the chest wall with talc to seal the cavity so that fluid has nowhere to accumulate in the future.
After any of these procedures, a pathologist will look at the fluid and tissue specimens under a microscope to reach a diagnosis. Ensuring that a properly trained and experienced pathologist reviews these specimens is absolutely critical. It is only through a pathological review that an accurate diagnosis can be made. Some doctors specialize in reviewing pathology relating to mesothelioma, and, on the other hand, some pathologists have never reviewed pathology to diagnose mesothelioma. It is at this stage of the process that mesothelioma is so often misdiagnosed. Getting a second opinion from a pathologist who specializes in mesothelioma is always a good idea. Click here for a list of doctors and hospitals that specialize in mesothelioma.
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