Mesothelioma Diagnosis

A diagnosis of mesothelioma typically occurs within six months after a patient first visits their doctor concerning breathing difficulties or pain in the chest or abdomen. The initial step is to furnish an accurate and complete history of all medical problems, including current health issues, past problems, and a detailed description of the patient's current symptoms. At this stage, it is critical to mention any asbestos exposure that may have occurred in the past. If the doctor is aware that such exposure has occurred, he or she can be sure to consider the possibility of a disease related to asbestos, which can expedite a diagnosis.

Diagnostic Tests for Mesothelioma

If mesothelioma is suspected, the physician will want to confirm that the disease is present, where it is located, determine the type and size of the cancer, and determine whether or not the disease has spread. There are several tests available to help answer these questions.

Initial Considerations for Diagnosis

Preliminary factors that should be discussed with a physician before a diagnosis of mesothelioma include:
Medical history: a physician will need to discuss past and present health issues, most importantly respiratory problems. The doctor should ask the patient about a family history of cancer as well as if they previously or currently smoke.
Physical Examination: key signs a doctor should be on the lookout for include evidence of a pleural effusion or pleural mass, a reduction of chest expansion capabilities, a lack of breathing sounds, mediastinal displacement, tenderness in a localized area and any protruding tumors.
Prior asbestos exposure: The American Cancer Society states that 80% of mesothelioma cases are caused by prior exposure to asbestos. Most commonly in professional environments such as power plants and chemical plants, countless men and women have been exposed to this toxic fiber including 25 million members of the armed forces.
While as many as 3,000 new patients are being diagnosed with mesothelioma annually, it is imperative to do preliminary testing to accurately establish a mesothelioma case.

Imaging Tests

Chest X-ray: This is typically the first imaging test your doctor will order. It is usually not the sole determinant of a proper prognosis, and so additional tests may be ordered.
CT Scan: Sometimes referred to as a CAT scan, this is similar to an X-ray but produces multiple images that are then assimilated by a computer to allow viewing of the tissue in greater detail. Patients receiving a CT scan are sometimes injected with a dye that will create greater contrast, thus providing greater detail.
PET Scan: Cancerous cells use and absorb sugars differently than healthy cells. This allows a PET scan to be an efficient method of detecting them. Patients are given an injection of glucose and then a scanner is used to identify any cells that are absorbing the glucose abnormally.
MRI: An MRI creates highly detailed images in three dimensions that allow a trained radiologist to identify any suspicious areas. This procedure uses a magnetic field and radio waves to produce the images.

Tissue and Fluid Tests

It is normal for a doctor to perform a biopsy of the suspicious area. This involves retrieving a sample of the tissue or fluid and then testing the sample for cancerous cells. There are four main types of biopsies that a doctor may choose to order.
Fine Needle Aspiration: Mesothelioma typically leads to a build-up of fluids in the area afflicted, such as the mesothelium, or lining, in the chest cavity. To perform a fine needle aspiration, the doctor uses an extremely thin, long needle to extract a fluid sample.
Thoracoscopy: If the doctor wishes to confirm or eliminate symptoms of pericardial or pleural mesothelioma, a thoracoscopy might be ordered. This involves a tiny incision in the chest wall in order to obtain a tissue sample.
Laparoscopy or Bronchoscopy: These two procedures are conducted on different areas of the body. A bronchoscopy may be ordered to check the airway and trachea. A laparoscopy involves the removal of a sample of the tissue from the peritoneal area.
Mediastinoscopy: This test is used to examine the lymph nodes located in the neck and chest to see if the cancer has spread from its initial site.

Blood Tests

Thanks to recent breakthroughs of specific biomarkers in the blood, doctors can now detect mesothelioma in earlier stages. That being said, elevated levels of certain biomarkers  in a patient's blood does not necessairly mean that a cancer is present.
Mesomark assay - The Mesomark assay test determines the amount of soluble Mesothelin-Related Peptides (SMRP) in a patient's serum. Doctors can then measure the amount to determine if mesothelioma is present. Presence of SMRP in a patient's blood can be detected even in the earlier stages of the cancer, which gives hope for future diagnosis of mesothelioma.
miRview - This diagnostic test allows physicians to differentiate malignant mesothelioma from other forms of metastatic carcinomas affecting the membranes around the lung.  MiRview does this by testing a tissue-specific microRNA biomarker from the tumor in order to differentiate between mesothelioma and other cancers.

Diagnosis Codes for Mesothelioma

Standardized codes have been assigned to the various types of mesothelioma. Patients may not regularly encounter these codes, however, it is helpful to have them available should the doctor refer to them or a patient encounter them while performing research.

• ICD-9 code 163: Pleural mesothelioma
• ICD-9 code 158: Peritoneal mesothelioma
• ICD-9 code 164: Pericardial mesothelioma

After Mesothelioma is Confirmed

A primary care physician will likely refer the patient to an oncologist, or a doctor who specializes in cancer, who has experience treating mesothelioma. The oncologist can help determine which treatment options are best for each case. Patients are also encouraged to perform their own research, providing education on the various options available in order to better discuss them with the physician. Patients are also advised to locate any available sources of support during this difficult time.