How Is Malignant Mesothelioma Diagnosed? -Part 1

Mesothelioma is most often diagnosed after a patient goes to a doctor because of symptoms. If there is a reason to suspect you may have mesothelioma, your doctor will use one or more tests to find out if the disease is present. Symptoms might suggest that a person may have mesothelioma, but tests are needed to confirm the diagnosis.

Signs and symptoms of mesothelioma

Early symptoms of mesotheliomas are not specific to the disease, and people often ignore them or mistake them for common, minor ailments. Most people with mesothelioma have symptoms for a few months before they are diagnosed, although in some people this is longer.

Symptoms of pleural mesothelioma (mesothelioma of the chest) can include:

• pain in the lower back or at the side of the chest

• shortness of breath

• cough

• fever

• sweating

• fatigue

• weight loss

• trouble swallowing

• hoarseness

• swelling of the face and arms

• muscle weakness

Symptoms of peritoneal mesothelioma can include:

• abdominal (belly) pain

• swelling or fluid in the abdomen

• weight loss

• nausea and vomiting

The symptoms and signs above may be caused by mesothelioma, but they may also be caused by other conditions. Still, if you have any of these problems (especially if have been exposed to asbestos), it's important to see your doctor right away so the cause can be found and treated, if needed.

Medical history and physical exam

If you have any signs or symptoms that suggest you might have mesothelioma, your doctor will want to take a complete medical history to check for symptoms and possible risk factors, especially asbestos exposure. You will also be asked about your general health.

A physical exam can provide information about possible signs of mesothelioma and other health problems. Patients with pleural mesotheliomas often have fluid in their chest cavity (pleural effusion) caused by the cancer. Fluid can build up in the abdominal cavity (ascites) in cases of peritoneal mesothelioma, or in the pericardium (pericardial effusion) in cases of pericardial mesothelioma. Rarely, mesothelioma can develop in the groin and look like a hernia. All of these might be found during a physical exam.

If symptoms and/or the results of the physical exam suggest a mesothelioma might be present, more involved tests will likely be done. These might include imaging tests, blood tests, and other procedures.

Imaging tests

Imaging tests use x-rays, radioactive particles, or magnetic fields to create pictures of the inside of your body. Imaging tests may be done for a number of reasons, including to help find a suspicious area that might be cancerous, to learn how far cancer may have spread, and to help determine if treatment has been effective.

Chest x-ray

This is often the first test done if someone has symptoms such as a constant cough or shortness of breath. It may show an abnormal thickening of the pleura, calcium deposits on the pleura, fluid in the space between the lungs and the chest wall, or changes in the lungs themselves as a result of asbestos exposure. These findings may also suggest a mesothelioma.

Computed tomography (CT) scan

The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a regular x-ray, a CT scanner takes many pictures as it rotates around you while you are lying on a narrow platform. A computer then combines these into images of slices of the part of your body that is being studied.

CT scans are often used to help assess the likelihood that mesothelioma is present and help determine the exact location of the cancer. They can also help stage the cancer (determine the extent of its spread). For example, they can show if the cancer has spread to the liver or other organs. This can help to determine if surgery might be a treatment option. Finally, CT scans can be used to determine if treatment such as chemotherapy has been helpful in shrinking or slowing the growth of the cancer.

Prior to the scan, you may be asked to drink a contrast solution and/or get an intravenous (IV) injection of a contrast dye that helps better outline abnormal areas in the body. You may need an IV line through which the contrast dye is injected. The injection can cause some flushing (redness and warm feeling). Some people are allergic and get hives or, rarely, more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.

You need to lie still on a table while the scan is being done. During the test, the table moves in and out of the scanner, a ring-shaped machine that completely surrounds the table. You might feel a bit confined by the ring you have to lie in while the pictures are being taken.

In recent years, spiral CT (also known as helical CT) has become available in many medical centers. This type of CT scan uses a faster machine. The scanner part of the machine rotates around the body continuously, allowing doctors to collect the images much more quickly than standard CT. As a result, you do not have to hold your breath for as long while the image is taken. This lowers the chance of blurred images occurring as a result of breathing motion. It also lowers the dose of radiation received during the test. The slices it images are thinner, which yields more detailed pictures.