Mesothelioma Cancer Diagnosis

Mesothelioma is diagnosed using a series of imaging tests followed by a biopsy.

Diagnosing mesothelioma can be difficult because the symptoms are similar to those of so many other common diseases. Typically, ailments like chest pain, shortness of breath, and coughing bring a patient to their doctor. An accurate diagnosis largely depends on the patient providing a complete medical and occupational history, which may indicate any past exposure to asbestos which may have caused the disease.

Here’s what you can expect from the mesothelioma diagnosis process.

Imaging Tests

After the doctor takes a detailed medical history they will usually order a series of diagnostic test to further investigate the cause of the problems.

X-RAY

The first test is often an X-ray. While X-rays are most useful in detecting abnormalities in the skeletal system, including broken and fractured bones, they can also be used to detect abnormalities in soft tissue, including pleural effusion (fluid in the lungs) or the presence of a tumor or pleural plaques or calcification. An X-ray that shows suspicious spots or fluid retention will usually lead to more sophisticated tests.

COMPUTED TOMOGRAPHY (CT) SCANS

The CT scan rotates an X-ray generating device around the entire body to provide cross-section images (or “slices”) of the inside of the body. Performed at either a hospital or an outpatient facility, CT scans are painless and don’t require anesthesia or special preparation. You simply lie on a table, which may be raised, lowered, or tilted in order for the technician to get the most accurate pictures possible. Technicians will be sure you’re as comfortable as possible during the procedure.

MAGNETIC RESONANCE IMAGING (MRI)

MRI uses a magnetic field and radio waves to create cross-sectional images of the head or body. This test is good at detecting tumors in or around the lungs, which makes it especially useful for diagnosing mesothelioma. Your doctor may recommend that you drink a harmless contrast dye before the test.

During the test, you’ll lie on a table that moves through the MRI machine, which directs radio waves towards the body. Clicking and other noises are a normal part of the procedure. Most MRIs last from 30 to 90 minutes; many people fall asleep during the test. If you have a fear of closed-in spaces, some hospitals and other facilities offer open MRIs, or you may be offered a sedative before the test.

Biopsy

The final test in a mesothelioma diagnosis is usually a biopsy, which involves removing a sample of fluid or tissue from the affected area and sending it to a pathologist for examination.

Some biopsies require no anesthesia or only local anesthesia. In this case, the physician removes tumor samples through a thin needle or a flexible, lighted tube called an endoscope. In other cases, a biopsy requires surgery and general anesthesia. Different procedures are used to collect cell or tissue samples, depending on the suspected location of cancer.

The sample will be sent to a pathologist who specializes in cancer and its diagnosis. This doctor will examine the cells under a microscope to check for any abnormalities that might indicate cancer.

Early Diagnosis

Early detection of mesothelioma is extremely difficult due to the disease’s latency period. By the time the symptoms became apparent, the cancer has usually progressed to stage 3 or 4, when available treatments are palliative rather than curative. In addition, because of the rarity of the disease and the fact that the symptoms mirror those of more common illnesses, mesothelioma is often misdiagnosed.

If you think you may have been exposed to asbestos, talk to your doctor about scheduling regular tests for abnormalities. Labor unions, doctor’s offices, or law firms sometimes sponsor mass screenings for people at a particular work site or in a particular industry who may have been exposed to asbestos.

Recent advancements in testing give some hope for earlier detection. A few years ago, a Japanese company invented a blood test for mesothelioma, known as Mesomark &tm;. The Japanese Mesomark&tm; test, available in the US since 2007, measures the blood serum concentrations of a marker called soluble mesothelin-related protein (SMRP). High levels of SMRP may indicate the presence of mesothelioma.

Research continues into other ways to recognize mesothelioma in its early stages, when more options are available for treatment, including surgery.

Source: https://www.maacenter.org/mesothelioma/diagnosis/

Symptoms of Mesothelioma Cancer

Early symptoms of mesothelioma are often confused with other diseases.

Mesothelioma symptoms do not usually manifest themselves until anywhere from 20 to 50 years after exposure to asbestos, at advanced stages of the disease. This makes the disease extremely difficult to diagnose until the disease has advanced, limiting treatment options. Additionally, many symptoms of mesothelioma are commonly associated with other diseases and ailments, making diagnosis even more complicated.

