Written By: Karen Ritter, RN BSN
Mesothelioma Diagnosis
Getting a malignant mesothelioma diagnosis is the first step to starting treatment and killing your tumors. If you’re experiencing symptoms of mesothelioma, there are several tests and procedures used to determine the cause. Early diagnosis and early treatment are the best ways to improve outcomes.
Medically Reviewed By
Dr. Hassan Khalil
Mesothelioma Thoracic Surgeon
Medically Reviewed By
Dr. Hassan Khalil
Mesothelioma Thoracic Surgeon
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Important Facts About Mesothelioma Diagnosis
- A tissue biopsy is the only way to confirm a diagnosis of mesothelioma. Imaging tests provide evidence of abnormalities through scans.
- Blood marker tests are another diagnostic test, although they are not used to confirm the diagnosis.
- There are five imaging tests used for a mesothelioma diagnosis. Five of them are used for both pleural mesothelioma and peritoneal mesothelioma. One, an echocardiogram, is also used to diagnose pericardial mesothelioma.
- Mesothelioma misdiagnosis frequently happens due to the rarity of the cancer. It’s crucial to find physicians specializing in mesothelioma for an accurate diagnosis.
How Is Mesothelioma Diagnosed?
Doctors make a diagnosis of mesothelioma by conducting physical exams, evaluating symptoms and performing imaging tests. The only definitive way to diagnose mesothelioma is through a tissue biopsy.
People with a history of asbestos exposure can develop this malignant mesothelioma. However, not everyone exposed will ever develop this rare cancer. The rate of occurrence is low, with only 3,000 new cases diagnosed in the United States each year.
Patients experiencing mesothelioma symptoms like coughing, chest pain, shortness of breath, abdominal pain or abdominal distention should seek a medical evaluation. During the appointment with your physician, you should explain the symptoms and include your history of asbestos exposure.
Tests for Mesothelioma
Imaging Tests
Imaging tests are used to locate abnormalities, such as fluid buildup or tumors inside the body. An X-ray is usually the first mesothelioma test. If worrisome signs are discovered, the doctor will request other tests. Common imaging tests used to look for mesothelioma are: a computed tomography (CT) scan; positron emission tomography (PET) scan; magnetic resonance imaging (MRI) scan; and echocardiogram.
Blood Marker Tests
According to the American Cancer Society, there is a certain substance found in blood (fibulin-3 and soluble mesothelin-related peptides) that may become valuable biomarkers for people with mesothelioma. The levels of fibulin-3 have been higher in mesothelioma patients (benign and malignant mesothelioma) than in healthy people. While blood tests are not reliable for diagnostic purposes, they can provide insight into the potential presence of disease and how well vital organs are responding to treatment.
Biopsies
If imaging and blood marker tests indicate the likelihood of someone having cancer, the doctor will refer the patient for a tissue biopsy. A biopsy involves taking a sample of tissue or fluid from a tumor or fluid accumulation. These samples are examined under a microscope to determine if cancer is present. Testing tissue biopsy samples can help determine the cell type of the cancer and the extent of the disease. It is the only way to definitively determine a diagnosis of malignant mesothelioma.
Imaging Tests
Imaging tests are the first step in diagnosing mesothelioma. These tests help doctors discover anatomical abnormalities, the presence of any masses and potential tumors (along with their location, size and severity). Each imaging test has its own purpose and helps doctors make an accurate diagnosis.
X-Ray - An X-ray provides a two-dimensional image of the patient and can show the presence of an abnormal mass or fluid buildup.
CT scan - CT scans are three-dimensional imaging tests that provide detailed images of soft tissue structures and can identify details of anomalies.
PET scan - PET scans involve the administration of radioactive sugar into the bloodstream that rapidly dividing cells, like cancer cells, easily absorb. A specialized camera sends a picture of the radioactive energy within the body back to the medical team. The camera also provides real-time images of cancer cells. This imaging scan is useful in staging as it shows whether tumors have spread to lymph nodes or other areas of the body.
MRI scan - MRI scans create detailed images of soft tissue to find the exact location of a tumor or the extent of its spread.
Echocardiogram - An echocardiogram is an ultrasound of the heart. Doctors may use this imaging scan if they suspect a patient has pericardial mesothelioma, which is a cancer that forms in the thin membrane surrounding the heart. An echocardiogram can also be used to assess heart function in patients with suspected mesothelioma. This works for diagnosing both pleural mesothelioma and peritoneal mesothelioma.
Blood Tests and Biomarkers
Blood and biomarker tests measure levels and substances found in a person’s blood. While these tests are not used in a mesothelioma diagnosis, they can help monitor the efficacy of treatment.
The levels of fibulin-3, cancerous antigen 125 (CA 125), osteopontin and soluble mesothelin-related peptides (SMRP) are commonly higher in mesothelioma patients than in healthy people. Doctors compare the levels of these substances in people diagnosed with mesothelioma to baseline levels. This information could impact future diagnostic testing and treatments.
