Sunday, 29 July 2012

Mesothelioma Diagnosis


Mesothelioma Diagnosis

How do medical professionals diagnose mesothelioma?
If you believe that you may have mesothelioma, a qualified medical professional will use a variety of diagnostic tests and methods to confirm the presence of the disease.
The first step that mesothelioma doctors will take in evaluating an asbestos related disease is to obtain a full medical history to determine the level and severity of mesothelioma risk factors and presenting mesothelioma symptoms. This interview will consider among other things, where asbestos exposure occurred, the length of exposure and the amount of asbestos that you were exposed to.
In addition, he/she will perform a medical exam to look for signs and symptoms of various types of mesothelioma. For example, if pleural mesothelioma is suspected the doctor will look for fluid in the chest, peritoneal mesothelioma often shows fluid in the abdomen and poricardial mesothelioma presents with fluid in the area of the heart.

 

Diagnostic Tests

Imaging Scans

Diagnostic image tests like x-rays, CT scans and MRI's are useful in obtaining more information about the cancer including how far it is progressed. Each method provides another piece of information for your doctor to assist him/her in making an accurate diagnosis. Chest x-rays are used to identify abnormalities in the lungs including unusual thickening, mineral deposits and fluid in the chest area. CT scans are capable of providing images of the same location from many different angles. MRI technology uses magnetic fields rather than x-ray to provide additional views.
  • PET Scan- Positron Emission Tomography, more commonly referred to as a PET scan, is a nuclear medicine diagnostic technique. Nuclear medicine involves introducing a small amount of radioactive material into the body (in this case, intravenously) to help doctors determine if the body is functioning properly. PET scans in mesothelioma patients are often used in conjunction with CT scans. PET scans can be particularly helpful in determining if the cancer has metastasized beyond its point of origin.
  • CT Scan - A Computer Tomography scan or CT scan, as it is more often referred to, is a commonly utilized method for locating the tumor in the body and determining the extent of the disease. Doctors will often prescribe a CT scan if mesothelioma is suspected because it offers more detail than a traditional X-ray. The CT scan provides cross-sectional imaging of the internal body structures that can be reconstructed on a computer monitor.
  • MRI - A magnetic resonance image, more commonly referred to as an MRI, is a noninvasive method used for diagnosing mesothelioma within the body. The MRI uses a magnetic field and radio frequency pulses, transmitting them to a computer. Traditional MRI equipment consists of a cylinder within which the patient lies. The MRI poses no risk for patients, though some find the enclosed spaces uncomfortable. These patients may request a mild sedative to allow them to remain still and calm during the procedure.
  • X-Ray - An x-ray is a commonly utilized mechanism not only for cancer diagnosis but for many different respiratory abnormalities, including bronchitis and pneumonia. Nevertheless, given that the symptoms of these respiratory disorders closely mimic those of malignant mesothelioma, often a chest x-ray is the first imaging technique used in a mesothelioma diagnosis. X-rays are particularly adept at identifying the proliferation of fluid within the pleural cavity, a symptom of mesothelioma known as a pleural effusion. If effusion is detected in the pleural cavity, doctors will often prescribe a surgical biopsy to test the fluid for malignant mesothelioma cells.
Biopsies
A biopsy is an important diagnostic procedure recommended by doctors for patients presenting with signs and symptoms of mesothelioma that have a history of asbestos exposure. Fine needle aspiration is the less invasive type of biopsy that can be performed. More invasive surgical biopsies are recommended if results from a needle biopsy are inconclusive or if a needle biopsy is not recommended for medical reasons.
  • Needle Biopsy The needle biopsy is considered the less invasive biopsy procedure. A pleural biopsy is generally recommended for patients in whom mesothelioma is suspected. Fluid is extracted through a syringe and then tested for the presence of malignant cells. Upon determining the presence of malignant cells, cancer specialists will determine the cellular classification of the malignancy and if mesothelioma is, in fact, present. The extraction of fluid from the pleural cavity, chest wall, or abdominal is also used as a palliative procedure to alleviate patient symptoms.
  • Surgery Biopsy A surgical biopsy is a far more extensive procedure than needle biopsy. Nevertheless, these procedures are sometimes necessary to make a conclusive diagnosis of mesothelioma. Surgical biopsy can be particularly useful once a diagnosis has already been established. For instance, a mediastinoscopy is a procedure, which assists physicians in staging the cancer. Once cancer is effectively staged, treatment recommendations can be made based on the best possible scenario for each individual patient’s circumstances.
Source
National Cancer Institute - Mesothelioma: Questions and Answers

