DIAGNOSIS

The early detection of mesothelioma is critical to the patient outlook and in determining applicable treatment options.  Due to the rarity of mesothelioma many doctors are not familiar with the symptoms or the conditions presented by patients. In addition, many mesothelioma symptoms are also symptoms of other medical conditions.

The extended length of time between asbestos exposure and a patient's symptomatic responses, often between 15-50 years, further hinders immediate detection of mesothelioma. The patients do not associate the symptoms they are currently experiencing to something that happened much earlier in their lives.

Although mesothelioma can often be difficult to initially detect, the below medical procedures and diagnostic tests can lead to a clear diagnosis.  Early medical diagnosis is one of the primary variables affecting long-term prognosis.

INITIAL EVALUATION

The initial patient evaluation is critical in identifying the potential for developing mesothelioma. To establish risk factors and to assess the symptoms, the physician will complete a medical history that includes a questionnaire to help determine the time frame and environment in which the patient may have been exposed to asbestos. Strong, open communication between the patient and doctor is important so that the earliest possible detection of mesothelioma can be made. It is important that the patient share all relevant information regarding previous work history and possible asbestos exposure.

PHYSICAL EXAMINATION

In addition to constructing a medical profile and detailed medical history, a complete physical examination will be performed. During a physical exam your doctor may do the following:

• Breath Sounds: listen to the chest cavity as the patient inhale and exhales. There may be an absence of breath sounds, or the sounds may be muted. The absence of, or muted nature of, breath sounds may be an indication of fluid in the chest cavity, or of pleural effusions.
• Sound Resonance: listen to the chest cavity while having the patient make vowel sounds -- comparing the sound resonance in the right and left chest cavities. Muted or dull sounds between the cavities could be an indicator of a buildup of fluid.
• Percussing / Tapping:  Tapping on the chest area a doctor may notice a dull, solid thumping sound, rather than a hollow resonance. This may also indicate the presence of fluid, or a mass, in the chest cavity.
• Lymph nodes: A physical examination will also check for enlarged lymph nodes.

There are often very few signs during an initial physical exam that would identify the presence of mesothelioma. On the basis of patient symptoms, medical history, the presence of specific risk factors (work environment, asbestos exposure), and a complete physical examination, the doctor can use one or more of the methods described below to determine if the disease is present.

DIAGNOSTIC TESTS

There are a variety of diagnostic procedures available to determine if a patient has mesothelioma. The presence of mesothelioma can be identified by comparing results from imaging scans, tissue biopsies, pulmonary function tests and other diagnostic techniques.

Imaging Techniques

There are many available technologies that allow doctors to view, or image, organs and tissue that might show the presence of fluid or tumors.

• A chest x–ray may show an unusual thickening of the pleura, lowering of the lung fissures (spaces between the lobes of the lungs), an accumulation of fluid in the lungs (pleural effusion) or an irregular mass in the chest cavity.
  
  
• A CT (computed tomography) scan uses x-ray and computers to give more sophisticated and detailed pictures of the inside of the body than conventional x-rays. A rotating x-ray beam is used to take a series of pictures of the body from different angles. A computer combines the series of pictures to produce a detailed cross-sectional image of a specific part of the body. The CT scan allows a radiologist to see distinct aspects of the lungs and pleura.
  
  
• Magnetic Resonance Imaging (MRI) uses a strong magnetic field and radio waves to scan the body. There is no radiation involved. This imaging method produces a series of cross-sectional pictures. MRI scans are useful for viewing "soft tissues" in the body and can show the extent of mesothelioma. New MRI techniques where surface imaging techniques are combined with quick breath-holding sequences and gadolinium contrast medium result in images which can be used to detect tumor growth in the pleura and thoracic wall better than previous methods. MRI images tend to be quite clear and are superior to routine x–ray images.
  
  
• Positron Emission Tomography (PET) scans use a camera that produces powerful images of the body’s biological functions. Because cancers and other disease processes metabolize sugars at a higher rate than normal tissues or organs, the PET scan uses tracers to indicate where there is abnormal metabolic activity and can pinpoint the regions of active disease. PET scans can also identify extremely small cancerous cells, indicate benign or malignant cells, and help determine whether treatment therapies are working.

Pathological Tests

Mesothelioma is diagnosed by a pathological examination. Tissue is removed and reviewed under the microscope, where a pathologist makes a definitive diagnosis and issues a pathology report.
Tissue samples are collected from the following procedures:

Thorascopy
A thoracoscope (telescope-like instrument connected to a video camera) is inserted through a small incision in the chest. This allows the doctor to see the tumor and use special forceps to take a tissue biopsy.  A tissue sample of both a pleural or pericardial tumor can be obtained using this technique.

Laparoscopy
In this procedure, a flexible tube is attached to a video camera that is inserted into the abdominal cavity via small incisions. Fluid can also be collected during thoracoscopy or laparoscopy.  A tissue sample of a peritoneal tumor is obtained with this procedure.

Bronchoscopy
Performed if pleural mesothelioma is suspected, the doctor inserts a flexible lighted tube down the trachea, and into the bronchi to check for masses in the airway. Small samples of abnormal-appearing tissue may be removed for testing.

Mediastinoscopy
This process is used to evaluate the lymph nodes.  Lymph nodes are collections of immune system cells that help the body fight infection. By examining the lymph nodes, the doctor can determine if the cancer has spread. The patient has a lighted tube inserted under the sternum (chest bone) at the neck level and then moved into the chest. The surgeon can see the lymph nodes and take tissue samples to check for cancer. This procedure can also help the physician determine if you have lung cancer or mesothelioma.

Pulmonary Function Tests (PFT’s)

PFTs encompass a wide variety of tests that evaluate the entire respiratory system. The tests are useful in the assessment and diagnosis of pulmonary disease and aid in determining a course of treatment. PFTs can be a simple peak flow measurement, or complex body plethysmography and ventilation/perfusion scans which are performed in hospitals and clinics. PFTs can also be useful in monitoring patient response to treatment.

SUPPORT
If you or a loved one has been diagnosed with mesothelioma you may be eligible for compensation.  Contact an experienced asbestos lawyer to determine your next steps.  Know your legal rights to help protect you and your family.

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