Understanding Your Mesothelioma Diagnosis
If you or a loved one has been diagnosed with mesothelioma, you may have many questions running through your head:- How did I get this terrible disease?
- Should I get a second opinion?
- What does this diagnosis mean for me, my family, and others that I care about?
- Could I have been misdiagnosed?
- How will I be able to pay for treatments?
How Mesothelioma Is Diagnosed
In most cases, cancer specialists will approach a mesothelioma diagnosis by first testing to see if another, more common disease is causing the symptoms. As part of this process, the doctor will obtain a full medical history from the patient, which may include asking about any exposure to asbestos.From there, the doctor will usually perform a series of tests, such as imaging scans and blood tests. If these initial tests indicate a potential for mesothelioma, a biopsy will be taken. A biopsy procedure is the only test that can positively confirm a mesothelioma diagnosis.
The Importance of Early Detection
Mesothelioma has a poor prognosis. However, many studies of the disease have shown that early detection and diagnosis can significantly improve the chances of survival. Catching mesothelioma before it spreads can increase the effectiveness of treatments, as well as open opportunities to try more aggressive treatments that might not otherwise be available.As a result, much of the research and development around mesothelioma has focused on improving detection and diagnosis of the disease. This includes recent developments of new biomarker blood tests, which can detect the presence of substances that indicate mesothelioma may be present in the body
How Doctors Diagnose Mesothelioma
There are three main types of tests used to diagnose mesothelioma: imaging scans, blood tests, and biopsies. Doctors typically perform the least invasive tests first, followed by more involved tests if they are warranted.Imaging Scans
Diagnostic imaging tests, like X-rays, CT scans, and MRIs, help doctors obtain information about the cancer, including how far it has progressed. Each method has its benefits and limitations.
Diagnostic Imaging Tests
X-rayCT-Scan
MRI
PET Scan
X-ray
X-rays are commonly used to diagnose many conditions, illnesses, and injuries. They can be particularly helpful in finding fluid in the lungs, often an early sign of mesothelioma.Blood Tests and Biomarkers
In recent years, a number of blood tests have been developed to identify substances in the blood that can point to the presence of mesothelioma cancer cells. The presence of these substances, known as biomarkers, do not always indicate a mesothelioma diagnosis, but they can provide useful information that can demonstrate a need for a biopsy. Biomarker tests are also known as “assays.”
- MESOMARK®
This assay looks for the presence of mesothelin, a glycoprotein (sugar and protein molecule) that is produced in excessive amounts by mesothelioma cells. Specifically, MESOMARK® tests for soluble mesothelin-related peptides (SMRPs), which are created when mesothelin is dissolved in the bloodstream. - N-ERC/Mesothelin
Another byproduct of mesothelin, N-ERC/Mesothelin is a protein fragment that is soluble in the blood stream. Early tests showed a 95% sensitivity for the assay, potentially making it one of the most accurate blood tests for mesothelioma, if the results can be confirmed. - Fibulin-3
As another glycoprotein, Fibulin-3 is similar to mesothelin as it is produced in higher concentrations by mesothelioma cells. However, existing research has shown irregular results, with some question as to the accuracy of the test. Fibulin-3 assays may nonetheless be useful in distinguishing between malignant and benign lung diseases. - HMGB1
Recent studies have shown that testing for a certain protein – high mobility group box protein 1 (HMGB1) – can not only positively detect individuals with mesothelioma, but also can identify individuals who have been exposed to asbestos but have not yet developed the disease. Additional trials are needed to confirm the results. - Osteopontin
Osteopontin, which is a glycoprotein like mesothelin, is also produced in high amounts by mesothelioma. Unfortunately, this particular biomarker is a less accurate diagnostic tool than other assays, as osteopontin is also produced by other types of cancer, as well as kidney stones and ischemic stroke.
Biopsies
A biopsy is an important diagnostic procedure recommended by doctors for patients presenting with signs and symptoms of mesothelioma who have a history of asbestos exposure. Some biopsies can be minimally invasive (e.g., fine-needle aspiration) while others can involve a major surgical procedure (e.g., thoracoscopy).
The general purpose of a biopsy is to obtain a sample of the cancerous tissue. This tissue is then examined under a microscope by a histologist, who can determine whether the tumor is mesothelioma, some other cancer, or another disease altogether.
Biopsy Types
NeedleCamera-Assisted
Surgical
Needle
The least invasive way to obtain a biopsy is through fine-needle aspiration, which draws fluid containing the cancer cells to be studied. In many cases, needle biopsies are insufficient to gather enough tissue for analysis.Types of needle biopsies:
- Thoracentesis
- Paracentesis
- Pericardiocentesis
Mesothelioma is Commonly Misdiagnosed
Mesothelioma is often misdiagnosed, at least initially, partly due to the fact that many mesothelioma symptoms resemble the symptoms of other diseases. Also, because mesothelioma is so rare, doctors may be more inclined to diagnose a more common disease first, thereby delaying treatment. Misdiagnosis can differ depending on the type of mesothelioma a person has. The table below provides common misdiagnoses based on mesothelioma type.- Pneumonia
- Emphysema
- Asthma
- Bronchial infections
- Chronic Obstructive Pulmonary Disease (COPD)
- Adenocarcinoma and other lung cancers
