Most patients are referred to the International Mesothelioma Program (IMP) by their general practitioner or another doctor because of symptoms or an abnormal chest X-ray. Some patients have already undergone diagnostic testing prior to coming to the IMP, while others come for a second opinion or to seek more treatment options than may be available elsewhere.
Diagnosis of mesothelioma begins with a review of your medical history, including any history of asbestos exposure. Your team will perform a complete physical examination, along with a pulmonary function test, which can help diagnose lung diseases and measure the severity of the lung problem.
A surgeon or a medical oncologist will coordinate with a multidisciplinary team to determine which tests are necessary to diagnose and analyze your condition. The process of diagnosis may include a number of different procedures, including imaging and biopsy.
All diagnostic scans are performed using a low-dose technique to minimize radiation exposure.
Typically, patients have already had a chest X-ray before coming to the IMP. That test may be repeated, or existing films may be viewed. In addition to the X-ray, our expert thoracic radiologists will likely conduct additional imaging. We use state-of-the-art imaging techniques including:
- Multidetector CT (Computerized Tomography) scan: A CT scan is often used as a follow-up to an X-ray, to provide more detailed images of your lungs and surrounding organs.
- MRI (Magnetic Resonance Imaging): A chest MRI allows physicians to look for any invasion of a tumor into your chest wall, diaphragm, or other areas.
- PET CT (Positron Emission Tomography): The PET CT can be used to help determine the extent to which the disease has spread.
A biopsy involves sampling a piece of tissue from a node or tumor for examination. Pathologists specializing in mesothelioma conduct multiple tests on your tissue sample to determine the type and stage of cancer. Accurate disease identification and staging is extremely important to the decision-making process, and influences the diagnosis, selection of optimal surgical approaches, and choice of appropriate non-surgical therapies such as chemotherapy and radiation.
Sometimes, a biopsy is conducted without surgery; at other times, surgery is the best way to obtain a useful tissue specimen. A biopsy may be conducted using one of the following procedures:
- Needle biopsy of the lung: A sample of tissue or fluid is removed from your lung using a thin needle. CT scan or ultrasound imaging is used for exact guidance. A pathologist views the tissue sample under a microscope to identify the presence and type of cancer cells. If cancer cells are present, they will be further analyzed for genetic abnormalities.
- Surgery: Depending on the location of your node or tumor, it may be necessary to surgically remove a small piece of tumor through a more complicated surgery. In some cases, it is possible to remove a sample, analyze it, and continue with appropriate surgery all within minutes.
- Mediastinoscopy: A mediastinoscopy is performed to determine if the tumor has spread to the lymph nodes in the center of the chest. The degree of lymph node involvement helps determine how extensive the tumor is, and influences treatment options.
Diagnosis and Staging
Diagnosis begins with determining whether or not a node or lump is cancer. The pathologist will then analyze the tissue to establish the type of cancer, and to what degree the cancer has spread (metastasized).
When a doctor stages cancer, he or she is determining its size, its extent, and to what degree it has spread (metastasized) outside its initial location. The stages of malignant mesothelioma are grouped into localized and advanced.
Localized Malignant Mesothelioma (Stage 1)
In localized malignant mesothelioma, cancer is found in the lining of the chest wall and may also be found in the lining of the lung, the lining of the diaphragm, or the lining of the sac that covers the heart on the same side of the chest.
Advanced Malignant Mesothelioma (Stage 2, Stage 3, and Stage 4)
Advanced malignant mesothelioma includes stage 2, stage 3, and stage 4.
- In stage 2, cancer is found in the lining of the chest wall and the lymph nodes on the same side of the chest. Cancer may also be found in the lining of the lung, the lining of the diaphragm, or the lining of the sac that covers the heart on the same side of the chest.
In stage 3, cancer has spread to any of the following areas:
- The chest wall
- The mediastinum
- The heart
- Beyond the diaphragm
- The peritoneum
Cancer may have also spread to lymph nodes on the other side of the chest or outside the chest.
- In stage 4, cancer has spread to distant organs or tissues.
Depending on the stage of the cancer, patients meet with the appropriate combination of a surgical oncologist, medical oncologist, and radiation oncologist. Decisions regarding diagnosis and treatment are thoroughly reviewed by our entire team of clinicians. As a result, patients are guaranteed the broadest range of options, including clinical trials.