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How is Mesothelioma diagnosed?
What are the symptoms of Mesothelioma?
Causes
Diagnosis
Radiotherapy
Chemotherapy
Surgery
Mesothelioma is a form of cancer that affects the mesothelium, which is a thin membrane that lines the inner surface of the chest wall, where it is known as the pleura, and abdomen, where it is known as the peritoneum. It also surrounds the organs found within these cavities for example the heart, lung and intestines. It is far more common to have mesothelioma in the chest than in the abdomen. There is approximately 1 case of peritoneal mesothelioma for every 12 cases of pleural mesothelioma.
Mesothelioma is not an easy disease to diagnose. Often a number of investigations and hospital visits are required and even then it is not always possible to be certain that mesothelioma is present.
Please click here to view a diagram of the lungs and pleura for healthcare professionals to use when describing the location and extent of the disease. If you are a healthcare professional and would like a pad of 100 tear off diagrams please contact the Helpline on 0800 169 2409.
Symptoms & Referral
The earliest signs of the disease are quite vague. The most common symptoms are breathlessness, chest pain, fatigue and weight loss.
In most cases the first sign of something being wrong is when breathlessness or pain in the chest occur as a result of an effusion. This is when fluid accumulates in the space (pleural cavity) between the two layers of the pleural lining. At this stage the patient will often visit their GP.
Picture Source - http://medicina.bloguje.cz/img/pleura%5B1%5D.jpg
Staging Mesothelioma
When diagnosing cancer it is necessary to know the type of cancer (e.g. mesothelioma) and also the extent (stage) of the disease. The stage describes the size and position of the cancer and whether or not there is evidence that it has spread to nearby tissues or to other, more distant, sites. Staging can be helpful in assessing prognosis, in making recommendations for treatment and in assessing and comparing the results of treatment.
There are different systems available for staging mesothelioma. Here is a shortened version of the International Mesothelioma Interest Group (IMIG) staging system, the most commonly used system: -
STAGE 1 Disease limited to the pleura only on one side of the chest.
STAGE 2 Disease limited to the pleura on one side of the chest but the cancer cells have extended from the pleura into the underlying lung tissue or muscle of the diaphragm.
STAGE 3 The cancer has either spread beyond the pleura to glands in the chest and/or has advanced deeper into the tissues surrounding the pleura.
STAGE 4 The cancer has spread to distant organs or tissues or invaded deeply into tissues close to the pleura e.g. across the diaphragm into the abdomen, into the pleura of the opposite lung or into the spine or heart muscle.
In order to stage the extent of disease a CT scan is usually carried out and may be all that is required. Other scans that are occasionally used in some centres include Magnetic Resonance Imaging (MRI), Ultrasound Scan (USS) and Positron Emission Tomography (PET) scans.
CT (Computerised Tomography) Scan
A CT scan is an x-ray examination that gives much more information than a normal x-ray. It produces detailed pictures of a cross section of the inside of the body. A radiologist (a specialised x-ray doctor) and a radiographer carry out the examination. The CT scan takes between 10 and 30 minutes. The time will vary for each patient and it may be necessary to be in the Radiology Department for up to 90 Minutes.
You may be asked not to eat or drink anything for at least four hours before your appointment. Most people who have a CT scan are given a drink or injection about an hour before the scan, to allow particular areas of the body to be seen more clearly. During the scan it is necessary to lie still on the scan table and to hold your breath several times. The CT scan pictures will be reported by a radiologist (specialised X-ray doctor) and the results will be sent to the consultant who requested the scan.
A patient about to undergo a CT scan - Picture Source - www.tbrhsc.net
MRI (magnetic resonance imaging) Scan
This test is similar to a CT scan. An MRI test uses a powerful magnet and a computer to produce detailed images of any part of the body. An MRI scan usually takes between 20 and 40 minutes. The time will vary for each patient.
During the scan it is necessary to lie on the scanner table that is then moved into the magnet. During the scan there is a rhythmic tapping sound that can become quite loud. For some scans it may be necessary to hold your breath several times. A contrast agent (a colourless liquid that shows up on the scan) may be injected into a vein to show more information on the scan. The radiologist (specialised X-ray doctor) will decide this on the day and you will be fully informed. A radiologist will interpret your MRI scan pictures and the results will be sent to the consultant who requested the scan.
