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Mesothelioma Diagnosis



Diagnosis of mesothelioma is often a difficult process, because there are many doctors that are still unfamiliar with the symptoms. Sometimes these symptoms can be even put down to a number of more common diseases. The main problem of diagnosis is the latency period between first symptoms and contraction. Often the symptoms of mesothelioma can't be determined for decades and usually it is diagnosed in its latter stages so there is almost nothing that can be done for the patient.

If symptoms point toward mesothelioma and you have had previous asbestos exposure, it is important to visit a doctor for thorough examination. Diagnostic steps include:

  • Asses clinical and radiological findings
  • Review medical history (including history of asbestos exposure)
  • Complete physical
  • Chest or abdomen X-ray
  • Lung function test
  • CT scan or MRI
  • Biopsy (when proven necessary)
  • Imaging tests such as MRI and CT scans and fluid samples are tools used by doctors in the early stages of diagnosis, but are usually inconclusive.

Usually for proper and definitive diagnosis tissue samples are used. There are two major types of biopsy that can be used for diagnosis. The more definitive is an open biopsy that is performed with the use of a general anesthetic. During this process the chest or abdominal cavity is opened. It gives the surgeon chance to take quite a large sample. The second one is needle biopsy that is, in contrast to open biopsy, done using a local anesthetic. During this process a small sample of tissue is removed with minimally invasive surgery.

Usually doctor may use several methods to find out if the disease is really present.

Physical Examination and Medical history:

It is always necessary to check a complete medical history (interview) to discover a possible risk and sympthoms. Commonly doctor will ask you whether you have been exposed to asbestos.

To find some signs of mesothelioma and other health problems a physical exam is performed. Generally patients with mesotheliomas of the chest (pleural mesotheliomas) have fluid in their chest cavity caused by the cancer. In its turn fluid in the abdominal cavity (ascites) is a main marker of peritoneal mesothelioma, and fluid in the pericardium (pericardial effusion) - of pericardial mesothelioma.

Imaging tests:

Main markers of the disease such as lowering of the lung fissures (spaces between the lobes of the lungs), pleural calcifications (mineral deposits), irregular thickening of the pleura, and fluid in the pleural space can be defined by a chest x-ray. These data suggests to show the asbestos exposure.

There are a lot of methods that can help determine the location, size, and extent of the cancer. For example computed tomography (CT) scans, x-rays, and magnetic resonance imaging (MRI) scans. One can get a series of pictures of the body from many angles using the CT. Then these pictures are combined by a computer. The result of the combination is detailed cross-sectional images of a selected part of the body. During the CT scan a special harmless dye injected into a vein to highlight details. The main distinction of MRI is using of the magnetic fields for creation images of selected areas of the body instead of x-rays.

Examination of tissue samples and fluid:

In cases when a pleural effusion was diagnosed, a sample of this fluid usually is taken by inserting a needle into the chest cavity. To obtain abdominal and pericardial fluid a similar technique is commonly used. After that samples are examined under a microscope to determine the presence of cancer cells.

Recently a new technique was developed to obtain a tissue sample of a pleural or pericardial tumor called thoracoscopy. A telescope-like instrument connected to a video camera (thoroscope) is inserted through a small incision into the chest. This method is used not only to take a tissue biopsy but also to see the tumor. One can also uses laparoscopy to see and obtain a biopsy. In this procedure, a small incisions on the front of the abdomen is made to insert a small and flexible tube attached to a video camera into the abdominal cavity.

To remove a larger sample of tumor or, sometimes, to remove the entire tumor surgeries usually use either a thoracotomy (which opens the chest cavity) or a laparotomy (which opens the abdominal cavity).

Also the doctor may do a bronchoscopy for patients who might have pleural mesothelioma. A flexible lighted tube is inserted through the mouth and trachea during this procedure. It allows seeing if there are other masses in the airway. There is also a possibility to remove small samples of abnormal-appearing tissue for testing.

The doctor may also use a mediastinoscopy. During this procedure a lighted tube is inserted at the level of the neck under the sternum (chest bone). Then it moved down into the chest. This helps the surgeon to examine the lymph nodes - bean-sized collections of immune system cells that help the body fight infections and cancers. This method also allows to remove samples. However mesotheliomas rarely spreads to lymph nodes. The reason to examine lymph nodes is that it can help to understand whether a cancer is still localized or if it has started to spread. And what is more important it can help distinguish lung cancer from mesothelioma.

The survival after diagnosis is usually 12 months. For patients with high performance status palliative chemotherapy can be helpful. Needless to say that there is a direct relation between a chance of recovery and the stage of the cancer. The treatment options, the amount of fluid in the chest or abdomen, the size of the tumor, surgical removal of lump, type of mesothelioma cancer cell and cancer recurrence depend on the stage of cancer.

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