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How it is mesothelioma diagnosed?
Most people begin by seeing their GP when they have symptoms. Your GP will examine you and may arrange for you to have some tests or x-rays. You may be referred to hospital for these tests and for specialist advice and treatment.
At the hospital the doctor will take your medical history and occupational history before doing a physical examination.
Chest x-ray
A chest x-ray will be taken to check for any abnormalities in your lungs, such as thickening of the pleura or fluid around the lungs.
Sputum cytology
You may also be asked to give a sample of phlegm (sputum or spit) so that it can be examined under a microscope for cancer cells - this is known as sputum cytology. This test cannot diagnose mesothelioma, but may help to exclude other illnesses.
The following tests may also be used to diagnose mesothelioma and your doctor may arrange for you to have one or more of them at the hospital.
CT scan (computerised tomography scan)
A CT scan takes a series of x-rays, which builds up a three-dimensional picture of the inside of the body. The scan is painless but takes from 10 to 30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.
CT scans of the chest and of the abdomen will show the size and position of the mesothelioma and whether it has spread to other parts of the body.
The CT scan is painless but it will mean lying still for about 10-30 minutes.
You may be given a drink or injection of a dye that allows particular areas of your body to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine, or have asthma, you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.
You will probably be able to go home as soon as the scan is over.
There are other much more common causes of thickening of the pleura and peritoneum, and fluid around the lungs or in the abdomen, so the chest x-rays and scans alone cannot make the diagnosis.
Pleural or peritoneal aspiration
If there is fluid in your chest or abdomen the doctor can take a sample by using a local anaesthetic and passing a needle through the skin into the fluid. Some of the fluid is then drawn off into a syringe and can be analysed in the laboratory to look for mesothelioma cells. Taking fluid from between the pleura is known as a pleural aspiration and taking fluid from the abdomen is known as drainage of ascites (or peritoneal aspiration).
Biopsy
Your doctor will usually need to take a sample of tissue from the thickened pleura or peritoneum. A local anaesthetic is used to numb the area and a special type of needle is passed through the skin into the tumour. The needle has a tip that can cut out a sample of the tumour. The doctor may use ultrasound or a CT scanner to position the needle accurately for the biopsy. An ultrasound uses sound waves to build up a picture of the organs in a part of the body. A small device is passed over the skin to show the doctor where the tumour is and guide the needle into the right place.
Sometimes the doctor will want to see the area of the pleura or the peritoneum directly in order to get a sample of tissue from the right area. This is done by using a thin flexible tube with a light and camera at the end. The tube (endoscope) can be passed through the skin of the chest, where it is called thoracoscopy, or the abdomen, where it is called laparoscopy. The procedure is done under a general anaesthetic by a surgeon. You will usually be able to go home the same day.
Analysing the biopsy in the laboratory is the only way your doctor can make the diagnosis of mesothelioma. Sometimes, even after taking a biopsy, the doctors may be unsure of the diagnosis, because mesothelioma can be very difficult to distinguish from other illnesses. In this situation, the biopsy samples may be sent to other laboratories for confirmation of the diagnosis, some of your tests may need to be repeated or you may be referred to another hospital for a second opinion.
It will probably take several days for the results of your tests to be ready and a follow-up appointment will be arranged for you before you go home. Obviously, this waiting period will be an anxious time for you and it may help to talk things over with a close friend or relative.
source - www.cancerBACUP.org.uk
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