Pleural Mesothelioma: Diagnosis

Your doctor may perform some of the following procedures to diagnose pleural mesothelioma.

CT scan

This type of X-ray provides a very detailed picture of the size and location of the cancer. The images taken are compiled by a computer to create a more complete image of the disease. The procedure is also called a computerized axial tomography (CAT) scan.

PET scan

A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body.

Thoracoscopy

The diagnosis of malignant pleural mesothelioma may involve your doctor looking inside the chest cavity with an instrument called a thoracoscope. For this procedure, an incision is made through the chest wall and the thoracoscope is put into the chest between two ribs. This procedure is usually done in the hospital.

Bronchoscopy

A bronchoscopy involves an examination of the lungs and air passages. The doctor places a lighted tube down the patient’s throat and trachea into the lungs. This procedure is called a bronchoscopy, and the instrument used is called a bronchoscope.

Thoracentesis

Some patients develop fluid in their lungs. This is called a pleural effusion. Your doctor might take a sample of this fluid with a needle injected into the chest and test the fluid for cancer cells. Your doctor may also perform this procedure for draining fluid from the lungs to help relieve pain.

Mediastinoscopy

This is a test that examines the mediastinum. This area is in the center of your chest, between your lungs, and contains the heart, blood vessels and lymph nodes.

Needle Biopsy

For this procedure, the doctor uses a thin needle to take samples of cells for examination under microscope. This test can be uncomfortable but may take only a few minutes. Small pieces of the tissue are taken and then sent to a laboratory for analysis.

The doctor might also use an X-ray, CT scan or fluoroscopy to guide the needle as it is inserted into the tumor. Fluoroscopy is a diagnostic procedure in which X-rays are passed through the body and then projected onto a screen, providing a continuous image of the body’s internal structures.

Wedge Biopsy

For this procedure, a doctor makes an incision through the skin, and a wedge of tissue or tumor is obtained and sent to a laboratory for analysis. A wedge biopsy is often used when other biopsy methods have been unable to confirm a diagnosis.

Cytology and Pathology

Pathology is a study of a disease, which looks at specific cells and types of a disease process to determine the cause. Pathology tests are performed on samples of body fluid or tissue to determine the cell type (cytology) of a specific disease. The process of looking at these samples may include using microscopes, electron microscopes and various stains. This refers to special cell-staining techniques that identify specific types of malignant mesothelioma tumors. Certain types of dyes or coloring are added to the patient’s biopsy samples. Depending on how the tissue responds to the dye, the doctor can make a better estimate about the outcome of the illness. In making the diagnosis, the more information the doctor has about the tumor, the better he or she can recommend appropriate treatment.

After your biopsy, a sample of the tissue or fluid removed may be sent to a hospital laboratory to be analyzed.

• If fluid is removed during a thorancentesis or thorascopy, it is sent to a Cytology lab for analysis. Your doctor will receive a written report of the results. The doctor may receive an oral report from the lab prior to the written results.

• If a tissue biopsy from a bronchoscopy, needle biopsy or thorascopy is done, it is sent to a surgical pathology lab for analysis. The final report will be sent to your doctor.

• Surgical removal of a tumor, pleura or lung is sent to a surgical pathology lab. In the lab the material is analyzed with special stains. The material may be placed under a microscope for magnification and further review to determine the cell type. After analysis is completed, small pieces of any remaining tissue are preserved in paraffin for future us

Diagnosis

Diagnosis is the process of determining the kind of disease that is present. An accurate diagnosis is important because it helps to determine the type of treatment that you will undergo.

Your doctors may use a number of procedures to aid in the diagnosis of mesothelioma. The most common of those procedures are listed here. Whether one or a combination of these tests are conducted in a given patient’s case will depend on factors unique to the patient. Some tests might first be conducted to determine whether a biopsy should be performed. A biopsy is usually necessary to confirm a diagnosis.

For your reference, a word with “-scopy” at the end refers to the use of a scope or viewing instrument that can be used to look directly inside the body at the abnormal or suspected area. A word that ends in “-ectomy” refers to the removal of tissue through surgery.

