A diagnosis of mesothelioma is usually made approximately six months after the patient has visited their general practitioner with concerns over breathing difficulties or pain in the chest or abdomen. Mesothelioma is a disease that is not typically diagnosed until the cancer is in the later stages due to its long latency periods. It is critical that the doctor and patient work together in order to furnish a complete health history and a detailed description of the patient’s symptoms. At this stage it is also extremely important for the patient to mention any previous exposure to asbestos, hopefully expediting a diagnosis.
Mesothelioma Diagnostic Procedures
After these initial doctor visits, if mesothelioma, or any other disease caused by asbestos exposure is still considered a possibility, the physician will want to determine if and where the malignancy is located, determine the type and size of cancer, or of it has metastasized to other areas of the body. Diagnostic tests used to either exclude mesothelioma or diagnose it are usually issued in the following order:
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- The patient will be asked for their complete medical history including past and current health conditions, as well as current symptoms.
- The patient will be asked to detail any known exposure to asbestos including period and proximity of exposure. If the patient is unsure of whether or not they were exposed, the doctor may not recommend asbestos-related tests in the diagnosis.
- A physical examination will be conducted to determine the causes behind the patient’s current symptoms and serve as a recommendation for the appropriate tests to be conducted.
- Chest X-Ray– The most common imaging test to determine growth around the heart and lung cavity.
- CT Scan – Provides a detailed image of the whole body where a patient will be administered intravenous dyes in order to provide for a more detailed image.
- PET Scan - Detects cancer cells through glucose deposits.
- MRI Scan or magnetic resonance imaging– Uses radio magnetic waves to create three-dimensional images of the body.
Tissue and Fluid Tests
A biopsy is a common procedure that involves retrieving a sample of the tissue or fluid from a suspicious area, and then testing that sample for cancerous cells. There are four main types of biopsies that a doctor will likely order:
- Fine Needle Aspiration—Is used to detect pleural mesothelioma and involves the extraction of fluid buildup in the affected area using a find long needle.
- Thoracoscopy—Is used to test pericardial mesothelioma where a small incision is made on the chest wall to extract tissues for further examination.
- Bronchoscopy and Laparoscopy—Similar to a thoracoscopy but these incisions are made along the trachea areas and the abdomen areas respectively.
- Mediastinoscopy—Is conducted to test if the cancer has spread and involves a small incisions near the neck or the chest.
Scientists have recently begun to associate various biomarkers in the blood as a means of detecting mesothelioma in the earlier stages. This means that elevated levels of specific biomarkers in a patient’s blood is not a definite indication that cancer is present, however, learning more about these existing biomarkers and developing new ones could lead to more decisive and effective diagnosis of mesothelioma:
- Mesomark assay—The Mesomark assay test determines the amount of soluble Mesothelin-Related Peptides (SMRP) in a patient's serum. Doctors can then measure the amount to determine if mesothelioma is present. Presence of SMRP in a patient's blood can be detected even in the earlier stages of the cancer, which gives hope for future diagnosis of mesothelioma.
- miRview - This diagnostic test allows physicians to differentiate malignant mesothelioma from other forms of metastatic carcinomas affecting the membranes around the lung. MiRview does this by testing a tissue-specific microRNA biomarker from the tumor in order to differentiate between mesothelioma and other cancers
Mesothelioma Diagnostic Codes
Although patients will rarely encounter the standardized coding system for disease classification, the patient should still become familiarized with them. It is helpful to know and understand these codes should the physician refer to them, or the patients encounter them during research. The diagnostic codes for mesothelioma are:
- ICD-9 code163: pleural mesothelioma
- ICD-9 code158: peritoneal mesothelioma
- ICD-9 code164 pericardial mesothelioma
Next Step: Patient Involvement
Once a diagnosis of mesothelioma has either been determined, or is strongly suspected, a primary care physician will more than likely refer the patient to an oncologist. Oncologists are doctors that specialize in the diagnosis, prognosis, and treatment of cancer; some specialize further in specific cancers, such as mesothelioma. An oncologist will work with the patient to determine what treatment options are best for each individual case. Patients are also encouraged to perform their own research, which can provide them with education and a platform from which to discuss various options with their physician.