A patient being prepared for an MRI Scan - Picture Source - www.mtbeurope.info
Ultrasound Scan
This is a painless examination of some of the organs and / or blood vessels in the body. Warm gel is placed on the skin and the ultrasound probe passed over the area. The ultrasound probe produces high frequency sound waves. Reflections from these sound waves enable images of the internal organs to be seen on a television screen. An ultrasound scan usually takes up to 15 minutes although the time will vary for each patient.
A radiologist or sonographer will interpret the ultrasound scan pictures and the results will be sent to the consultant who requested the scan.
PET (positron emission tomography)
A PET scan uses low-dose radioactive sugar to measure the activity of cells in different parts of the body. A very small amount of a mildly radioactive contrast is injected into a vein, usually in your arm. A scan is then taken. Areas of cancer take up more of the radioactive contrast that normal surrounding tissue so they show up on the scan.
PET scans are a new type of scan and you may have to travel to a specialist centre to have one.
A patient having a PET Scan - Picture Source - www.abdn.ac.uk
Specimens & Biopsy
Scans and x-rays can provide very strong evidence to support a diagnosis of mesothelioma especially when coupled with a history of exposure to asbestos. However a definite diagnosis of cancer can usually only be made by a pathologist (a doctor who specialises in assessing cells and tissue by looking at them through a microscope). He or she will be looking for characteristic changes in appearance that confirm that cancer is present. In the case of mesothelioma which is difficult to diagnose under the microscope it is often necessary to subject the tissue to a number of different very complex tests.
Where there is an accumulation of fluid as there can be in pleural mesothelioma (pleural effusion) and peritoneal mesothelioma (ascites) it is usual in the first instance for some of the fluid to be drawn off into a syringe and sent to the pathologist who will look for mesothelioma cells. This procedure is known as either a pleural aspiration or peritoneal aspiration. If the patient requires a drain to be inserted to allow an accumulation of fluid to be removed slowly over a few days, a sample of the fluid will usually be taken from the drain and sent for analysis.
Biopsy
It is usually necessary for a sample of tissue from the thickened pleura or peritoneum to be taken in order to identify mesothelioma cells. The removal of a piece of tissue for diagnostic purposes is called a biopsy. Part of a lump, a large section or a thin core of tissue may be removed using a variety of methods.
Sometimes the biopsy is done at the same time that the drain is inserted and whilst the patient is undergoing a scan. The scanning equipment will guide the doctor with greater certainty to an affected part of the pleura or peritoneum.
Mesothelioma is a very difficult disease to diagnose, and as well as the scans and procedures described above, it may be necessary for the patient to undergo a small (key hole) exploratory operation, under a general anaesthetic. This will also enable the doctors to fully understand the extent of the disease. If not already done, a biopsy may also be performed during the operation.
Whatever type of biopsy you have it takes several days for the analysis to be performed and in some cases longer as the specimen may be sent to a pathologist in another part of the U.K.
All of the above procedures involve some discomfort and risk. Where possible it is best for a diagnosis of Mesothelioma to be confirmed by a pathologist. There are times however, when a patient is not well enough to undergo, or chooses not to proceed further, with the tests to confirm a diagnosis. Sometimes, despite having all of the above biopsy procedures, the doctors are unable to confirm the diagnosis.
Multi-Disciplinary Teams
To assist in the diagnosis of cancer, hospitals have teams of doctors and nurses, each with their own areas of expertise, who work together to try and provide the best treatment and care for patients.
These are known as Multi-Disciplinary Teams (MDTs). MDTs meet regularly to discuss the cases of individual patients, with confirmed or suspected mesothelioma, to agree on the likelihood of the diagnosis being correct, on the stage of the disease and best treatment strategy.
Always ask if your case has been, or will be, discussed at a specialist Multi-Disciplinary Team meeting.
Mesothelioma UK and the Mesothelioma Nurse Action Team have produced a range of patient information booklets including Accessing Mesothelioma Treatment and Care, Pleural Effusion and Local Anaesthetic Thoracoscopy.
If you would like a paper copy please call the Freephone Helpline on 0800 169 2409 or you can click on the links above.
© Mesothelioma UK 2010