Common Symptoms of Mesothelioma

• Shortness of breath or difficulty breathing
• Coughing
• Fluid in the chest, lungs, or abdomen
• Weight loss
• Loss of appetite
• Inability to sleep
• Husky voice
• Difficulty swallowing

Symptoms by Type of Mesothelioma

Symptoms vary according to the type of mesothelioma.

Because the three major types of the disease are similar but originate in different parts of the body, the patient is likely to have symptoms that overlap. For example, nearly all mesothelioma patients suffer from shortness of breath and fatigue, but the pain may be more apparent in the abdominal/stomach area for peritoneal patients and in the chest for those with pleural or pericardial mesothelioma.

The growing tumors cause the pleura, pericardium, or peritoneum to expand, allowing fluid to enter. That generally causes pain – acute to severe – in the affected regions, such as the chest or abdomen. Breathing difficulties also make it hard to sleep and often result in loss of appetite and, eventually, weight loss.

Pleural Mesothelioma Symptoms by Stage

Pleural mesothelioma is staged similar to other types of cancers. Symptoms vary according to the stage of the disease, and generally don’t appear until the tumors are quite advanced. Many symptoms are caused by the physical presence of the tumors, meaning that until they have grown to sufficient size, symptoms are relatively minor and/or generalized. As tumors grow and eventually metastasize, symptoms become more severe.

Shortness of breath and persistent coughing, most common in later stages of pleural mesothelioma, generally bring a patient to the doctor’s office. Both difficulty breathing and persistent coughing are caused by the lungs’ inability to expand properly due to tumors in the pleural region.

Recognizing Symptoms

Symptoms of mesothelioma vary from case to case and with the severity of the illness.The general overall health of the individual, as well as his/her age, may also play a role in how the patient is affected by the disease and which symptoms are most bothersome.

One of the most difficult problems with diagnosing mesothelioma and connecting the symptoms with the disease is the fact that so many of the symptoms can easily be mistaken for other more common (and less serious) chest or respiratory diseases like flu, pneumonia, bronchitis, heart disease, and others.

A doctor well versed in mesothelioma treatment will take time to investigate a patient’s history and hopefully connect past exposure to asbestos with the symptoms. Patients can also assist their doctor if they were knowingly exposed. Anyone that was ever exposed to asbestos, even if it was decades ago, should inform their doctor of the exposure. That information will not only aid the doctor in diagnosis but will also help eliminate the need for many costly and uncomfortable tests that may be ordered while attempting to arrive at a conclusive determination.

Source:
1.“Malignant Mesothelioma.” American Cancer Society.Web.

http://www.cancer.org/acs/groups/cid/documents/webcontent/003119-pdf.pdf.
2. Malignant Mesothelioma Treatment (PDQ®).” National Cancer Institute.

web. http://www.cancer.gov/cancertopics/pdq/treatment/malignantmesothelioma/patient/page2.
3. Suman, S. “Primary Pericardial Mesothelioma Presenting as Pericardial Constriction: A Case Report.”Heart 90.1 (2004): 4e-4.

Web. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767997/.
4. “Symptoms, Diagnosis and Treatment.” American Lung Association.

Web. http://www.lung.org/lung-disease/mesothelioma/symptoms-diagnosis.html.
5. https://www.maacenter.org/mesothelioma/symptoms/

Mesothelioma Cancer Cell Types

In this poignant opening, we describe the broad scope of the upcoming text on the rest of page, which describes that various types of mesothelioma cells and provides a platform from which to dive into the additional information provided about each cell type.

Epithelioid Mesothelioma

Epithelioid mesothelioma is the most common type of malignant mesothelioma cell type, accounting for 50-70% of all mesotheliomas. Individual cells are known to be relatively uniform in shape and with a uniquely “tubular” appearance. When the cell is viewed under intense magnification, the cell nuclei is known to be distinctly distinguishable from other cell nuclei.

Other cancer cell types, such as adenocarcinomas, however, have been known to take similar shape and are often misclassified. Adenocarcinomas are cancer cells that can also occur within the mesothelium, but cannot originate within this membrane. Typically adenocarcinomas will originate within more internal tissue before surfacing within the mesothelium.