Pleural Mesothelioma

Peritoneal Mesothelioma

Pericardial Mesothelioma

Symptoms of Mesothelioma

Mesothelioma is a form of cancer that develops in the lining around the lungs (the “pleura”), abdomen (the “peritoneum”), or heart (the “pericardium”).
Mesothelioma is almost always caused by exposure to asbestos. In contrast, lung cancer refers to a malignancy of the lung itself.

This section is not intended as a tool for self-diagnosis, nor is it intended to be a substitute for consulting with a doctor who specializes in the diagnosis and treatment of mesothelioma. This section is merely designed to help you learn about mesothelioma.

Pleural Mesothelioma

Pleural mesothelioma, also known as mesothelioma of the pleura, is a tumor of the lining surrounding the lungs. The pleura is a thin tissue around the lungs and the inside of the chest. In order to protect the lungs, the pleura produces a small amount of fluid which helps cushion the lungs, making the lungs move more smoothly during breathing.

Benign (Non-Cancerous) pleural mesothelioma

Benign pleural mesothelioma is a non-cancerous tumor that has not spread to other organs of the body. If the tumor is large, it may squeeze the lung itself and cause shortness of breath and pain.

Malignant Pleural Mesothelioma

Malignant Pleural mesothelioma is cancerous and can spread to other parts of the body. This rare form of cancer is found in the pleural sac lining of the lung. Exposure to asbestos is considered the primary cause of pleural mesothelioma.

Symptoms

Pleural mesothelioma may include shortness of breath, chest pain, back pain, pain in the rib cage, fluid build-up in the lung lining, hoarseness, coughing up blood, swelling of the face and arms, muscle weakness, paralysis and sensory loss.

Peritoneal Mesothelioma

Peritoneal mesothelioma, also known as cancer of the peritoneum, is a cancer of the abdominal lining.

One way doctors diagnose peritoneal mesothelioma is by looking inside the abdominal cavity with an instrument called a peritoneoscope. In this procedure, a cut is made through the abdomen wall and the peritoneoscope is placed into the abdomen. This test, called a peritoneoscopy, is usually performed in the hospital.

Some patients develop excessive fluid in the abdomen. This is called an effusion or ascites. A doctor may take a sample of such fluid to diagnose peritoneal mesothelioma. Fluid in the abdomen might also be drained to relieve symptoms of peritoneal mesothelioma. The procedure for drawing out this fluid is called “paracentesis”.

For more information about the diagnosis of this disease, click here

Symptoms

The symptoms of this cancer may include stomach pain, weight loss, nausea, vomiting, hernia, fluid in the abdominal cavity or a mass in the abdomen.

Pericardial Mesothelioma
Pericardial mesothelioma is also known as mesothelioma of the pericardium or cancer of the sac that holds the heart.

Your doctor may diagnose this cancer using a thoracoscope to perform a thoracoscopy, which might also involve opening up the chest cavity to remove the tumor.

Patients who develop excessive fluid around the heart, called an effusion, may have a sample of the fluid taken to diagnose pericardial mesothelioma. Fluid might also be drained to relieve symptoms of pericardial mesothelioma. The procedure for drawing out this fluid is called “pericardiocentesis.”

For more information about the diagnosis of this disease, click here.

Symptoms

Symptoms can include chest pain and shortness of breath. The tumor and/or fluid that accumulates between the heart and the sac can compress the heart, causing such symptoms

Mesothelioma and Lung Cancer

Pleural mesothelioma and lung cancer are both serious illnesses, but they are not the same. Pleural mesothelioma – sometimes called “asbestos lung cancer” – is really not a form of lung cancer, but a cancer of the lining that surrounds the lung.

A main difference between lung cancer and mesothelioma is that lung cancer is in the tissue of the lung. By contrast, pleural mesothelioma occurs in the lining around the lung.

Smoking is often considered a primary cause of lung cancer, while asbestos exposure is considered a primary cause of mesothelioma. Asbestos exposure may also be associated with lung cancer. Smoking is not linked to mesothelioma, however. Those exposed to asbestos and who smoke are as much as 90 times more likely to be develop lung cancer than those who don’t smoke.