Some physicians use the Mesomark test. This is a blood test used to monitor a patient’s SMRP level. When the SMRP level is higher than the baseline level or has not decreased since the last test, it may indicate that treatment has not been effective. However, if the SMRP level decreases compared to previous testing, then doctors will continue with the current treatments.
Mesothelioma Biopsies
A mesothelioma biopsy involves the extraction and examination of tissue or fluid from the body. It’s the final step in the diagnostic process.
By examining the biopsy sample, doctors can analyze the cells and determine if any are cancerous. There are also different types of biopsies, such as surgical biopsies or needle biopsies. Biopsies of tissue samples are the only way doctors can make a conclusive diagnosis of mesothelioma.
The histological makeup of the cancer can also be determined through tissue examination. Certain cellular makeups respond differently to treatment plans.
Tissue Biopsies
Doctors use surgical biopsies to extract tissue from a patient. The tissue sample is sent to a pathologist to examine for the presence of mesothelioma. This procedure is done using traditional surgical methods, needle biopsy or camera-assisted surgery. Surgical biopsies are the best way to give a correct mesothelioma diagnosis.
The various biopsy procedures include:
Thoracotomy
This is an open surgical procedure where a biopsy of the chest cavity can be obtained. This is useful for diagnosing pleural mesothelioma. Surgeons can also get a firsthand look at the extent of the disease.
Thoracotomy – This is an open surgical procedure where a biopsy of the chest cavity can be obtained. This is useful for diagnosing pleural mesothelioma. Surgeons can also get a firsthand look at the extent of the disease.
Thoracoscopy
A thoracoscopy is an alternative, less aggressive way of getting a chest cavity biopsy for pleural mesothelioma. This method uses a smaller incision and a small camera with instruments.
Thoracoscopy – A thoracoscopy is an alternative, less aggressive way of getting a chest cavity biopsy for pleural mesothelioma. This method uses a smaller incision and a small camera with instruments.
Laparotomy
This is an open surgical procedure where a biopsy of the abdominal cavity can be obtained. This is useful for diagnosing peritoneal mesothelioma. This procedure provides a firsthand look at the extent of the disease.
Laparotomy – This is an open surgical procedure where a biopsy of the abdominal cavity can be obtained. This is useful for diagnosing peritoneal mesothelioma. This procedure provides a firsthand look at the extent of the disease.
Laparoscopy
This is an alternative, less-aggressive way of obtaining an abdominal biopsy for peritoneal mesothelioma. This procedure uses smaller incisions, a small camera with instruments.
Laparoscopy – This is an alternative, less-aggressive way of obtaining an abdominal biopsy for peritoneal mesothelioma. This procedure uses smaller incisions, a small camera with instruments.
Mediastinoscopy
A mediastinoscopy examines the mediastinum. This is the space in the middle of the chest between the lungs. This procedure can be used to determine the severity of a patient’s pleural mesothelioma. Evidence of tumors in the mediastinum indicates a late-stage diagnosis.
Mediastinoscopy – A mediastinoscopy examines the mediastinum. This is the space in the middle of the chest between the lungs. This procedure can be used to determine the severity of a patient’s pleural mesothelioma. Evidence of tumors in the mediastinum indicates a late-stage diagnosis.
Fluid Biopsies
Fluid biopsies are another form of biopsy that may be able to indicate signs of mesothelioma, although not as accurate as tissue biopsies. Fluid samples can be obtained from accumulated fluid in the lungs, abdomen or around the heart. Doctors use a needle to extract the fluid and examine it under a microscope for the presence of mesothelioma cells. If cancer exists, the fluid may determine the presence of mesothelioma or another type of cancer.
This method is less invasive than using surgery to obtain biopsies, but it is not as conclusive as a tissue biopsy either. A fluid biopsy also does not give doctors a look at the tumor. It’s also difficult to obtain tumor cells in the fluid to indicate mesothelioma.
Histology and Cytology Reports
After a patient undergoes a biopsy, the next step in a mesothelioma diagnosis is finding out if cancer is present. This process is a pathology evaluation, and there are two options depending on the type of sample extracted. Histology and cytology reports help doctors evaluate the tissue (histology) or fluid (cytology) biopsies obtained.
Misdiagnosis
Due to mesothelioma being a rare form of cancer, it can be difficult to diagnose. Many doctors have never encountered this type of cancer and may not be able to provide an accurate diagnosis. This results in a high percentage of mesothelioma misdiagnosis compared to other cancers.
Mesothelioma is commonly misdiagnosed because the symptoms can be similar to other illnesses like the common cold, flu and pneumonia. To prevent misdiagnosis, patients should seek a mesothelioma specialist.
Misdiagnosis may also occur if the pathologists have limited experience identifying mesothelioma cancer cells. Pathologists with limited or no experience may mistake mesothelioma for a more common form of lung or abdominal cancer.
Mesothelioma may also be staged incorrectly, resulting in limited treatment options available at the time of diagnosis. Patients should consider getting a second opinion to double-check their diagnosis and treatment.
