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Mesothelioma Diagnosis
Diagnosing mesothelioma is often difficult, because the symptoms are
similar to those of a number of other conditions. Diagnosis begins with a
review of the patient's medical history. A history of exposure to asbestos
may increase clinical suspicion for mesothelioma. A physical examination
is performed, followed by chest X-ray and often lung function tests. The
X-ray may reveal pleural thickening commonly seen after asbestos exposure
and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is
usually performed. If a large amount of fluid is present, abnormal cells
may be detected by cytology if this fluid is aspirited with a syringe. For
pleural fluid this is done by a pleural tap or chest drain in
ascites with an paracentisis or ascitic drain and in a pericardial
effusion with pericardiocentisis. While absence of malignant cells on
cytology does not completely exclude mesothelioma, it makes it much more
unlikely, especially if an alternative diagnosis can be made (e.g.
tuberculosis, heart failure).
If cytology is positive or a plaque is regarded as suspicious, a biopsy
is needed to confirm a diagnosis of mesothelioma. A doctor removes a
sample of tissue for examination under a microscope by a histpathologist.
A biopsy may be done in different ways, depending on where the abnormal
area is located. If the cancer is in the chest, the doctor may perform a
thoracoscopy. In this procedure, the doctor makes a small cut through the
chest wall and puts a thin, lighted tube called a thoracoscope into the
chest between two ribs. Thoracoscopy
allows the doctor to look inside the
chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laproscopy.
To obtain tissue for examination, the doctor makes a small opening in the
abdomen and inserts a special instrument into the abdominal cavity. If
these procedures do not yield enough tissue, more extensive diagnostic
surgery may be necessary
If it is found only where it has originated, it is described as
localized. If the cancer has spread to other organs, beyond the original
membrane surfaces, then it is described as advanced. |
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