Mesothelioma and Asbestos

Mesothelioma is a rare form of cancer caused by exposure to asbestos. Asbestos is a naturally-occurring fiber that, when released into the air, can be inhaled or swallowed. Asbestos has no smell or taste, and asbestos fibers are so small that they are not visible to the naked eye. Asbestos fibers can “stick” in the lung, abdomen and other body tissues and over time, lead to the development of asbestos-related diseases like mesothelioma. There is a long latency period between asbestos exposure and the development of mesothelioma; in other words, decades may pass after a person’s first exposure to asbestos before he or she becomes ill. A person who has been diagnosed with asbestosis (a non-cancerous scarring of the lungs) is at an increased risk of developing mesothelioma in the future.

Millions of people in the U.S. have been exposed to asbestos, and it is estimated that approximately 3,000 people are diagnosed with mesothelioma each year. In these pages, you will read about asbestos and the common ways in which people have been exposed to asbestos.

Pain Management

Here are some suggestions provided by www.cancer-pain.org to help you work effectively with your health care providers in assessing your pain:

• Put it in writing. If possible, written notes about your pain (see Pain Diary, below) are valuable in giving accurate and comprehensive information.
• Plan to ask questions. It’s important that you fully understand what your health care professional says to you about your pain. Ask questions until you are satisfied that you understand.
• Have a notetaker. Sometimes it’s difficult to talk about your pain, ask questions and take notes on what’s being said to you all at the same time, especially if you are in pain. Bringing a friend or family member to take notes during the discussion about your pain can provide a valuable resource for you once the conversation has ended.
• Make your views heard. Don’t hesitate to offer an opinion about what may be causing or contributing to your pain. No one knows your body as well as you, and your insights can be valuable to your health care providers.
• These are points to consider as you prepare to discuss your pain and its management with your health care providers:
  • The location of all of your pains.
  • How the pain feels (use descriptive words such as dull, aching, throbbing, stabbing, piercing, pinching, sharp, aching, burning, tingling).
  • The intensity of your pain (when it is at its worst) and whether the intensity changes throughout the day and night.
  • When you have the pain (all the time or occasionally).
  • How quickly the pain comes on (suddenly or intermittently), how long it lasts (a few minutes or several hours), and how often it occurs.
  • What makes the pain worse? Describe conditions under which the pain becomes more intense, such as moving, walking, talking, coughing, laying down, eating, going to the bathroom, etc.
  • What eases the pain? Be ready to discuss anything that has helped you, including medication(s) you have been using, and the amounts you are taking.
• Medications you are taking. Tell them about your pain medications, including any over-the-counter pain relievers, any alternative medications like herbs, and any medications you may be taking for other health conditions not related to cancer.
• Side effects of your pain medications. Tell them what side effects you are experiencing, how the side effects are currently being treated, and if you are satisfied with this treatment.
• Quality of life issues: What impact does the pain have on your quality of life? Can you work, enjoy your family and friends, eat and sleep well? If not, describe how the pain is limiting your activities. Also, tell your health care provider(s) what you want from pain management in terms of quality of life.
• To keep an accurate record of what you are experiencing, consider creating a simple pain diary. You can do this in a notebook, recording information such as the date, time of day, level of pain you are feeling, what you did to remedy or alleviate it (i.e., medications taken, use of ice or heat, and so forth), and the outcome of your efforts to control the pain (Did the medication work? For how long? Were there side effects?)

Many health care professionals also use various “pain assessment scales” to record patients’ levels of pain. You can use this system, as well, in conversation with your health care provider. Make sure you always use the SAME scale when describing your pain, for consistency and clarity. One of the simplest involves describing your pain level in terms of numbers: “0″ means “no pain at all,” and “10″ means “the worst possible amount of pain.” The higher the number, the greater the pain. If your health care provider uses a different assessment measuring approach, you may want to use that one. Ask for an explanation of how she or he records patient pain levels.

Innovations in Treatment

Doctors and researchers are always on the lookout for new ways to treat malignant mesothelioma. The following innovations in treatment, while not a cure for malignant mesothelioma, show some promise in helping to treat the disease.

