Early Signs of Mesothelioma
Mesothelioma diagnosis may be difficult. The onset of mesothelioma is usually very slow. The first symptom may be a constant pain in the chest. This pain may later be accompanied by difficulty breathing due to an accumulation of fluid in the chest. Mesothelioma cancer is usually diagnosed after a person develops breathing difficulty, shortness of breath, chest discomfort, chest pain, and fatigue. When a person goes to the doctor for the first time with these symptoms, the doctor will usually take a chest x-ray and listen to the chest. Many times the chest x-ray will show a large area of white which indicates an accumulation of fluid.
It is very common for mesothelioma to cause a pleural effusion. Pleural effusion occurs when too much fluid collects in the pleural space (the space between the two layers of the pleura). It is commonly known as “water on the lungs.” It is characterized by shortness of breath, chest pain, gastric discomfort (dyspepsia), and cough. There are two thin membranes in the chest about as thick as a piece of saran wrap, one (the visceral pleura) lining the lungs, and the other (the parietal pleura) covering the inside of the chest wall. Normally, small blood vessels in the pleural linings produce a small amount of fluid that lubricates the opposed pleural membranes so that they can glide smoothly against one another as a person inhales and exhales, which prevents friction and irritation. Any extra fluid is taken up by blood and lymph vessels, maintaining a balance. However, when too much fluid forms or something prevents its removal, the result is an excess of pleural fluid, or an effusion.
Diagnosing Mesothelioma
A mesothelioma diagnosis can be made by your doctor and it begins with a review of a patient’s medical history, with a focus on any history of asbestos exposure. Physically diagnosing mesothelioma typically starts with a chest CT-scan or MRI. A medical professional may prescribe a full series of tests, including x-rays, lung function tests, CT (CAT) scans, and MRI (magnetic resonance imaging). If a case of mesothelioma is suspected, a physical biopsy of the suspect tissue will be used to confirm the diagnosis.
If the diagnosis is indeed Mesothelioma, the next step will be to find the stage or extent of the cancer. A “staging” test attempts to find out if and where the cancer has spread. Knowing the stage of the disease is essential to planning a course of treatment.
When mesothelioma develops, the pleura often becomes thickened and studded with tumor nodules. Part of the body’s response to the presence of the tumor is to weep fluid into the pleural space. As the fluid collects in the pleural space, it compresses the lung, making it increasingly difficult for a person to breathe. Difficulty breathing stems from decreased lung capacity and shortness of breath.
If the mesothelioma has produced fluid, it is usually possible for the doctor to drain the fluid out of the pleural space (thoracentesis) giving immediate relief of the mesothelioma symptoms. When the fluid is drained, the lung is able to return to close to its normal size and it becomes immediately easier for the person to breathe.
Medical Tests for Mesothelioma
- Chest x-ray — This is likely to be one of the first tests you have and it will show if there is any thickening of the pleura and fluid around the lungs.
- CT Scan (CAT Scan) — CT scans of the chest and of the abdomen will show the size and position of the disease and whether it has spread to other parts of the body. A CT scan is a type of x-ray which builds up a three-dimensional picture of the inside of the body. The scan is painless but takes longer than an x-ray, about 30 minutes.
- Thoracentesis — If there is fluid in the chest or abdomen the doctor can take a sample by using a local anaesthetic and passing a needle through the skin into the fluid. In this procedure a doctor inserts a needle into the pleural space to drain fluid for analysis. This is then drawn off into a syringe and can be analysed in the laboratory to look for mesothelioma cells.
- Biopsy — Your doctor will usually need to take a sample of tissue from the thickened pleura or peritoneum. A local anaesthetic is used to numb the area, then a needle is passed through the skin to the tumour. The doctor may use ultrasound or a CT scanner to position the needle accurately for the biopsy. Sometimes the doctor will want to see the area of the pleura or the peritoneum directly in order to get a piece of tissue from the right area. This is done through a small hole in the chest, where it is called thoracoscopy, or the abdomen, where it is called laparoscopy. This is done using a brief anaesthetic and you will usually be able to go home the same day.
There are other, much more common causes of thickening of the pleura and peritoneum, and fluid around the lungs and in the abdomen, so the chest x-rays and scans alone cannot make the diagnosis. A mesothelioma diagnois requires a sample of fluid or biopsy to confirm mesothelioma.
Actual Diagnosis of Mesothelioma
Analysing the biopsy in the laboratory is the only way your doctor can make the diagnosis of mesothelioma. Sometimes even after taking a biopsy the doctors may have difficulty being sure of the diagnosis. Because the disease can be difficult to diagnose and treat, consultation with a mesothelioma doctor and treatment center with expertise and experience with mesothelioma is frequently recommended.