Long-Term Survivor After Misdiagnosis
Mesothelioma survivor Alexis K. was almost diagnosed with a terminal prognosis until seeing additional specialists. They revealed that her mesothelioma diagnosis was treatable. She was initially staged at stage 4.
However, the team of doctors determined it was not stage 4 and that her case was unusual. This change opened up new treatment options. Since mesothelioma is such a unique illness, many doctors don’t have the experience needed to treat it.
“For me, having it diagnosed was just the first step, and getting a second opinion gave me new options as I entered treatment.”
— Alexis Kidd
Alexis received a mesothelioma diagnosis and followed up with a second opinion. She put herself in a better position by staying on top of her own health care and requiring confirmation from a specialist. Take control of your health care and get a second opinion from a specialist by using our free Doctor Match program.
Mesothelioma Diagnosis for Veterans – Getting a Second Opinion
Most veterans with mesothelioma will see a general oncologist within the Veterans Affairs (VA) healthcare system first. Since these doctors typically do not have the experience and knowledge needed to accurately distinguish mesothelioma from other diseases, it is important to get a second opinion from a mesothelioma specialist. A general oncologist may consider a veteran’s disease to be inoperable or suggest the wrong treatment.
Many times, a mesothelioma specialist can offer a veteran treatments that will extend their life and improve their quality of life. Additionally, there are three top mesothelioma treatment centers in the VA healthcare system. These centers are located at the Boston VA, Houston VA and Los Angeles VA.
Malignant Mesothelioma Diagnosis
The process for how to get a mesothelioma diagnosis involves three steps:
- Reach out to your primary doctor. If they are unable to run tests for cancer, they will refer you to an oncologist or surgeon at a local hospital or a cancer center.
- Undergo imaging tests. The most common imaging tests are X-rays, CT scans, PET scans and MRI scans. Each type of scan reveals further proof that the abnormalities shown might be tumors in the lining of your lungs or abdomen.
- Receive a biopsy. This is the only conclusive way to ensure you get an accurate mesothelioma diagnosis. Biopsies involve doctors removing tissue or fluid samples to evaluate for cancer cells.
Treatment For Mesothelioma
After doctors confirm a mesothelioma diagnosis, they will consider mesothelioma treatment options and create a comprehensive treatment plan for the patient. This plan is tailored to each patient. Surgery is the best option, but many mesothelioma patients are not surgical candidates.
Even if a patient has late-stage mesothelioma, the surgeon may try to remove all of the cancer without any life-threatening complications. One major issue with surgery for late-stage mesothelioma patients is that cancer has likely spread to vital organs. Attempting to remove tumors in this scenario would require removing the affected organs, which may not be possible.
Chemotherapy and radiation are available treatments for patients who can’t undergo surgery. They are also used in collaboration with surgery. Another option is immunotherapy, which recently received FDA approval for the management of malignant pleural mesothelioma. Multimodal treatment involves multiple types of treatment methods and has shown promising results.
In most cases where a patient survives beyond the expected prognosis, their treatment involves a combination of chemotherapy, immunotherapy, radiation and surgery. Learn more about how you can beat the odds after your mesothelioma diagnosis in our free Mesothelioma Survivor’s Guide.
Frequently Asked Questions About Mesothelioma Diagnosis
How does a doctor diagnose mesothelioma?
Doctors analyze imaging scans and tissue or fluid samples to diagnose mesothelioma. The first step is performing X-rays, CT scans, PET scans and MRI scans on patients. These imaging tests will show visual evidence of mesothelioma. A tissue biopsy will finalize whether or not a patient has this cancer.
What test shows mesothelioma?
Imaging tests show the presence of mesothelioma on scans. However, they’re not 100% conclusive. X-rays, CT scans and MRI scans can show masses that look like tumors, or fluid buildup caused by tumors. Testing a fluid or tissue sample provides scientific proof that cells are diseased and can lead to a mesothelioma diagnosis.
How can a mesothelioma misdiagnosis occur?
Doctors may misdiagnose mesothelioma in numerous ways. The cancer is often mistaken for other, less serious health concerns, or even other types of cancer. A misdiagnosis can also occur by stage. The rarity of mesothelioma means few doctors have experience diagnosing mesothelioma properly.
Sources & Author
- Tests for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/how-diagnosed.html. Accessed: 04/10/19.
- Types of biopsies used to look for cancer. American Cancer Society. Retrieved from: https://www.cancer.org/treatment/understanding-your-diagnosis/tests/testing-biopsy-and-cytology-specimens-for-cancer/biopsy-types.html. Accessed: 04/10/19.
- Pathology Reports. National Cancer Institute. Retrieved from: https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/pathology-reports-fact-sheet. Accessed: 04/10/19.
- Harvey Pass, MD, Mary Hesdorffer, NP, Sarah Elizabeth Lake, Sarah Ann Lake (2014). 100 Questions & Answers. Jones & Bartlett Learning.