Alimta

Alimta, when given with another chemotherapy drug called cisplatin, is a chemotherapy drug recently approved by the FDA for the treatment of patients with malignant pleural mesothelioma.

Photodynamic Therapy

Photodynamic therapy uses special drugs and a special type of light to kill cancer cells during surgery. A drug that makes cancer cells more sensitive to light is injected into the patient’s vein several days before surgery. During surgery, a special light is used to locate the cancer. This treatment is being studied for early stages of malignant mesothelioma.

Immunotherapy

This type of treatment harnesses the power of the body’s own immune system. Immunotherapy is currently being researched as a treatment for malignant mesothelioma.

Gene Therapy

In studies of gene therapy for cancer, the goal is to improve the body’s natural ability to fight malignant mesothelioma directly or to make the cancer cells more sensitive to other kinds of therapy.

Brachytherapy

Brachytherapy is radiation therapy applied from within the body as opposed to from a machine outside the body. Radioactive sources are placed in or near the tumor, giving a high radiation dose to the tumor while reducing the radiation exposure in surrounding healthy tissues. This precision can help to minimize side effects.

Clinical Trials

A clinical trial (also clinical research) is a research study using human volunteers to answer specific health questions. Carefully conducted clinical trials help discover treatments that work in people and ways to improve health. Interventional trials determine whether experimental treatments or new ways of using known therapies are safe and effective under controlled environments. Observational trials address health issues in large groups of people or populations in natural settings. If you are interested in participating in a clinical trial, talk to your doctor about whether a clinical trial may be an appropriate option in your case.

Phase I

Phase I trials are considered the first step in testing the safety and efficacy of a new drug. Doctors and researchers are trying to determine many things about the drug’s effect on the disease and on the patient. Among the things that researchers are trying to determine are correct dosage, safety profile, and any side effects.

Phase II

At this stage, researchers select a relatively small group of patients to study the specific effects of the pre-determined dosage. Phase II studies also typically focus on a specific type of disease.

Phase III

During Phase III testing, researchers compare the effectiveness of the new, experimental drug against already existing therapies. Usually, patients are randomly assigned to therapeutic groups to cut down on the possibility of human bias. Phase III trials can be large, recruiting patients from across the country.
For more information about clinical trials, visit http://www.clinicaltrials.gov/ct/info/whatis

Radiation

Radiation therapy is an intense X-ray treatment to damage or kill cancer cells. Although not a cure for mesothelioma, radiation therapy nonetheless may be used at different stages of the disease to slow its growth. Radiation is often the main treatment for patients in weak health. Radiation is also used to destroy small clusters of cancer cells that may have been missed in surgery. When used in conjunction with surgery, radiation treatment is referred to as adjuvant radiation.

• External Beam Radiation
  The form of radiation therapy used most often is external radiation, in which a machine very similar to an X-ray machine directs strong beams of light at the cancerous cells from outside the body, killing the tumor cells underneath.
• Internal Radiation (Brachytherapy)
  Internal radiation therapy, also called brachytherapy, involves the placement of radiation sources in the body. With mesothelioma patients, the radioactive material is positioned inside the abdomen or the chest.

Supportive Care or Palliative Therapies

Palliative treatments refer to those procedures that relieve symptoms and help make the patient more comfortable. Here are some palliative therapies that may be used to treat mesothelioma.

• Pleurodesis
  Pleurodesis is a procedure that is sometimes used to control pleural effusion, or the buildup of fluids between the lungs and the lung lining. Pleurodesis causes the space between the lungs and the lung lining to close, reducing the chance for fluid to accumulate. One method of pleurodesis uses thoracoscopy, whereby a small incision, or a few small incisions are made in the skin and a thoracoscope is passed through the incision to get a better look at the pleura. The sclerosing agent is then applied.
• Pain Management
  Pain management is another way to treat the discomfort associated with mesothelioma. For additional information on pain management, please see Pain Management.

