How mesothelioma is diagnosed

Usually, you begin by seeing your family doctor (GP) who will examine you and may arrange for you to have some blood tests and x-rays. On this page Tests for pleural mesothelioma Tests for peritoneal mesothelioma Waiting for test results Your GP should urgently refer you for a chest x-ray if you have a history of asbestos exposure, and any of the following symptoms: chest pain difficulty breathing unexplained symptoms, such as shoulder pain, a cough or weight loss. Depending on the results of any tests and x-rays, your GP may refer you to hospital for further tests and for specialist advice and treatment. At the hospital, the specialist will ask you about your general health and any previous medical problems before they examine you. You may be asked questions about any possible exposure to asbestos in your past, such as during jobs you’ve had or at places you’ve worked. This is called your occupational history. You may also be asked if someone in your family, a parent for example, worked with asbestos. Don’t worry if you can’t remember all of the details at first. You can let your doctor know later about anything you remember. Tests for pleural mesothelioma Back to top Pleural mesothelioma often starts as tiny lumps (nodules) in the pleura, which may not show up on scans or x-rays until they’re quite large. You may need to have a number of different tests before your doctors can make an accurate diagnosis. We describe some of these tests here. If you need other tests, your doctors will be able to give you information about them. Chest x-ray A chest x-ray checks for any abnormalities in your lungs, such as thickening of the pleura or fluid around the lungs. There can be other causes of these problems apart from mesothelioma. CT (computerised tomography) scan A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10–30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan. You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you’re allergic to iodine or have asthma, because you could have a more serious reaction to the injection. You’ll probably be able to go home as soon as the scan is over. An image of someone having a CT scan Someone having a CT scan. View a large version of the image of someone having a CT scan. Drainage of fluid from the pleura (pleural aspiration) Mesothelioma cells can irritate the pleura and cause a pocket of fluid to develop. This is called a pleural effusion . Your doctor can take a sample of this fluid to send to the laboratory as mesothelioma cells are sometimes present. The sample is taken by first using a local anaesthetic to numb the area. A needle is then inserted through the skin into the fluid and some of the fluid is removed. This procedure is done while you’re having an ultrasound scan. The scan helps the doctor guide the needle to the place where the fluid is. Biopsy A biopsy is always needed to help the doctors diagnose pleural mesothelioma. It involves taking a sample of tissue from the thickened pleura and, occasionally, from the lymph nodes in the middle of the chest. Your doctor may take a biopsy in different ways: CT or ultrasound guided biopsy A local anaesthetic is used to numb the area. Your doctor will pass a special type of needle through the skin into the thickened area while using an ultrasound or a CT scanner to guide the needle into the right place. The needle has a tip that can cut out a sample of tissue. Thoracoscopy This allows the doctors to look at the area of the pleura directly and also to look at other structures around the lungs and take further biopsies, if required. You’ll be given either a general anaesthetic or a local anaesthetic with a sedative to make you drowsy. A small cut is made in the chest wall and the doctor puts a thin, flexible tube with a light and camera at the end (thoracoscope) into your chest. An ultrasound scan may be used to guide the thoracoscope to the thickened area of pleura. Your doctor can then take a biopsy of the pleura. Mediastinoscopy Occasionally, your doctor may arrange for you to have a mediastinoscopy. This test may be done if your doctors think the mesothelioma has spread to the lymph nodes in the middle of the chest.This procedure is similar to a thoracoscopy and is usually done under a general anaesthetic. A small cut is made in the base of the neck. A thin, flexible tube with a light and camera at the end (mediastinoscope) is inserted through the cut and is used to examine the lymph nodes in the space between the lungs. Biopsies can also be taken, if needed. Having a biopsy can be uncomfortable but shouldn’t be painful. If you have any pain during or after the procedure, let your doctor or nurse know. Once a biopsy has been taken, it’s sent to the laboratory and examined by a pathologist (a doctor who advises on the type and spread of cancer). Sometimes, even after taking a biopsy, the doctors may still not be sure of the diagnosis. This is because pleural mesothelioma can be very difficult to tell apart from some other illnesses. In this situation, the biopsy samples may be sent to other laboratories to confirm the diagnosis. Some of your tests may need to be repeated or you may be referred to another hospital for a second opinion. Tests for peritoneal mesothelioma Back to top A number of similar tests may be used to help diagnose a peritoneal mesothelioma. Abdominal x-ray This can help show up any fluid or swelling in the abdomen. CT (computerised tomography) scan You may have a CT scan of your abdomen. Drainage of fluid from the abdomen (peritoneal aspiration) Mesothelioma cells can cause fluid to collect in the abdomen. This is called ascites. Your doctor can take a sample of this fluid to send to the laboratory as mesothelioma cells are sometimes present. The sample is taken by first using a local anaesthetic to numb the area. A needle is then inserted through the skin into the fluid and some of the fluid is removed. Biopsy A biopsy of the peritoneum is always needed to help the doctors diagnose peritoneal mesothelioma. It can be carried out by: Laparoscopy This procedure allows the doctor to look at other structures in the abdomen and take further biopsies if required. You’ll either be given a general anaesthetic or a local anaesthetic with a sedative to make you drowsy. A small cut is made in the tummy wall and your doctor puts a thin, flexible tube with a light and camera at the end (laparoscope) into your abdomen. Your doctor can then take a small biopsy of the peritoneum. CT or ultrasound guided biopsy The doctor uses an ultrasound or a CT scanner to position the needle accurately for the biopsy. As with pleural mesothelioma, peritoneal mesothelioma may be difficult to diagnose. You may need to have further tests or occasionally be referred to another hospital for a second opinion. Waiting for test results Back to top Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready. You may find it helpful to talk with your partner, family or a close friend. Your specialist nurse or one of the organisations listed can also provide support. You can also talk things over with one of our cancer support specialists or you can contact Mesothelioma UK’s helpline.