Mesothelioma and You: What you need to know for early detection (Part 2)
In the first part of this series, we addressed mesothelioma types and symptoms. Our goal is to help people detect the disease early, in order to get the right treatment. This part of the series addresses tests that doctors will or can administer to detect if you have mesothelioma.
As mentioned in the last post, there are three types of mesothelioma:
The most common is Pleural mesothelioma, which occurs in the chest. Mesothelioma can lie dormant for 25-50 years after exposure to asbestos. That is why it is important to get tested as soon as one suspects a problem or an individual has a history of exposure.
There are many tests doctors use to diagnose mesothelioma. According to cancer.org, here is what to expect2:
If you have any signs or symptoms that suggest you might have mesothelioma, your doctor will want to take a complete medical history to learn about your symptoms and possible risk factors, especially asbestos exposure. You will also be asked about your general health.
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.
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 could suggest mesothelioma.
The CT scan is an x-ray test 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 table. A computer then combines these into images of slices of the body. Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues in the body.
This test uses sound waves to look at the heart. It may be done if your doctor suspects that you have fluid around your heart (a pericardial effusion). It can also tell how well the heart is working. For the most common version of this test, you lie on a table while a technician moves an instrument called a transducer over the skin on your chest. A gel is often put on the skin first.
For a PET scan, a radioactive substance (usually a type of sugar related to glucose, known as FDG) is injected into the blood. The amount of radioactivity used is very low. Because cancer cells in the body grow quickly, they absorb more of the sugar than most other cells. After waiting about an hour, you lie on a table in the PET scanner for about 30 minutes while a special camera creates a picture of areas of radioactivity in the body.
Like CT scans, MRI scans make detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into very detailed images of parts of the body.
Blood levels of certain substances are often higher in people with mesothelioma. Blood tests for these substances are not used to diagnose mesothelioma, but high levels may make the diagnosis more likely.
Symptoms and test results may strongly suggest that a person has mesothelioma, but the actual diagnosis is made by removing cells from an abnormal area and looking at them under a microscope. This is known as a biopsy. It may be done in different ways, depending on the situation.
If mesothelioma might be causing a buildup of fluid in the body, a sample of this fluid can be removed by inserting a thin, hollow needle through the skin and into the fluid to remove it. Numbing medicine is used on the skin before the needle is inserted. This may be done in a doctor’s office or in the hospital. Sometimes ultrasound (or an echocardiogram) is used to guide the needle (these use sound waves to take pictures of parts of the body).
The fluid is then tested to check its chemical makeup and is looked at under a microscope to see if it contains cancer cells. If cancer cells are found, special tests might be able to tell whether the cancer is a mesothelioma, a lung cancer, or another type of cancer.
Suspected tumors in the chest are sometimes sampled by needle biopsy. A long, hollow needle is passed through the skin in the chest between the ribs and into the pleura. Imaging tests such as CT scans are used to guide the needle into the tumor so that small samples can be removed to be looked at under the microscope.
An endoscope is a thin, tube-like instrument used to look inside the body. It has a light and a lens (or tiny video camera) on the end for viewing and often has a tool to remove tissue samples. Endoscopes have different names depending on the part of the body where they’re used. Endoscopic biopsy is commonly used to diagnose mesothelioma.
This procedure uses an endoscope called a thoracoscope to look at areas inside the chest. It can be used to look at the pleura and take tissue samples for biopsies. Thoracoscopy is done in the operating room while you are under general anesthesia (in a deep sleep). The doctor inserts the thoracoscope through one or more small cuts made in the chest wall to look at the space between the lungs and the chest wall. This lets the doctor see possible areas of cancer and remove small pieces of tissue to look at under the microscope.
For this test, the doctor uses an endoscope called a laparoscope to look inside the abdomen and biopsy any peritoneal tumors. This is done in the operating room while you are under general anesthesia (in a deep sleep). The laparoscope is inserted into the abdomen through small cuts on the front of the abdomen.
If imaging tests such as a CT scan suggest that the cancer has spread to the lymph nodes between the lungs, the doctor may want to remove some of them to see if they really contain cancer. This area is the mediastinum, and looking at it with an endoscope is called mediastinoscopy. This is also done in an operating room while you are under general anesthesia (in a deep sleep).
This test does not require any cuts in the skin. It uses a bronchoscope – a long, thin, flexible, fiber-optic tube that is placed down the throat and into the lungs to look at the lining of the main airways. This procedure is done while you are asleep or sedated. If a tumor is found, the doctor can take a small sample of the tumor through the tube.
Sometimes endoscopic biopsies aren’t enough to make a diagnosis and more invasive procedures are needed. By making an incision in the chest (thoracotomy) or an incision in the abdomen (laparotomy) the surgeon can remove a larger sample of tumor or, sometimes, remove the entire tumor.
No matter how they were obtained, all biopsy and fluid samples are sent to the pathology lab. There, a doctor will look at them under a microscope and test them to find out if they contain cancer cells (and if so, what type of cancer it is).
This test looks for different proteins on the surface of the cells or inside them. It can be used to tell if the cancer is a mesothelioma or a lung cancer, which can sometimes appear to start in the inner lining of the chest.
This is a newer test that actually looks at patterns of genes in the cancer cells. Mesothelioma cells have different gene patterns than other cancer cells.
This can sometimes help diagnose mesothelioma. The electron microscope can magnify samples many more times than a normal light microscope. This more powerful microscope makes it possible to see the small parts of the cancer cells that can distinguish mesothelioma from other types of cancer.
If mesothelioma has been diagnosed, pulmonary function tests (PFTs) may be done to see how well your lungs are working. This is especially important if surgery may be an option to treat the cancer. Surgery often requires removing part or all of a lung, so it’s important to know how well the lungs are working to start with. These tests can give the surgeon an idea of whether surgery may be an option, and if so, how much lung can safely be removed. There are a few different types of PFTs, but they all basically have you breathe in and out through a tube that is connected to a machine that measures your lung function.
Martin Harding & Mazzotti LLP cares about you and your condition. We have represented many victims of mesothelioma over the years, and we have done so with compassion and empathy. If you or someone you know have developed asbestosis or mesothelioma, please contact our law offices to discuss your rights.