Chemotherapy

Chemotherapy uses certain chemical agents or drugs that are specifically destructive to malignant tissues and cells. Doctors may recommend single agent chemotherapy or a combination chemotherapy treatment. The single agent chemotherapy treatment involves the use one type of chemical or drug. The combination chemotherapy method involves the use of more than one chemical or drug. While it is not a cure for mesothelioma, chemotherapy treatment may slow the progression of the cancer. What follows is a partial listing of the chemotherapy treatments a doctor might recommend to treat mesothelioma:

• Alimta (Pemetrexed)
  Alimta, when used with Cisplatin is indicated for treatment of malignant pleural mesothelioma and is usually given through an intravenous tube (IV infusion).
• Onconase (Ranpirnase)
  A new drug that may help slow the growth of mesothelioma tumors.
• Navelbine (Vinorelbine)
  Like Alimta, when combined with other drugs in chemotherapy, Navelbine is used to treat mesothelioma tumors. Clinical trials are still underway and testing on some patients has begun. Navelbine is usually given intravenously.
• Carbonplatin (Paraplatin)
  A chemotherapy medication that interferes with the growth of cancer cells. It has been shown to slow the spread of cancer. Some serious side effects have been reported with the use of Carboplatin.
• Cisplatin (Platinol)
  Cisplatin is a clear fluid given in combination with other drugs in the treatment of certain types of cancer, including mesothelioma. In treatment for mesothelioma, Cisplatin is usually administered with Alimta. As with many chemotherapy drugs, certain side effects may occur. Cisplatin is usually given by IV infusion.
• Related Drugs and Therapy
  Besides the chemotherapy drugs doctors prescribe for the treatment of malignant mesothelioma, there are other drugs intended for post-chemotherapy use. Doctors will also prescribe drugs intended for use at the same time chemotherapy or radiation is underway, that are meant to minimize the side effects that can accompany these treatments.
  • Taxotere, Taxol
    Tumors can return after chemotherapy in some cases. Taxotere and Taxol are drugs that are used to help rid the body of cancer cells when cancer recurs following a previous chemotherapy treatment. These drugs inhibit the duplication or reproduction of cancerous cells. They are delivered through intravenous infusion.
  • Zofran and Anti Nausea Drugs
    One of the most common side effects of chemotherapy treatment is nausea. Zofran is a drug used to ease nausea. Others are Emeset, Oncoden and Zofron. These drugs can help to control radiation therapy induced nausea, as well as post-op nausea and other kinds of nausea.
  • Endostatin
    A natural protein shown to inhibit the growth of blood vessels. The administration of Endostatin results in cancerous tumors “starving” due to lack of blood. This drug is still in clinical trials and has not been approved for general prescription, however.

Surgery

In some cases, surgery may be indicated to alleviate symptoms or slow the progression of mesothelioma. Surgery may be performed in tandem with other treatments such as chemotherapy and radiation, also known as “multi-modal therapy.”

Whether a surgery is recommended in your case will depend on factors unique to your situation, including the type and location of the cancer, the “stage” of the cancer, and your overall health. Of course, whether your doctor recommends surgery in your case will depend on factors individual to your case.

Pleural Mesothelioma Surgeries

Thoracentesis

This procedure involves the draining of fluid that may build up (called a “pleural effusion”) in the chest between the lung and the pleura. A tube is placed in the chest in order to drain out the fluid. Thoracentesis is a “palliative” treatment, meaning that its purpose is to help relieve discomfort.

Pleurodesis

Pleurodesis is a surgical procedure to help control pleural effusion, which is the buildup of fluid between the lungs and the lung lining. Pleurodesis closes the space between the lung and the lung lining, reducing the chance for fluid to accumulate.
There are two approaches to performing a pleurodesis. In the first, a tube that is inserted into the chest drains the excess fluid. After this fluid is drained, a schlerosing agent (a substance that causes tissue to scar or harden), such as sterile talc powder, is injected through the chest tube and into the pleural space. The schlerosing agent is allowed to distribute itself through the pleural space, with the patient being asked to move about in order to facilitate the distribution. Once the agent is distributed, suction is applied to the tube in the chest. Similar to collapsing a plastic bag, the suction brings the two pleural surfaces together, allowing them to “scar” together.

The second method of pleurodesis uses thoracoscopy, whereby a small incision, or a series of small incisions, are made in the skin. A thoracoscope is passed through the incision in order to get a better look at the pleura. The schlerosing agent is then applied to the area.

