A patient who presents to a physician, or other healthcare provider, with any of the above symptoms, should be sure to inform that physician that they have worked around asbestos, or a family member with whom they lived worked around asbestos.  In some cases, doctors will fail to diagnose mesothelioma, because they are unaware of the potential asbestos exposure.  Many types of Mesothelioma can look like other types of lung cancer, such as adenocarcinoma or sarcomatoid mesothelioma.  This enhances the necessity that an individual with asbestos exposure inform their doctor, and if diagnosed with one of those types of cancer, seeks a second opinion to rule out mesothelioma.

Typically, when a physician is given symptomology that could indicate a cancer, the doctor or other healthcare provider will order a series of test to determine the presence of mesothelioma.  Typically, a combination of the following will be used:

 Non-Invasive Tests

• Physical Examination:  There are many symptoms of mesothelioma which may be evident to a doctor on the basis of a physical exam.  A doctor may be able to see lumps in the chest, abdomen or groin, or may be able to feel lumps just under the surface of the skin.  A doctor will also likely listen to the sounds of a patient’s chest, to listen for any abnormalities associated with breathing, or when the patient is making specific noises.  A doctor may also tap on the chest to listen for the echo.  These types of exams where the doctor is listening to the chest can indicate if there is fluid present in the chest that shouldn’t be there.  This will not be sufficient on its own, however, and will likely be just a starting point for further testing.
• X-Ray:  A patient who presents with symptoms which leads to suspicion of cancer will typically get a chest or abdominal X-Ray.  X-rays are relatively cheap to perform and can often be done and read at the time of the office visit.  These X-Rays will allow the doctor and radiologist to determine if there are any abnormal masses or tumors located in the chest or abdominal area.  Chest X-Rays may also reveal thickening of the pleural, pericardial, or peritoneal layers, and may also reveal deposits which are indicative of cancers, such as mesothelioma.  X-Rays do not show a high definition picture, however, and the finding of thickening, deposits, or a tumor or mass on an X-Ray will typically lead to other follow-up tests.
• Computed Tomography (CT) Scan:  A CT Scan is similar to an X-Ray in that its purpose is to give the physician a picture of the chest and abdomen.  Unlike an X-Ray, where the subject merely stands or lays in front of the camera, a CT unit requires the patient to be inserted into the CT machine, and the camera actually is able to take multiple scans of the patient to show an enhanced image.  A CT Scan provides a higher resolution scan and offers the physician and radiologist interpreting the scan a 3-D image of the area.  The reason it is called computed tomography is because the X-Rays taken by the scanner are interpreted by a computer to produce that 3-D image.  Due to the enhanced nature of the picture offered, cancer specialists and radiologists can often determine the exact location of the tumor or mass, and can initially diagnose mesothelioma at this time.  The CT Scan may also be able to show what Stage the mesothelioma is at.
• Contrast Dye X-rays or CT Scans:  There are numerous chemical dyes which can be introduced in the body which actively seek out cancer cells, cancer sites, or places where tissue is undergoing change.  A physician may inject a patient with these dyes and then perform a number of imaging scans.  The dye will gather in the affected area, and the dye will provide a contrast to the image, allowing the physician and radiologist to get a better view of the cells and/or tumor.
• Magnetic Resonance Imaging (MRI):  An MRI machine also generates a picture of the interior of the body, using magnets and radio waves.  Unlike an X-Ray or CT scan, this machine does not employ radiation technology to achieve the picture.  Like the CT Scan, an MRI provides cross-sectional pictures, as opposed to the images of the X-Ray.  MRI scans can be used to show the extent of progression of mesothelioma, as these scans are able to show soft tissue structures where the cancer may have metastasized in higher resolution.  As with X-Rays and CT Scans, MRI scans can be enhanced by the use of dyes to highlight the cancerous areas.  Typically, those contrast dyes are made of gadolinium, and have been very helpful to physicians diagnosing mesothelioma.  MRIs can be used to show actual pictures of an entire organ, and thus allow a physician / radiologist to see the extent of involvement if any cancer is suspected.
• Positron Emission Tomography (PET) Scan:  This is another scanning technique which allows the physician / radiologist to view the interior of the body without performing any invasive, surgical procedure.  PET Scans are actually referred to as nuclear medicine imaging techniques.  PET scans are not solely focused, however, on taking pictures of bodily structures, the way the previous scans were.  A PET scan employs technology that takes pictures of the ongoing bio-processes in the patient’s body.  Typically, a tracer is used and then that tracer is measured by the PET scan technology.  In the case of mesothelioma patients, the radioactive tracer is often glucose (sugar).  Glucose is rapidly absorbed by cancerous cells.  Radioactive glucose will be injected into the patient, and the PET scan can then see where that glucose is being absorbed.  Traditionally, a physician will use a PET scan in conjunction with a CT scan to ensure the best pictures.