Biphasic Mesothelioma

Biphasic mesothelioma refers to a cell structure associated with malignant mesothelioma tumor cells. Among mesothelioma cancer cells, they are generally divided into two subcategories. Epithelioid mesothelioma cells are the most common type, accounting for approximately 80% of all malignant mesothelioma cells. Sarcomatoid mesothelioma cells are far rarer, accounting for just 10-15% of malignant mesothelioma cells. Biphasic mesothelioma cancers are those which comprise a combination of the two aforementioned malignant cells types.

Epithelioid mesothelioma malignant cells have a clearly defined tubular structure. Upon intense magnification, the cell structure is clearly visible, including a distinguishable nucleus. Sarcomatoid mesothelioma malignant cells are clearly different than epithelioid cells, with their oval shape being clearly distinguishable from their counterpart. Upon intense magnification, the cell structure is loosely visible while the nucleus is often muddled and difficult to distinguish.

Papillary Mesothelioma

Papillary mesothelioma is better and more commonly referred to among the medical establishment as well-differentiated papillary mesothelioma, or WDPM. Papillary mesothelioma, unlike other mesotheliomas, is generally considered to be of low malignant potential. Papillary mesothelioma is also likely to stay localized and not spread to other areas of the body outside of its origin.

Treatment for papillary mesothelioma is not standardized, as this particular type of mesothelioma is extraordinarily rare. Surgery is typically recognized as the preferred treatment and is often available to patients diagnosed with papillary mesothelioma. Other treatments include several types of chemotherapy, including those used for traditional mesothelioma tumors.

This particular mesothelioma is not associated with any particular symptoms. The disease is classified as clinically indolent, meaning there is relatively no pain or discomfort associated with the mesothelioma and the tumor is relatively inactive. Those diagnosed with papillary mesothelioma are typically expected to make a complete recovery and prognosis is positive across the board. The most common papillary mesothelioma tumors form within the peritoneum (membrane which surrounds the abdominal cavity) in women of reproductive age. Other cases have been documented as originating in the lining of the heart and lungs.

Unlike malignant mesotheliomas, which are typically associated with asbestos exposure, there is no conclusive evidence linking papillary mesothelioma to asbestos exposure and those diagnosed with papillary mesothelioma will often have no asbestos history of significance.

Sarcomatoid Mesothelioma

Sarcomatoid mesothelioma is a rare malignant cell type and only accounts for between 10-15% of all mesothelioma cancer cells. This is least common type of mesothelioma. Sarcomatoid mesothelioma cells are oval shaped, but consistently irregular and not as uniform as epithelioid mesothelioma cells. The nucleus of sarcomatoid cells, so clear and distinguishable in epithelioid cells of the same type, is muddled and not as visible.

The oval shape of the sarcomatoid mesothelioma cells is common in other cell structures, and while it is not often associated with mesothelioma, they can closely mimic those of other malignancies, including those of sarcomatoid carcinoma and sarcoma. While sarcomatoid mesothelioma cells can manifest in other parts of the body, there are relatively rare within the lungs (the origin of most mesothelioma malignancies).

Pulmonary sarcomatoid carcinoma is that carcinoma most closely mimics sarcomatoid mesothelioma. Symptoms of both cell type also parallel, including chest pains, effusions of the chest and abdomen, and difficulty breathing.

1

Butnor, K., Sporn, T., Hammar, S. et al. Well-Differentiated Papillary Mesothelioma. (2001). The American Journal of Surgical Pathology: 1304-1309.

2

Spano, J., Soria, J., Sabourin J. Well-Differentiated Papillary Mesothelioma (WDPM): Successful therapy by local surgery alone or combined with intraoperative intraperitoneal heated chemotherapy (IPHC) perfusion using cisplatin. (2003). Proceeding of the American Society for Clinical Oncology; 22.

https://www.maacenter.org/mesothelioma/types/mesothelioma-cell-types/

Types of Mesothelioma Cancer

Mesothelioma is a rare form of cancer that originates in the mesothelium, a thin layer of flat cells that protect the body’s internal organs as they move within the chest and abdominal cavity. Mesothelioma initially develops in these thin layers; however, in later stages it may spread (metastasize) to other parts of the body and cause serious health problems.

The only scientifically verified cause for mesothelioma is exposure to asbestos. There is no known cure for mesothelioma; prognoses are generally poor because the cancer is typically very advanced by the time it is discovered.

