Diagnosis of Mesothelioma.
The diagnosis of mesothelioma is arrived at and confirmed through a series of tests, which include medical history, occupational history (any occupational history which shows exposure to asbestos either primarily or secondarily), blood tests, radiological and imaging tests and confirmation by biopsy form the basis of diagnosing mesothelioma.
Testing for Mesothelioma.
(A) Medical history and evaluation of your symptoms.
Your medical history and symptoms similar to those of mesothelioma can lead the doctor to further carry out certain more specialized tests for mesothelioma. Your occupational history too becomes important in view of what is explained in causes of mesothelioma. Any history of exposure to asbestos will be specially looked for and is important for your doctor to diagnose mesothelioma.
(B) Physical examination.
This will look for telltale signs of any lumps felt over the chest or abdomen. Irregular beating of the heart detected by the doctor will make him suspicious of pericardial involvement.
(C) Radiological or Imaging Tests for Mesothelioma.
1) Chest X ray for mesothelioma.
A thickened pleura seen on chest x ray can be indicative of pleural mesothelioma. Below is an x ray showing pleural mesothelioma. Notice the dark spots spread over the chest.
Chest X ray showing pleural or lung mesothelioma.
2) CT Scan for Mesothelioma.
Computed Tomography scan or CT scan for mesothelioma involves taking a series of x rays of the cross section of the body part at various levels using computer processing. This gives the trained radiologist a complete three dimensional picture of the inside of the body. It is like comparing a loaf of bread sliced into a number of slices, which allows you to view the inside of the bread.
The patient may be injected with a dye or maybe given one to drink. This is for more contrast to get a more clear picture of the inside of the body part which has been CT scanned.
The dye is harmless and well tolerated and gets excreted. However, it can cause an allergic reaction in those who are allergic to iodine or those who have bronchial asthma. The doctor may therefore take your relevant history or may even do a sensitivity test to determine if you are allergic to the dye.
Below is a CT scan image showing mesothelioma.
Image of patient undergoing a CT scan.
3) MRI for Mesothelioma.
MRI or Magnetic resonance imaging is use of magnetic waves to get a more detailed image of the body part to be investigated. It shows a more detailed and contrast picture than a CT scan. The various soft tissues of the body are more differently defined and gives the radiologist a clearer image so that he is able to differentiate the normal tissue from the abnormal one and is able to confirm presence of a mesothelioma tumor and its metastasis, if any.
A contrast dye may be given to the patient to swallow. This dye does not contain iodine, thereby eliminating chances of an allergic reaction. Another advantage of MRI is that it does not expose the patient to radiation. MRI is however contraindicated in patients who have a pacemaker because the magnetic fields created by MRI can interfere with the functioning of the pacemaker.
Picture showing MRI being done on patient.
4) PET scan for Mesothelioma.
PET scan or Positron emission tomography is a new and more developed scan which is used if the x rays and CT scan do not give a conclusive diagnosis to the doctor. In PET scan, mildly radioactive glucose is injected into the vein of the patient. PET Scan is then taken 2 hours later. Cancer areas are seen more active than the normal surrounding tissue on the scan.
(D) Biopsy for Mesothelioma.
The previous tests will conclude whether you need a biopsy or not. Biopsy for mesothelioma consists of histopathologically examining the fluid and tissue of the relevant mesothelium, under the microscope. The fluid could be that of pleural effusion or peritoneal effusion or pericardial effusion. The fluid and the part of suspected tissue can be removed for examination by any of the following methods.
1) Fine needle aspiration for mesothelioma.
A fine long needle is inserted into the chest wall and the pleural fluid which has built up due to inflammation in the pleural sac is aspirated and sent to the pathologist for examination of any abnormal cells. Similarly peritoneal fluid can also be aspirated.
2) Thoracoscopy to diagnose mesothelioma.
Through a small incision in the chest wall, the doctor inserts a thoracoscope into the chest wall for visual examination of the affected part. He may then draw pleural fluid or take a small part of the suspected pleural membrane for histopathological examination, which can confirm a suspected diagnosis of mesothelioma. This procedure is done by giving a local anesthetic to the patient.
3) Peritoneoscopy to diagnose mesothelioma.
Similarly, for a suspected peritoneal mesothelioma, a peritoneoscope is inserted into the abdomen and the peritoneal membrane is examined. Peritoneal fluid and/or small amount of peritoneal tissue may be removed for examination under the microscope for any
(E) Blood Tests for Mesothelioma.
Blood mesothelioma test offers hope for an early diagnosis of mesothelioma. As mentioned early, symptoms of mesothelioma present very late after the disease has reached 3rd or 4th stage, when treatment is palliative ( for relief from symptoms) rather than curative. The discovery certain mesothelioma bookmarkers has made it possible to detect mesothelioma in the early stages.
(1) Mesomark Assay for mesothelioma.
This is a test in molecular biology which determines the levels of SMRP in human blood or serum. SMRP stands for Soluble Mesothelin Related Peptide and is a protein or bookmarker which is produced by mesothelioma cells. It shows elevated levels in mesothelioma.
(2) miRview Test for mesothelioma.
This is a new molecular diagnostic test, which measures microRNA biomarkers to accurately differentiate mesothelioma from other cancers.
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