Mesothelioma Diagnostic
Chest X-Ray, Computed Tomography, Positron Emission Tomography, Magnetic Resonance Imaging and BIOPSY are the common method for diagnostic Mesothelioma

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Diagnosis for mesothelioma involves knowing the medical history of the patient to know if he has been exposed to asbestos, and other general information about the patientís health. A physical examination provides information about signs of mesothelioma and other health problems. Patients with pleural mesothelioma often show fluid in their chest. These symptoms can be detected by a physical exam or imaging techniques can be used.



Chest X-ray is the most common tool to detect the abnormalities in lung and pleura, caused due to chronic exposure to X-rays. This may show irregular thickening of pleura, pleural effusion (fluid in the pleural space) or calcium deposition in the pleura. All these observations suggest asbestos exposure, which could have lead to the development of mesothelioma.



CT Scanner or X-ray source is rotated at an angle of 360O around the patientís body. During its entire trip, the scanner takes a number of pictures of patientís body. All these pictures are assembled together digitally (by a computer linked with the scanner). Finally, an image of a cross section of patientís body is obtained, unlike conventional X-ray technique, where one picture can be taken. The CT Scanner takes pictures of several slices of the part of the body that is being studied.

After obtaining the first set of pictures, an IV (intra venous) injection of a radioactive dye or radio contrast agent is given. This helps to obtain a better outline of internal body structures and internal abnormalities. Then, a second set of pictures is taken.



This technique is based on the fact that cancerous cells use sugar much faster than the normal tissues. In this test, radioactive glucose (sugar) is injected into the vein. Since cancerous tissue takes up the radioactive sugar faster, radioactive deposits are discovered in cancerous region. This test is used to tell if a thickening of tissues is cancer or just a scar tissue. It can, obviously, spot apread of the cancer.



MRI Scans make use of radio waves and strong magnets instead of X-rays. Energy from these radio waves is taken up by different body tissues and later, released in a specific pattern. Since, for different tissues, the pattern of energy released is different, computer to translate different patterns into a detailed image of the body parts uses this fact. It can also produce images of slices of the body that are parallel with the body length. Less often, a contrast agent may be used, as in CT Scan.

MRI Scans are useful in locating the presence of mesothelioma in the diaphragm. This technique is particularly useful in examining brain and spinal cord. Abnormalities in bones cannot be detected using MRI Scan

Imaging techniques like X-rays, CT Scan or CAT Scan, PET and MRI help in knowing the location, size and extent of cancer.



No blood tests, so far, have been found useful in diagnosing malignant mesothelioma.



In case the patient has pleural effusion, a fluid sample is taken from chest cavity inserting a needle. A pathologist to determine if cancer cells are present then tests the fluid in laboratory.

Thoracoscopy, a relatively new technique, is used to obtain a biopsy of pleural tumour. A small incision is made in the chest, and through this incision, a thoracoscope is inserted into the chest. This thoracoscope displays the tumour to the surgeon, who can then obtain a tissue biopsy using forceps. Pleural space fluid can also be obtained using this technique. The samples are sent to the pathology laboratory, where they are tested for malignance.

Bronchoscopy is a technique, which is resorted to at times for the patients having pleural mesothelioma. A flexible lighted tube is inserted through mouth, down the trachea, and finally into the bronchi to see the presence of tumours. Samples of abnormal tissues present on the way can be removed for testing.

In mediastinoscopy, a lighted tube is inserted under the sternum at the level of neck. This lighted tube is then moved down the chest. Mediastinoscopy allows a surgeon find access to the lymph nodes. The cells of lymph nodes help fight the body against cancers and other infections. A sample is obtained from lymph nodes. This specimen is then tested in the laboratory to find if cancer is still localized or it has started to metastasize. Mesothelioma doesnít usually invade lymph nodes but other lung cancers do. So, this test can also be used to differentiate mesothelioma from other lung cancers.

Once malignance is located in the biopsy, further tests are conducted to find out if cancer cells have invaded other tissues too. This is what is known as staging. A doctor needs to know the stage to which cancer has reached to define a treatment for the patient.

In stage 1 of mesothelioma, the cancer is found in the lining of the chest cavity near the lung and heart, or in the diaphragm and lung. This cancer in stage 1 is also known as localized malignant mesothelioma. In stage 2, the cancer has spread beyond the chest lining to the lymph nodes located in the chest (though, this doesnít happen in most of the cases, thatís why, mesothelioma is diagnosed in later stages). By the time cancer reaches its stage 3, it has spread into the chest wall, center of the chest, heart, through the diaphragm or abdominal lining. In some cases, it even spreads to nearby lymph nodes. In stage 4, the cancer has spread to distant tissues.


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