Basic Mesothelioma Diagnosis

This page tells you about tests you may have that can diagnose mesothelioma. In consist of several steps, from GP to the diagnosis steps,, ^^

There goes,,

At the GP

Usually you begin by seeing your family doctor who will examine you and ask about your general health. Your doctor will ask you about your symptoms. This will include what they are, when you get them and whether anything you do makes them better or worse.

Your doctor will ask you to lie down for a physical examination. The doctor will feel the area where there is pain or swelling. It may feel tender, or it may be possible to feel a lump. Your doctor will listen to your chest, to see if there are any signs of fluid collecting.

After your examination, your doctor may need to refer you to hospital for tests and X-rays. You may be referred directly to a specialist. Or your GP may send you to hospital for some tests first.

At the hospital

If you see a specialist, you will be asked about your medical history and symptoms. The specialist will then examine you by feeling the area that is painful or swollen. You may be asked to have blood tests to check your general health. Then your tests will be arranged in the out patients department.

If your doctor suspects you may have mesothelioma, you may have quite a few tests. This is because it can be difficult to diagnose. Many of the usual tests used to diagnose lung disease prove negative when used to diagnose mesothelioma.

You may have

• X-rays
• CT scan
• Thoracoscopy (and biopsy of the pleura)
• Fluid drainage (thoracocentesis or abdoparacentesis)

Of these tests, X-ray, CT scan and thoracoscopy are the most important for diagnosing mesothelioma. But of course, at this stage, your specialist doesn't know what's wrong. So, as mesothelioma can be difficult to diagnose, you may have a range of tests.

X-ray

You will almost certainly be asked to have a chest X-ray or abdominal X-ray. A chest X-ray can show up fluid collecting around the lung. An abdominal X-ray may show up a swelling or fluid in the abdomen (tummy).

CT scan

This is a computerised scan using X-rays. You may be asked to have a CT scan of your chest or abdomen. A CT scan can show abnormal swellings in body organs or lymph nodes. You may be given an injection of dye called ‘contrast’ before the scan. This helps to make the scan clearer to read.

Thoracoscopy

This is a small operation usually carried out by a specialist surgeon. It is done under a general anaesthetic. A small cut (incision) is made in your chest wall and a thoracoscope (a telescope like instrument with a video camera attached) is inserted through the hole. Using forceps the doctor can take a small sample (biopsy) of the pleura, the tissues which cover the lungs. This is then sent to a laboratory for testing to see if there are any cancer cells. This is sometimes the only certain way of finding out what's wrong because mesothelioma can be so difficult to diagnose. Other tests may not always show mesothelioma or may not be able to show whether the problem is mesothelioma or a different type of lung problem.

Fluid drainage

Many people with pleural mesothelioma have fluid around their lungs (a pleural effusion). People with peritoneal mesothelioma may have fluid in their abdominal cavity (peritoneal effusion). The diagram shows a pleural effusion.

Fluid build up happens because cancer cells are irritating the pleura or peritoneum. Fluid in the plura can make it difficult to breathe. Fluid in the abdomen can make the abdomen feel swollen and tight and uncomfortable. If mesothelioma is the cause of the fluid build up, the fluid may contain cancer cells. To drain the fluid off, a needle is put into the chest or abdominal cavity and the fluid drained through a tube into a bag. A sample of the fluid will be sent to a laboratory for testing to see if contains cancer cells. Your doctor may call this 'thoracocentesis' or pleural aspiration if you are having fluid removed from your chest. If you are having fluid removed from your tummy (abdomen), you may hear your doctor call it an abdoparacentesis or peritoneal aspiration.

Difficulty with diagnosis

Mesothelioma can be difficult to diagnose. This is because there are many different types of cells that can make up a mesothelioma tumor. Sometimes it can be very difficult for a pathologist (doctor who looks at cells under a microscope) to decide if the cells or tissue taken from the lungs (pleura) or the abdomen (peritoneum) are a type of mesothelioma. These cells can often look very similar to other types of cancerous cells. For example, pleural mesothelioma can look like other types of lung cancer and peritoneal mesothelioma can look like some types of ovarian cancer. Also, many of the usual tests doctors use to diagnose lung disease prove negative when they use them to diagnose mesothelioma. For these reasons if your doctor suspects you may have mesothelioma, you may have quite a few tests so they can be sure of a correct diagnosis. In some cases, you may even need to have surgery to find out what's wrong. This surgery is called a surgical biopsy.

Basic Mesothelioma Information, Part 2

Mesothelioma risks and causes

Mesothelioma is quite a rare cancer but it is becoming more common. Just over 2,100 people were diagnosed with mesothelioma in the UK in 2003. There are about 4 times as many cases in men as in women. This is probably because many cases have been caused by exposure to asbestos at work.

