Tests for Mesothelioma 

Doctors may conduct the following tests for patients exhibiting mesothelioma symptoms, or whenever the disease is suspected:

Physical Examination and Medical History 

Doctors will examine you thoroughly for any symptoms of mesothelioma, and ask for your occupation and residence history. This is to help determine if you have ever been exposed to asbestos, whether in the workplace, or because of proximity to old asbestos mines or factories. 

Imaging Tests  

The following Imaging tests are employed to determine the presence of mesothelioma:

• Chest X-ray: A primary screening tool that can reveal pleural thickening, calcium deposits, fluid accumulation, or asbestos-related lung changes. This is typically the initial imaging test used for lung abnormality detection.

• CT Scan: Creates detailed cross-sectional images using X-rays to locate mesothelioma, determine cancer staging, and assess treatment response. It's crucial for evaluating surgical candidacy and monitoring treatment effectiveness.

• Echocardiogram: An ultrasound-based heart examination that detects pericardial effusion (fluid around the heart) and evaluates cardiac function.

• PET Scan: Uses radioactive sugar to identify areas of high metabolic activity, helping differentiate between cancer and scar tissue. Particularly useful for detecting cancer that has spread to lymph nodes or distant sites.

• PET/CT Scan: A combination imaging technique that merges PET's metabolic activity detection with CT's detailed anatomical imaging, allowing for precise correlation between areas of concern.

• MRI Scan: Produces detailed soft tissue images using radio waves and magnets instead of x-rays. Particularly valuable for examining the diaphragm and determining exact tumor location and extent, often using gadolinium contrast for enhanced detail.

Blood Tests

While mesothelioma can’t be diagnosed with blood tests alone, the doctors may look for elevated levels of substances such as Fibulin-3 and soluble mesothelin-related peptides (SMRPs). These substances have limited value at the moment, and are still undergoing further study, but they may be employed in some cases. 

Fluid Testing 

Mesothelioma can cause fluid build-up which leads to swelling. If there is any present in a patient, samples may be collected through suction using a thin, hollow tube:

• Thoracentesis - fluid removal from the chest
• Paracentesis - fluid removal from the belly 
• Pericardiocentesis - fluid removal from the area around the heart

The fluid is examined in a laboratory, under a microscope. Identifying the cell structure will determine whether it is mesothelioma or another type of cancer, and the specific type of mesothelioma it is, in order to plan the best course of treatment. 

Biopsy 

A biopsy is a procedure that involves taking cell samples for laboratory analysis. The following biopsies may be done to diagnose mesothelioma:

Needle Biopsy

This minimally invasive procedure involves passing a long, hollow needle through the chest wall and into the pleura to extract small tumor samples, guided by CT imaging. While it requires no surgical incision or hospital stay, its main limitation is that the samples are often too small for definitive mesothelioma diagnosis. A notable risk is pneumothorax (air between lung and chest wall), which may require treatment with a catheter if significant enough to cause lung collapse, though minor cases often resolve spontaneously.

Endoscopic Biopsy

This widely-used diagnostic method employs various specialized endoscopes to examine and sample different body areas under general anesthesia. 

• Thoracoscopy examines the chest cavity through small incisions, allowing tissue sampling and lymph node removal. 
• Laparoscopy explores the abdominal cavity through a specialized instrument called a laparoscope, which may be used in conjunction with special attachments that can collect tissue samples
• Mediastinoscopy examines lymph nodes between the lungs through a neck incision. 
• Endobronchial ultrasound needle biopsy is a newer technique that uses an ultrasound-equipped bronchoscope to sample lymph nodes near the airways, performed either under general anesthesia or with local anesthetic and sedation.

Open Surgical Biopsy

This most invasive option is employed when endoscopic biopsies prove insufficient for diagnosis. It involves making larger incisions - either a thoracotomy (chest) or laparotomy (abdomen) - allowing surgeons to remove larger tissue samples or even the entire tumor for definitive diagnosis.

Pulmonary Function Tests 

If mesothelioma is found, pulmonary function tests are administered to see how well the lungs are still functioning. This is crucial to determine if surgery is a viable option. Surgical interventions for mesothelioma that reach the lungs typically require removal of a portion of the infected area. If the pulmonary function tests indicate that breathing will become impossible with the removal of infected tissue, other treatment options may be explored. 

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