Mesothelioma: Diagnosis, Screening and Prevention

For a description of the three types of mesothelioma, please see our article Mesothelioma: description and history.

Diagnosis

Mesothelioma symptoms often take decades to develop after exposure to asbestos. The disease can also be easily misdiagnosed because its symptoms are similar to those of other diseases such as lung cancer. The unfortunate reality is that diagnosing mesothelioma is a difficult process.

The process usually begins with a physical examination and a review of the patient's complete medical history. After a number of imaging and other tests to identify suspicious cell formation, a fluid diagnosis or tissue biopsy is performed to confirm the presence of mesothelioma. Some of the more commonly used tests and imaging methods used include:

• X-ray - a chest x-ray can disclose fluid buildup in a lung (pleural effusion) and may sometimes reveal a mass, pleural plaques or calcification, or scarring from the exposure to asbestos.
• Computed Tomography (CT) - in addition to revealing pleural effusion, CT scans are able to define them, as well as defining pleural thickening, calcification, thickening of interlobular fissures, and potential chest wall invasion. They are also valuable in guiding fine needle aspiration for tissue diagnosis. CT scans, however, cannot differentiate between pleural disease or adenocarcinoma of the lung which may have spread to the pleura and mesothelioma.
• Magnetic Resonance Imaging (MRI) - MRI scans are better able to differentiate tumors from normal structures and can better assess the enlargement of lymph nodes between the lungs (mediastinal lymph nodes) than CT scans. MRI scans are usually used to determine the extent of tumor prior to treatment.
• Positron Emission Tomography (PET) - PET imaging is the best way to determine the staging of mesothelioma. But it is very expensive and not always covered by insurance.
• CT/PET - combined CT and PET scans are a relatively new tool that can identify the optimal treatment option for the patient.
• Video-Assisted Thoracoscopic Surgery (VATS) - in this minimally invasive procedure, a camera in a scope and other instruments are inserted into small incisions through the chest wall to retrieve tissue samples. This technique often results in less post-operative pain and a shorter recovery period than that of thoracotomy, which requires much larger incisions through the chest wall. Other therapies for pleural effusions such as pleurodesis, which uses talc, can be done concurrently.
• Thoracoscopy - the chest cavity is examined with a thoracoscope, which is inserted through a cut made through the chest wall between two ribs. Unlike VATS which usually requires general anesthesia, thoracoscopy can often be done with a painkiller or local anesthetic. If fluid has collected in the chest, a doctor uses gentle suction through a needle in the chest to drain it (thoracentesis).
• Peritoneoscopy - a peritoneoscope is inserted through an opening made in the abdomen. Peritoneoscopy is used to look inside the abdomen when peritoneal mesothelioma is suspected. Paracentesis may then be used to drain fluid that may have collected there.

Once tissue or fluid is collected, sometimes during one of the testing techniques mentioned above, pathological diagnosis of the samples will help determine the course of treatment that will be undertaken. Most hospitals have their own labs that allow pathologists to examine the samples and ascertain whether the suspicious cells are malignant or benign. Unfortunately, not all pathologists have subspecialty training in mesothelioma diagnosis so, in some cases, follow-up pathological examinations of the samples may have to be undertaken for a conclusive diagnosis.

Screening and prevention

Since radiological studies such as x-rays, CT scans, and other diagnostic tests are not sensitive enough to detect cell masses before symptoms occur, mesothelioma is nearly impossible to screen at this time.

The risk of mesothelioma can be reduced by decreasing exposure to asbestos. OSHA has implemented standards regulating procedures for workers exposed to asbestos on the job. Such workers should at the very least wear masks and protective clothing, and should change their clothing before leaving the work site to avoid carrying out asbestos particles.

If you or a loved one has been diagnosed with mesothelioma, you may be entitled to compensation. An experienced mesothelioma (asbestos litigation) lawyer can advise you of your rights and options.

Contact us today to find an experienced mesothelioma lawyer near you.