There are three major forms of mesothelioma: pleural, peritoneal, and pericardial.

Pleural Mesothelioma

Pleural mesothelioma, which comprises more than 75% of all diagnosed mesothelioma cases, affects the pleura, a sac that contains the lungs. Victims inhale asbestos fibers, which lodge in the pleural tissue and cause inflammation that eventually turns to tumors.

More you know:  Pleural Mesothelioma

Peritoneal Mesothelioma

Peritoneal mesothelioma develops in the mesothelial lining of the abdominal cavity. It accounts for 15% to 20% of all mesothelioma cases diagnosed throughout the world, making it the second most common form of the disease. Opinions are divided on how asbestos actually makes its way into the abdomen. Theories range from ingestion to circulation through the lymphatic system. As with pleural mesothelioma, the fibers lead to inflammation and eventually tumors form.

More you know:  Peritoneal Mesothelioma

Pericardial Mesothelioma

The rarest of the three major forms of mesothelioma, pericardial mesothelioma attacks the lining of the heart, known as the pericardium. Scientists theorize that asbestos makes its way from the lungs into the bloodstream, circulating throughout the body and ultimately lodging in the heart. Tumor formation occurs through a similar mechanism to pleural mesothelioma.

More you know:  Pericardial Mesothelioma

Benign Mesothelioma

While the vast majority of mesothelioma cases are malignant, some mesothelioma tumors are benign.

Sometimes referred to as a “solitary fibrous tumor of the pleura,” benign mesothelioma is usually not cancerous, though cancerous forms can occur from time to time. Appearing more in men than women, these tumors usually start in the tissues under the mesothelium, which is known as the submesothelium. A similar tumor may grow in the peritoneum, the lining of the abdomen.

The most important difference between benign mesothelioma tumors and the cancerous forms is that benign tumors do not spread, invading adjacent tissue. Cases of benign mesothelioma are easily treatable. In most cases surgery to remove the tumor is sufficient. On the other hand, malignant tumors often spread quickly, making treatment difficult.

Mesothelioma Cell Types

Mesothelioma manifests in three primary cell types. Prognosis, symptoms and treatment may differ based on the type of cell.

More you know:  Mesothelioma Cell Types

SOURCE:

1

Cancer Research, UK. Types of Mesothelioma.

2

Cancer Research, UK. What is Mesothelioma?

3

National Library of Medicine and National Institutes of Health. Localized benign pleural mesothelioma: a case report.

www.maacenter.org/mesothelioma/types

What mesothelioma is

Mesothelioma is a type of cancer that can develop in the tissues covering the lungs or the abdomen. It is a cancer of mesothelial cells. These cells cover the outer surface of most of our internal body organs, forming a lining that is called the mesothelium.

Mesothelioma in the chest

About three quarters of mesotheliomas occur in the chest (75%). They start in the two sheets of tissue known as pleural membranes (or pleura) that cover the lungs. The gap between the pleura is called the pleural space. The pleura are fibrous sheets that help to protect the lungs. They also produce a lubricating fluid that helps the pleural membranes to slide over each other easily when the lungs expand and deflate as we breathe. Mesothelioma of the pleura is called pleural mesothelioma.





The sheet of tissue covering the heart (the pericardium) is very close to the pleura. So in some people pleural mesothelioma may also spread into the pericardium. The diagram below shows the pleural membranes thickening due to mesothelioma.

Mesothelioma in the abdomen

The sheet of tissue covering the organs of the abdomen (tummy) is called the peritoneum. It helps to protect the contents of the abdomen and keep them in place. It also produces a lubricating fluid. The fluid helps the abdominal organs to move smoothly against each other as we move around.


Mesothelioma of the tissues lining the abdominal cavity is known as peritoneal mesothelioma. About a quarter of mesotheliomas occur in the abdomen (25%). So it is much less common than pleural mesothelioma. Peritoneal mesothelioma does not usually spread to other parts of the body.

Benign mesothelioma

A type of non cancerous (benign) mesothelioma can develop in the lining of the lungs, or in the lining of the reproductive organs. It can occur in either men or women. These non cancerous tumours are very rare and we don't cover them in this section.


source:cancerresearchuk.org