Mesothelioma is typically detected after a person presents symptoms to a healthcare provider. If there’s suspicion of mesothelioma, various tests will be conducted to determine the cause of symptoms. While symptoms may suggest mesothelioma, definitive diagnosis requires specific tests.
Medical History and Physical Examination
Your healthcare provider will review your medical history, focusing on symptoms and risk factors like asbestos exposure. A physical exam will check for signs of mesothelioma, such as fluid buildup around the lungs (pleural effusion), abdomen (ascites), or heart (pericardial effusion). In rare cases, mesothelioma may appear as a groin mass resembling a hernia.
Imaging Tests
- Chest X-ray: Often the initial test, revealing abnormalities such as pleural thickening or fluid accumulation indicative of mesothelioma.
- CT Scan: Provides detailed cross-sectional images to locate the cancer, determine its stage, and evaluate treatment effectiveness.
- Echocardiogram: An ultrasound of the heart to check for fluid around the heart (pericardial effusion) and assess heart function.
- PET Scan: Uses a radioactive sugar to identify areas of high radioactivity, helping to differentiate between cancer and scar tissue and to detect metastasis.
- PET/CT Scan: Combines PET and CT scans for a detailed view of areas with higher radioactivity.
- MRI Scan: Uses radio waves and magnets to create detailed images of soft tissues, helpful for assessing tumor location and extent.
Blood Tests
Certain substances, like Fibulin-3 and soluble mesothelin-related peptides (SMRPs), may be elevated in mesothelioma but are not definitive for diagnosis. Blood tests also assess overall health and organ function.
Fluid and Tissue Samples
- Fluid Analysis: Fluid build-up (pleural effusion, ascites, or pericardial effusion) can be tested for cancer cells. Procedures include thoracentesis, paracentesis, and pericardiocentesis.
- Needle Biopsies: Samples of tumor tissue or lymph nodes are taken using a thin needle guided by imaging techniques. Risks include pneumothorax, which may require treatment.
- Endoscopic Biopsies:
- Thoracoscopy: Examines the chest cavity using a thoracoscope to biopsy pleura or lymph nodes.
- Laparoscopy: Uses a laparoscope to examine the abdomen and biopsy tumors.
- Mediastinoscopy: Examines the mediastinum (area between the lungs) to biopsy lymph nodes.
- Endobronchial Ultrasound Needle Biopsy: Uses a bronchoscope with ultrasound to biopsy lymph nodes near the lungs.
- Open Surgical Biopsy: Involves making an incision to remove larger tumor samples or the entire tumor.
Testing and Diagnosis
All samples are analyzed in a lab to confirm the presence and type of cancer. Special tests help differentiate mesothelioma from other cancers. The type of mesothelioma—epithelioid, sarcomatoid, or mixed—will be identified.
Pulmonary Function Tests (PFTs)
If mesothelioma is diagnosed, PFTs assess lung function, crucial if surgery is considered. These tests measure airflow and lung capacity to determine surgical feasibility.
Medical oncologist Dr. Anne Wolf is director of the Mesothelioma Program and chair of the Clinical Research Committee at the University of Texas MD Anderson Cancer Center in Houston.
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