Invasive / Surgical Diagnosis Tests

While pictures can often assist in confirming a physician’s suspicion that mesothelioma is indicated, they cannot provide the same reliability that surgical tests can offer.  The only way to definitively diagnose mesothelioma is via a pathological examination whereby a pathologist can actually view the cells and/or test their chemical markers.  To ensure this process, samples of the suspected mesothelioma cells are needed.  The non-invasive tests are invaluable in assuring that the physician, in seeking a surgical or invasive diagnosis technique, will be looking in the correct area when a sample is needed.  If a physical exam or scanning technique reveals the presence of fluid, or a tumor, the physician will need samples for that pathological process to confirm whether or not it is actually mesothelioma.  In those cases, the following procedures are often indicated:

• Needles Aspiration Biopsy (NAB):  A needles aspiration biopsy, also known as a fine needle aspiration, is a method of surgical intervention to collect samples.  If a scan or physical exam indicates the presence of fluid, or a tumor, a physician or oncologist will want a sample of that fluid or tumor.  A fine needle aspiration is what they will use to obtain that sample.  The fluid is often contained in the space between the parietal and visceral layers of the pleura, peritoneum, or pericardium.  In that case, thin, hollow needle will be inserted into that cavity, and fluid will be withdrawn.  In those cases involving a tumor, the physician or oncologist will place the tip of the needle into the tumor and suction cells from the tumor itself.  These cells will then be placed on slides to be examined under a microscope.  Though a needle aspiration biopsy is often the least invasive for the patient, the risk is that it can result in missed cells due to the small number of cells taken, and a definitive diagnosis may not be possible.
• Thoracoscopy:  A thoracoscopy is a specialized procedure, designed to examine, biopsy, and/or resect a lump, mass, or disease which is contained within the pleural or thoracic cavity.  A thoracoscope is a specialized device which is used for this procedure.  The thoracoscope will be inserted into the chest cavity.  It contains its own light source and lens so that the operator can view the appropriate areas.  Typically, the thoracoscope will have places at the end of the instrument where other instruments may be placed, such as those needed for removing samples.  Another technique which can be used is video-assisted thoracoscopic surgery.  Due to the fact that instrument will be placed in the chest, and manipulated, this intervention typically involves general or local anesthetic.  A physician, typically a thoracic surgeon, performing this test, will insert the probe, find the tumor or fluid filled cavity, and insert the necessary instruments to remove samples for testing.
• Laparoscopy:  A laparoscopy is a surgical intervention focusing on the abdomen, or pelvic region.  A laparoscopy involves making small incisions, through which a laparoscope is inserted.  A laparoscope is small, telescopic instrument with a small camera which can be inserted to view internal organs and structures.  Surgical instruments can be inserted through the other incisions.  If a physician determines the presence of a tumor or fluid in the peritoneal cavity, this is one of the methods a physician can obtain samples of those areas.  The laparoscope allows the physician to locate the tumor or fluid, and the instruments inserted can then take the necessary samples for testing.
• Pleuroscopy:  A plueroscopy is a surgical intervention focusing specifically on the pleura.  Similar to a laparoscopy, a plueroscopy involves an incision being made in the chest.  A pleuroscope, a long, thin tube with a lens at the end so the physician can see, is then inserted into the incision and placed in the pleural cavity.  Once the pleuroscope is in place, the doctors can then use the camera to view the pleura cavity for an effusions or tumors.  Doctors can also take samples of the fluid or tumors for pathological testing.
• Bronchoscopy:  A bronchoscopy is an intervention which focuses on the airways.  Unlike a laparoscopy or plueroscopy, an incision is not always required.  The majority of the time, the physician will place the bronchoscope, a long tube with a camera at the end, into the airways, usually via the nose or mouth.  If this is not possible, it may be necessary for the doctor to insert the tube in the trachea, by making an incision in the throat, called a tracheostomy.  The doctor can then use the bronchoscope to visualize the airways and determine if any tumors or other abnormalities are present.  These abnormalities may include fluid build ups, bleeding, inflammation, tumors, masses, or other foreign bodies being present in the lungs or airways.  The bronchoscope also allows the practitioner to take samples from a specific area, either by using the device itself through tools inserted in the device, or though other means which allow visual confirmation that another biopsy modality is in the right place.
• Mediastinoscopy:  A mediastinoscopy is a procedure employed by physicians to allow them to view the various contents of the mediastinum.  The mediastininum is actually a name give to a collective of structures in the central thoracic cavity.  The focus, typically, in a mediastinoscopy where mesothelioma is suspected, is to view the lymph nodes contained in the mediastinum.  A mediastinoscopy allows the physician to determine if the mesothelioma has spread to those nodes, or spread beyond the point of origination.  A mediastinoscopy is a long tube with a camera at the end which is inserted through an incision in the chest.  It also allows the physician to retrieve samples of fluid or tumors which are visualized so those samples can be pathologically analyzed.

There have also been advances in blood testing which may assist in the determination of whether a patient has mesothelioma.  But, the standard is still a pathological evaluation of a biopsied sample of fluid or tissue, to ensure that a proper diagnosis is achieved.

 Once a patient is diagnosed with mesothelioma, the next step will be to determine the staging or progression of the mesothelioma cancer, and to use that information to develop a plan for proper treatment.

 A patient should also be aware that a diagnosis of mesothelioma brings with it certain legal rights which can be protected.  Asbestos exposure is the leading cause of mesothelioma diagnoses in the United States, and it is not a disease that should have happened.  While it may not be the first idea in the patient’s mind, they should be sure that after settling on plan of treatment, they should take action to protect their rights.