Pleurectomy/Decortication

Pleurectomy/decortication involves removing the pleura, where most of the tumor is located. This procedure may help control pleural effusions (fluid build-up) and help to decrease the pain caused by the tumor. It is a palliative treatment, meaning that its goal is to help to lessen the discomfort caused by mesothelioma.

Pneumonectomy

A pneumonectomy is the removal of all or part of the lung. Your surgeon will make an incision in the side of the chest. When the lung is revealed, the surgeon visually assesses the tumor and decides how much tissue should be removed.

Extrapleural pneumonectomy

This extensive surgery usually involves the removal of the pleura, pericardium, diaphragm, and the whole lung on the side of the cancerous tumor. Your surgeon may decide to remove some of the surrounding tissues, as well.

Peritoneal Mesothelioma Surgeries

Paracentesis

Peritoneal mesothelioma can cause fluid to build up in the abdomen in a process called peritoneal effusion. This excess fluid is drained through a needle and tube inserted into the abdomen. Paracentesis (sometimes called an “ascitic tap”) can help take the pressure off the internal organs, and also helps reduce the risk of infection that may be caused by the fluid buildup. This is a “palliative” procedure, meaning that the goal of paracentesis is to help to relieve the discomfort associated with peritoneal mesothelioma.

Peritonectomy

A “peritonectomy” involves removing the peritoneum, the lining of the abdomen where the mesothelioma first develops. This form of surgery is most often used when the cancer is detected in the very early stages of the disease. Your surgeon might recommend that a peritonectomy be performed in tandem with “intraperitoneal hypothermic perfusion,” a form of heated chemotherapy where the chemotherapy drugs are administered directly into the abdomen during and/or after surgery.

Cytoreductive (or “debulking”) surgery

During cytoreductive or debulking surgery, the surgeon opens the abdominal cavity (a procedure known as a “laparotomy”) to look for all signs of cancer and attempt to remove as much of the tumor as possible. This surgery can be quite long in duration because of the amount of detail the surgeon must use to search for and remove signs of cancer in the abdominal area. Your surgeon might recommend that this surgery be performed in tandem with “intraperitoneal hypothermic perfusion,” a form of heated chemotherapy administered into the abdominal cavity.

Pericardial Mesothelioma Surgeries

Pericardiocentesis

This is the process for drawing fluid out of the affected area to help to relieve the discomfort associated with pericardial mesothelioma. For this procedure, a needle is inserted into the pericardium (the sac around the heart) to drain the fluid and relieve circulatory problems. The draining of this fluid can be associated with complications, however.

Extrapleural pneumonectomy

An aggressive surgery also used in appropriate situations to treat pleural mesothelioma, an extrapleural pneumonectomy involves removal of the pleura, diaphragm, pericardium, and the entire lung on the side of the tumor.

Treatment

Here is a description of treatments for mesothelioma that a doctor may recommend. Whether a treatment is recommended depends on factors individual to each case. Though there is no known cure for the disease, these treatments can help to make the patient more comfortable or help to slow the progression of mesothelioma.

Surgery

Chemotherapy

Radiation

Supportive Care or Palliative Therapies

Innovations in Treatment

Pericardial Mesothelioma: Diagnosis

Pericardial mesothelioma is also known as mesothelioma of the pericardium or cancer of the sac that holds the heart. Your doctor may diagnose pericardial mesothelioma using a thoracoscope to perform a thoracoscopy, which might also involve opening up the chest cavity to remove the tumor.

Patients who develop excessive fluid around the heart, called an effusion, may have a sample of the fluid taken to diagnose pericardial mesothelioma.

Peritoneal Mesothelioma: Diagnosis

One way doctors diagnose peritoneal mesothelioma is by looking inside the abdominal cavity with an instrument called a peritoneoscope. In this procedure, a cut is made through the abdomen wall and the peritoneoscope is placed into the abdomen. This test, called a peritoneoscopy, is usually performed in the hospital. Some patients develop excessive fluid in the abdomen. This is called an effusion or ascites. A doctor may take a sample of such fluid to diagnose peritoneal mesothelioma.