Diagnosing mesothelioma

Tests for mesothelioma
This page tells you about tests you may have that can diagnose mesothelioma. You can scroll down the page to read all the information here. Or you can use these links to go straight down to sections on
Seeing your GP
At the hospital
X-rays
CT scan
Thoracoscopy (and biopsy of the pleura)
Fluid drainage (thoracocentesis or abdoparacentesis)
Difficulty diagnosing mesothelioma
At the GPUsually 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 hospitalIf 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 scanThis 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. There is more about having a CT scan in the CancerHelp UK section about cancer tests.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 drainageMany people with pleual 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 diagnosisMesothelioma can be difficult to diagnose. This is because there are many different types of cells that can make up a mesothelioma tumour. 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.

Further tests for mesothelioma
This page tells you about further tests you may have to find out whether the mesothelioma has spread. This is called staging. The stage of your cancer is important because it helps to decide on the best treatment. But it may not be possible to be sure of the stage without having surgery. There is information on
Bronchoscopy
MRI scan
Mediastinoscopy
PET scan
CT-PET scan
Laparoscopy (only for suspected abdominal disease)
BronchoscopyThis is a test that looks at the inside of the airways. A flexible tube called a bronchoscope is put into the airway. The tube has an eyepiece so that the doctor can see into your airways. Biopsies (samples of tissue and cells) can also be taken during a bronchoscopy. These are sent to a laboratory for testing to see if there are any cancer cells present. The test is usually done as an outpatient under local anaesthetic. This means you are awake for the test, but your throat has been numbed. Sometimes it is done with a general anaesthetic. If you have an anaesthetic, you may have to stay in hospital overnight. This depends on the time of day the test is carried out and your general health.
MRI scanThis is a scan that uses magnetism to build up a picture of the inside of the body. You may be asked to have a chest MRI or an abdominal MRI, depending on which type of mesothelioma you are being investigated for. But MRI isn't a routine test for mesothelioma, so you may not have one at all.MRI scans can be very noisy and some people who don't like small spaces find them difficult to cope with. Tell your doctor beforehand if you have any of these worries or fears. If you have any metal in your body, you cannot have an MRI scan. There is more about having an MRI scan in the About Cancer Tests section of CancerHelp UK. MediastinoscopyThis is a test that examines the mediastinum (the centre of your chest) to see if the mesothelioma has spread there. This area contains
The heart
The main blood vessels
Lymph nodes
The oesophagus (foodpipe)Sometimes in pleural mesothelioma, the lymph nodes in the chest are enlarged.
You need to have a general anaesthetic for this test and so have to stay in hospital for at least one night. The surgeon makes a small cut at the base of the neck. A small tube is put through the cut and into the mediastinum. The surgeon can look through this tube to examine the area. The tube may contain a small video camera, so the surgeon can look at the area on a screen. Tissue samples can also be taken, which will be examined under a microscope to see if there are any cancer cells. When you wake up, you will have a small dressing over the cut where the tube was put in. Don't be afraid to say if you are feeling sore. The nurses will be happy to give you a painkiller. Once you have got over the anaesthetic, you will be able to go home. This will probably be the day after the test.
PET scanYour doctor may suggest a PET scan if your mesothelioma is likely to be treatable with surgery. Unfortunately, surgery is only possible for a small number of people with mesothelioma. PET stands for 'positron emission tomography'. It is a fairly new type of scan that can show how body tissues are working, and not just what they look like. A PET scan may show whether the cancer has spread to lymph nodes or another part of the body. Your surgeon may need to rule this out before finally deciding that surgery is possible. There is more about having a PET scan in the CancerHelp UK section about cancer tests .CT-PET scanA combined CT and PET scan can give the doctor more information than either test on its own, and is more helpful in deciding which patients are likely to benefit from surgery.Laparoscopy This is a small operation that may be used to diagnose peritoneal mesothelioma. A tube with a camera and a light is put into your abdomen through a small cut. Your doctor can look inside to see whether there is any sign of cancer. The doctor will take samples (biopsies) of any abnormal looking areas. These will be sent to the laboratory for examination under a microscope. Laparoscopy is done under general anaesthetic. You will have a small wound with a couple of stitches. Sometimes, the camera is put in through more than one cut, so you may have more than one wound.
After the testsYou will be asked to come back to the hospital when your test results have come through. This is bound to take a little time, even if only a day or two. You may feel very anxious during this time.
Suggestion
While you are waiting for results it may help to talk to a close friendor relative about how you are feeling. Or you may want to contact a cancer support group to talk to someone who has been through a similar experience. Look in help and support for an organisation that can give you information about support groups or counselling services near you.