What is Mesothelioma
Stages of Mesothelioma
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Mesothelioma Symptoms and Diagnosis
Early symptoms of mesothelioma are non-specific in nature,
and may lead to a delay in diagnosis. In general, shortness of breath,
chest pain and persistent cough are common symptoms of pleural mesothelioma,
but in some cases, may not be severe enough to force the patient to seek
medical help. Some patients complain of pain in the shoulder blade or
lower back. These symptoms most often occur 2-3 months prior to a confirmed
diagnosis. In peritoneal mesothelioma, abdominal pain and swelling, nausea
or vomiting, bowel obstruction and weight loss are the most common symptoms.
Importantly, these symptoms are not unique to mesothelioma, and may be
symptoms of other conditions as well. Evaluation by a qualified physician
is always suggested.
As mesothelioma progresses, pleural effusion
(fluid build up between the two pleural layers) occurs in 95% of patients,
and it is this symptom which ultimately leads to patients visiting their
GP. During this visit, a chest x-ray is taken which may confirm the effusion.
A thickening of the pleura may also be noted at this time. If the GP suspects
cancer is a possibility, referral may be made to a hospital consultant
who specializes in lung cancer and mesothelioma.
When your GP recommends a referral, you
should be given the following information:
Where you are being referred.
When the appointment will be scheduled.
Who you will see.
What testing you can expect.
When the results of the testing will be available.
The National Institute for Health and Clinical
Excellence has developed the following general referral guidelines for
suspected cancer, effective June, 2005. These guidelines may not apply
to every individual, and you should always discuss the details of your
specific case with your health care team, so you can play a proactive
role in your treatment and care.
An assessment of urgency will be made by
your GP, and will be based on the following criteria:
- Immediate referral: The patient needs to be seen within
a few hours.
- Urgent referral: The patient will be seen within two
- Non-urgent: All other referrals.
Once urgency is determined, your GP will
send all information pertaining to your case to your specialist for evaluation.
A diagnosis of mesothelioma is most often obtained
with a careful assessment of clinical and radiological findings in addition
to a confirming tissue biopsy. Following are some of the tests your specialist
may recommend and their value in diagnosing and assessing mesothelioma.
Computed Tomography (CT)
CT scans are able to define pleural effusion, as
well as pleural thickening, pleural calcification, thickening of interlobular
fissures or possible chest wall invasion. CT, however, is not able
to differentiate between changes associated with benign asbestos disease,
or differentiate between adenocarcinoma of the lung versus mesothelioma.
CT scans may also be of value in guiding fine needle aspiration of
pleural masses for tissue diagnosis. This scan usually takes 10-30
minutes, but may vary according to the patient.
Magnetic Resonance Imaging (MRI)
MRI scans are most often used to determine the extent
of tumor prior to aggressive treatment. Because they provide images
in multiple planes, they are better able to identify tumors as opposed
to normal structures. They are also more accurate than CT scans in
assessing enlargement of the mediastinal lymph nodes which lie between
the two lungs, as well as a clear diaphragmatic surface, both of which
play an important role in surgical candidacy. An MRI scan usually
takes 20-40 minutes, but may vary according to the patient.
Positron Emission Tomography (PET)
PET imaging is now becoming an important part of
the diagnosis and evaluation of mesothelioma. PETs are considered
to be the most diagnostic of tumor sites, as well as the most superior
in determining the staging of mesothelioma. Because PET scans are
relatively new and may not be available in all locations, it may be
necessary to travel to a specialized center to have one.
Testing of the pleural fluid for malignant cells
is considered to have limited value in diagnosing mesothelioma. Diagnostic
thoracentesis, in which cells are extracted from the pleural cavity,
is commonly done when the possibility of mesothelioma exists. Unfortunately,
negative or inconclusive readings account for nearly 85% of all fluid
tested. Even in the event of a positive fluid report, doctors may
opt to perform a confirming tissue biopsy as long as it is not detrimental
to the patient’s health.
Tissue Analysis (Biopsy)
In most cases, it is ultimately a needle biopsy of
the pleura, or an open surgical biopsy, that yields a confirmed diagnosis
of mesothelioma. In a pleural biopsy procedure, the surgeon will make
a small incision through the chest wall and insert a thin, lighted
tube called a thorascope into the chest between two ribs. He will
then remove a sample of tissue to be reviewed under a microscope by
a pathologist. In a peritoneal biopsy, the surgeon makes a small incision
in the abdomen and inserts a peritoneoscope into the abdominal cavity.
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