Mesothelioma can be difficult to diagnose. Physicians may misdiagnose the disease because its symptoms are similar to a number of other illnesses, which may not be terminal or life threatening.
In any sense, it is important to alert your physician if you exhibit the common symptoms of mesothelioma, in order to benefit from an early diagnosis.
Shortness of breath, chest pains and swollen abdomen are symptoms that should be brought to the attention of your physician, especially if there is a history of working in a shipyard, construction site or industry that is in any way related to asbestos.
Diagnosis
A physician will want to do a complete medical history review and a physical examination. The initial diagnosis may consist of any of the following:
- X-Rays: X-rays of the chest or abdomen are utilized to investigate fluid build-up, masses, or signs of pleural disease. Pleural disease is benign, also related to asbestos exposure and also exhibiting shortness of breath due to thickening of the walls of the lungs.
- Lung Function Tests: These tests can determine how well your lungs work. They measure how quickly air is expelled, how well the lungs can hold air and other indications, such as removing carbon dioxide from the blood or sending oxygen to it.
- Computed Tomography (CT) Scan: CT scans are imaging tests that may be used in lieu of x-rays or in addition to them. Scans can be used to guide more tedious examinations, such as fine needle aspirations or to locate tumors or pleural disease.
- Magnetic Resonance Imaging (MRI): MRI is another form of scan technology which photographs structures within the bogy, aiding in the diagnosing and staging of a tumor.
The purpose of any of the initial steps above is to determine if there is a pleural effusion, or fluid collection between the lung and wall of the chest which would usually be the cause associated with shortness of breath and a potentially sure sign of mesothelioma. Early diagnosis is the first best step in fighting mesothelioma. There is no known cure at this time, however, there are treatments.
Recovery is dependent upon a number of factors:
- Size of the cancer
- Location of the cancer
- How far the cancer has spread
- How the cancer cells look under a microscope
- Patient’s age
- Patient’s overall health
Tests
Once mesothelioma is suspected, subsequent tests would be ordered for a final diagnosis:
- Thoracoscopy: This test is usually performed in a hospital. The physician will look inside the chest cavity with a thorascope inserted between two ribs through an incision made under local anesthesia.
- Peritoneoscopy: Also conducted in a hospital, this test uses a peritoneoscope to look inside the abdomen through an incision made under local anesthesia.
- Biopsy: If the findings indicate there is abnormal tissue, the physician will then cut out a small piece of tissue for analysis under a microscope to look for abnormal cells.
- Positron Emission Tomography (PET): PET imaging tests are a reliable and efficient way of testing for mesothelioma tumors and are also used in investigating the stage of Mesothelioma.
Types of Mesothelioma Cancer Cells
Epithelial mesothelioma is the most common and most treatable. The cancer cells are similar in shape to adenocarcinoma, another form of epithelial cancer originating in the glands that is often confused with epithelial mesothelioma.
Sarcomatoid mesothelioma is the rarest, but most serious and most aggressive form and rarely responds to any form of treatment. Sarcomatoid originates in the cells of the bone, cartilage, fat or muscle. It can be confused with other pulmonary sarcomatoid carcinoma or lung sarcomatoid carcinoma, illnesses that have a similar cell structure, the latter of which is associated with smoking. Life expectancy for this form of Mesothelioma is usually about six months.
Biphasic mesothelioma’s cell structure is a combination of Epithelial and Sarcomatoid cancer cells so there is none unique to biphasic mesothelioma. This form of Mesothelioma has the shortest survival expectancy of approximately three to six months.
The three types of mesothelioma cells listed above can further divide into other types of cancerous cells known as:
- Clear Cell: This cancer is called clear cell cancer because of the clear appearance of the cancer cells under a microscope.
- Small Cell: These cancer cells are almost always due to smoking. They are characterized by the small cells (vs. non-small cells) associated with lung cancer
- Acinar Cell: This cancer originates in the acinar cells of the pancreas.
- Tubopapillary Cell: This unique cell formation is related to peritoneal mesothelioma
Staging Mesothelioma
Staging is the process of confirming the extent of the spread of mesothelioma in order to decide on an appropriate treatment. Your physician will want to know the phase of the stage you are in order to determine if you are a candidate for surgery.
If the stage is more advanced, then the approach may be pain reduction or to treat the disease partially and as far as possible, a method known as palliative treatment. You and your doctor will confer to determine a treatment which will be ultimately be impacted by the stage of the mesothelioma.
Staging Systems
There are three staging systems: the Butchart Staging System, the TNM Staging System, and the Brigham Staging System. All of the systems divide Mesothelioma into stages I through IV and are used to determine the extent of the spread of cancer in the body.
BUTCHART STAGING SYSTEM
The Butchart staging system, created in 1970 by Eric G. Buthcart, a cardiothoracic surgeon is the original and simplest of the systems. Despite the newer and more accurate methods of staging mesothelioma, many physicians still prefer the Butchart staging system.
TNM STAGING SYSTEM
The TNM staging system was created by the American Joint Committee on Cancer (AJCC) and is the major staging system for the highest degree of accuracy. “T stands for tumor and it refers to the tumor size and how far it has spread to nearby organs; N stands for “spread to lymph nodes,” and M stands for metastasis (spread of cancer from one body part to another)”
BRIGHAM STAGING SYSTEM
The Brigham staging system like the others, looks at the four stages and bases a conclusion on whether the mesothelioma can be treated or removed by surgery. It also considers other factors, such as lymph node involvement. The Brigham stages are similar to the TNM system.
Stages of Mesothelioma
There are four stages of mesothelioma. Stage I, at this point, considered a localized disease, consists of two parts 1a and 1b. Stage II, III and IV are considered advanced disease:
- Stage I: In the early onset of mesothelioma, only one side of the chest will be affected. This may be the right or left pleura. In Stage IA, mesothelioma has advanced to a growth spreading in the pleural tissue covering the diaphragm, the muscle which separates the chest cavity from the abdomen. It may involve the lung and pericardium does not yet involve the visceral pleura covering the lung. In Stage IB, mesothelioma will begin to advance to the inner pleural layer (visceral) but is still confined to one side of the chest.
- Stage II: Mesothelioma has advanced to form a mass or tumor on the pleural tissue of the lung or the diaphragm. Still confined to one side of the body, the disease has now spread to both layers of the pleura; outer or parietal, covering the diaphragm and inner or visceral of the lung)
- Stage III: Mesothelioma has penetrated the diaphragm and spread to the pericardium (the thin sac or membrane covering the heart), and may have spread to the chest wall or lymph nodes on the same side as the development of the cancer.
- Stage IV: Mesothelioma has metastasized (spread to other parts of the body). It may have spread through various areas of the chest wall, grown through the diaphragm and advanced into the peritoneum (the serous membrane that forms the lining of the abdominal cavity). Further advancing, mesothelioma may spread to the opposite side of the body attacking the lymph nodes, the chest organs, around the collarbone and through the inner layer of the pericardium and other parts of the body through the bloodstream.
