Mesothelioma diagnosis is a difficult process because the disease often isn’t visible on external scans and the symptoms may be confused with a number of common ailments that misdirect the medical staff and defer more thorough investigations.
One major difficulty physicians and healthcare specialists face in recognizing the disease is that a mesothelioma diagnosis is based on a process of exclusion. In other words, once common ailments are ruled out, an investigation into the rare spectrums of illness begins. A definitive mesothelioma diagnosis requires a tissue biopsy obtained either through a needle biopsy or an open procedure. Needle biopsies are inconclusive in many cases and they lead to the need of a surgical procedure to obtain enough tissue to confirm the diagnosis and identify the cell type.
The Mesothelioma Diagnosis Process
The process of diagnosis usually begins with some form of radiological investigation. In pleural mesothelioma cases, where respiratory distress is the primary symptom, doctors may fall back on an x-ray to check for pneumonia or shadows on the lung indicative of tuberculosis or lung cancer. It is during this stage that fluid in the pleural cavity or an irregular pleural rind is noted. These discoveries then may lead to the commencement of more extensive procedures.
During the process of recognizing and diagnosing mesothelioma, examination procedures can include:
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What Limits a Successful Mesothelioma Diagnosis?
Mesothelioma symptoms can often be confused with a number of common ailments that misdirect the medical staff and hinder a more thorough examination. Because other ailments or diseases must be excluded first, the disease may progress beyond treatment by the time a diagnosis is found. For instance, in many developing countries where tuberculosis is common, when symptoms develop, it is considered more cost effective to treat for suspected tuberculosis. Therapy continues for 6 months and it is only at this time if symptoms persist that a more extensive diagnostic work-up begins. At this point, the window of opportunity to treat mesothelioma has often closed as the disease at this point is usually very advanced and refractory to mesothelioma treatment. Additionally, insurance will not approve a more costly test unless a patient has had an abnormal X Ray or another test that suggests a CT scan (Computed Tomography scan) is necessary.
Biopsies can also be controversial when it comes to diagnosing mesothelioma. Needle biopsies are also poor indicators since the mesothelioma tumor can be quite diffuse and thin. The biopsy is usually obtained under CT guidance. An experienced radiologist performs this procedure. Some of the problems associated with this technique are too little material to sample, sampling a small area will not allow a discussion of the type of mesothelioma or percentage of more virulent cells which aide the oncologist or surgeon in formulating a treatment plan.
Selected articles for further reading are listed below:
Prognostic Value of (18)F-FDG PET/CT in Patients with Malignant Pleural Mesothelioma.