Mesothelioma Symptoms


Mesothelioma Symptoms

What are the most common warning signs of mesothelioma?
Mesothelioma is difficult to diagnose because the early signs and symptoms of the disease can be subtle or mistaken. Symptoms are all too frequently ignored or dismissed by people who are inclined to attribute them to common every day ailments. Sometimes patients live with symptoms for up to 6 months before being diagnosed but usually the symptoms are present for two to three months prior to a mesothelioma diagnosis.
About 60% of patients diagnosed with pleural mesothelioma experience lower back pain or side chest pain and there are frequent reports of shortness of breath. Lower numbers of people may experience difficulty swallowing, or have a persistent cough, fever, weight loss or fatigue. Additional symptoms that some patients experience are muscle weakness, loss of sensory capability, coughing up blood, facial and arm swelling and hoarseness.
Peritoneal mesothelioma originates in the abdomen and as a result, symptoms often include abdominal pain, weight loss, nausea, and vomiting. In the event that there is a hernia present, fluid buildup may occur in the abdomen as well.
Asbestos exposure is considered the primary risk factor for the development of the cancer. Anyone previously exposed to asbestos displaying any of these symptoms should seek medical attention from a doctor who specializes in the treatment and diagnosis of mesothelioma and thoracic oncology.   

How long does it take for mesothelioma symptoms to appear?

One of the most unique facts about mesothelioma is that the disease is characterized by a long latency period that is very often associated with the disease. The latency period is the amount of time that elapses from the first point of asbestos exposure to the point where symptoms begin to appear so that a diagnosis can be made. In some mesothelioma cases the latency period is reported to be 10 years but the average latency for the majority of cases is between 35 and 40 years. As a result, the cancer often progresses to later stages before a diagnosis is made. When diagnosed in the later stages, mesothelioma treatment options become more limited and are less effective.

Symptoms of Mesothelioma

Provided below is a list of symptoms that mesothelioma patients may experience. Please click on a symptom to learn more about it.
Anemia
Mesothelioma patients diagnosed with anemia have a lower than normal red blood cell count or hemoglobin in the blood which can cause fatigue and if left untreated, result in a loss of bone marrow.
Blood Clotting Disorder
A symptom experienced by many mesothelioma patients that can lead to anemia and other serious complications if not given appropriate medical attention.
Bowel Obstruction
A very painful symptom that can sometimes develop in peritoneal mesothelioma patients due to fluid buildup in the abdomen.
Chest Pain
Often experienced in pleural mesothelioma and pericardial mesothelioma patients, chest pain can develop as the tumor grows and places strain on the lungs and heart.
Dysphagia
Pleural mesothelioma patients often develop difficulty swallowing (esophageal dyphagia) as the mesothelium continues to grow on the lungs.
Fluid Effusion
An effusion can occur in mesothelioma patients when there is fluid buildup affecting either the pleura or pericardium.
Hemoptysis
Hemoptysis, or the symptom of coughing up blood, can have its origins in the lungs, bronchi or trachea of mesothelioma patients.
Nausea
Nausea is experienced in a number of cancer patients as it is often a side effect of chemotherapy treatment. Those diagnosed with peritoneal mesothelioma may also experience nausea as a result of increasing abdominal pressure.
Peritoneal Effusion
Peritoneal mesothelioma patients may experience a buildup of fluid in the peritoneum as the tumor continues to grow. This can result in an effusion which can inhibit the function of abdominal organs.
Pleural Effusion
In pleural mesothelioma patients, pleural effusion may develop when there is a large amount of fluid present in the pleura, the lining between the lungs and chest cavity.
Weight Loss
Weight loss can occur in mesothelioma patients as a side effect from cancer treatment or as the result of other symptoms that may also be present such as difficulty swallowing or nausea.

Sources:
Ismail-Khan, Roohi. Robinson, Lary A. Malignant Pleural Mesothelioma : A Comprehensive Review. Cancer Control : Journal of the Moffit Cancer Center. 2006;13(4):255-263.
Vogelzang, Nicholas J. Rusthoven, James J. Phase III Study of Pemetrexed in Combination with Cisplatin Versus Cisplatin Alone in Patients with Malignant Pleural Mesothelioma. Journal of Clinical Oncology, Vol 21, Issue 14 (July), 2003: 2636-2644
Sugarbaker, David J. Garcia, J.P. Extrapleural Pneumonectomy on the multimodality therapy of malignant pleural mesothelioma. Results in 120 consecutive patients. Annals of Surgery 1996. September; 224(3): 288-296.