Asbestos and mesothelioma

Unusually for cancer, we do know what causes the majority of cases of mesothelioma. It is most often linked to exposure to asbestos. We have known of a link between asbestos and lung disease since the beginning of the 18th century. But the link with mesothelioma has only been known since the 1960's. Unfortunately, the number of cases of mesothelioma in the UK each year is expected to rise sharply over the next 20 years because of the heavy use of asbestos in industry from the end of the second world war up until the mid 1970s.

Between 7 and 8 out of every 10 people (70–80%) diagnosed with mesothelioma say they have been in contact with asbestos. Your risk is greater if you were exposed to large amounts of it from an early age for a very long period of time. But there are some patients that say they have no history of any heavy exposure to asbestos.

What is asbestos?

Asbestos is an insulating material that is heat and fire resistant. In the past, asbestos was used widely in the

• Building industry
• Ship building industry
• Manufacture of household appliances
• Motor industry
• Power stations
• Telephone exchanges

So most cases of mesothelioma occur in men who have worked in manufacturing using asbestos or used asbestos products, particularly in construction or engineering. The use of asbestos was very heavy in the years after the war (after 1945). Mesothelioma may not develop until 15 - 40 years after you have been exposed to asbestos, which is why we are seeing an increase in cases now. The number of cases is expected to peak around 2020 and then start to decline.

There are three main types of asbestos: blue, brown and white. Blue and brown asbestos are strongly linked with mesothelioma. They have been banned since the late 1980's and cannot be imported into the UK. White asbestos is now also thought to be harmful. The use of all asbestos was banned in 1999 in the UK.

How does asbestos cause mesothelioma?

Asbestos is made up of tiny fibres. You can breathe these fibres in when you come into contact with asbestos. The fibres work their way into the pleura, lining the lung. They irritate the pleura and damage the cells that the pleura are made of. Some of the fibres that have been breathed in can be coughed up and swallowed. This is probably the cause of peritoneal mesothelioma.

If you have been exposed to asbestos, your family may also have been exposed. Asbestos fibres can be carried home on your clothes. Research studies have confirmed that the family of people exposed to asbestos also have a higher risk of developing mesothelioma.

Radiation

Pleural and peritoneal mesothelioma has been known to develop after exposure to a type of radiation called thorium dioxide (Thorotast). This was used until the 1950's in some X-ray tests.

Other chemicals

A mineral found in Turkey called Zeolite may cause mesothelioma.

The SV40 virus

There has been some research into a virus called SV40 (the SV stands for 'simian virus'). There is a lot of dispute amongst scientists about this and it isn't generally accepted as a cause. It seems more likely that the virus doesn't cause mesothelioma. It is possible that SV40 may help to increase risk if you've been exposed to another more major risk factor. Doctors call this a 'co-factor'. But SV40 certainly hasn't been proved to be a co-factor so far. In any case, it is far less important a risk factor than asbestos.

Basic Mesothelioma Information, Part 1

Mesothelioma

Mesothelioma is a type of cancer. It is a cancer of mesothelial cells. These cells cover the outer surface of most of our internal body organs, forming a lining that is sometimes called the mesothelium. So this is where this type of cancer gets its name.

Mesothelioma cancer can develop in the tissues covering the

• Lungs
• Abdomen
  

The pleura

The tissues lining (or covering) the lungs are called the pleura. There are two pleura. These can be called pleural membranes. The gap between them is called the pleural space. The pleura are fibrous sheets. They help to protect the lungs. They produce a lubricating fluid that fills the gap between the two pleura. This helps the lungs to move smoothly in the chest when they are inflating and deflating as we breathe.

Mesothelioma is most often diagnosed in the pleura. This is known as pleural mesothelioma. Because it is so close, pleural mesothelioma can also affect the sheet of tissue covering the heart - the pericardium. Doctors call the pericardium the lining, although it is on the outside of the heart. It protects the heart and allows it to move smoothly within the sac that surrounds it. So it does much the same job for the heart as the pleura do for the lungs.

The peritoneum

The tissue lining the abdomen is called the peritoneum. It helps to protect the contents of the abdomen. It also produces a lubricating fluid. This helps the organs to move smoothly inside the abdomen as we move around.

Mesothelioma of the tissues lining the abdominal cavity is known as peritoneal mesothelioma. It is much less common than pleural mesothelioma.

It is unusual for mesothelioma to spread to other parts of the body. But if it does, it does not usually cause troublesome symptoms.

Benign mesothelioma

There is a form of non cancerous (benign) mesothelioma that can develop in the lining of the lungs, or in the lining of the reproductive organs. It can occur in either men or women.