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Mesothelioma Diagnosis

Diagnosing mesothelioma usually requires doctors to perform different tests, including X-rays and biopsies (analysis of tissue samples). Since mesothelioma is so rare — and its symptoms are similar to other health issues — a correct diagnosis is crucial. Mesothelioma specialists generally diagnose patients because general cancer doctors rarely have the experience needed to diagnose mesothelioma.

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Determining Diagnosis of Mesothelioma

To determine a mesothelioma diagnosis, doctors first have to rule out other, more common conditions that may be causing the symptoms. If doctors still suspect that mesothelioma could be present, they will do more in-depth tests to see if cancer cells are present.

Mesothelioma is diagnosed by:

  • Monitoring initial symptoms: Initial mesothelioma symptoms, such as a dry cough, difficulty breathing, or loss of weight and appetite, are typically mild and mimic symptoms of other more common health issues. These symptoms only worsen as the cancer grows.
  • Conducting early tests: To rule out other possible diseases, doctors may use imaging tests, such as an X-ray or a computed tomography (CT) scan, and take blood samples to look for signs of cancer.
  • Confirming a diagnosis: The only way to completely confirm a mesothelioma diagnosis is by taking a biopsy (samples of fluid and/or tissue) of the affected area. Biopsies allow doctors to study the samples under a microscope to see if mesothelioma cells are present.

If you suspect that mesothelioma may be the cause of your symptoms, talk to your doctor about your history of asbestos exposure. Doctors can use this information to look for other medical problems.

Quick Facts About Diagnosing Mesothelioma

  • Mesothelioma is not usually diagnosed until 20-50 years after exposure to asbestos.
  • Approximately 3,000 people are diagnosed with mesothelioma each year, according to information from the American Society of Clinical Oncology (ASCO).
  • Most people diagnosed with mesothelioma are 65 years old or older.
  • Mesothelioma can sometimes be diagnosed in younger adults, including teenagers and children, as noted in case studies from the Journal of Pediatric Surgery and the peer-reviewed journal Digestive Diseases and Sciences.

Life Expectancy After a Mesothelioma Diagnosis

The average life expectancy after a mesothelioma diagnosis depends on how early or late the cancer is diagnosed. 41% to 46% of patients diagnosed with localized mesothelioma (the cancer is contained to where it first developed and has not started to spread) will still be alive 2 years later, according to the ASCO.

By contrast, only 17% of mesothelioma patients will still be alive after 2 years if the cancer is diagnosed after it has spread throughout the body.

The type of mesothelioma a patient is diagnosed with also affects their life expectancy.

Below, get a breakdown of life expectancy by mesothelioma diagnosis.

Like pericardial mesothelioma, testicular mesothelioma is very rare and hard to diagnose. Those with this type of cancer may not have as long a life expectancy as those with peritoneal or pleural mesothelioma.

An early mesothelioma diagnosis is key to a longer life expectancy. If the cancer is diagnosed early on, it has not spread throughout the body. This typically means it is easier to treat because more of the cancerous tumors can be removed, potentially helping patients live longer.

Mesothelioma Pathology

Pathology is the study of how diseases develop. According to the College of American Pathologists, a pathologist studies tissue or fluid samples from at-risk patients and performs laboratory tests to determine the cause of their health issues.

A mesothelioma pathologist studies tissues, and cytopathologists look at fluid-containing cells from a mesothelioma patient.

Pathologists also closely work with a patient’s radiologists (doctors who perform imaging tests), oncologists (cancer doctors), and surgeons to help determine a care plan after a mesothelioma diagnosis has been confirmed.

Mesothelioma pathology is obtained only if other diagnostic tests suggest cancer as a possible cause of a patient’s symptoms.

Mesothelioma Diagnostic Tests

A mesothelioma diagnosis is made through several tests, which examine different parts of a person’s body to determine if cancerous tumors may be present.

The five most common types of mesothelioma diagnostic tests are:

  • Medical history and examination
  • Imaging scans
  • Blood samples
  • Fluid and/or tissue biopsy
  • Pulmonary function tests

Each test has its own distinct advantages and disadvantages, and not every test may be used to confirm a mesothelioma diagnosis depending on where the cancer develops and how far it has spread by the time someone undergoes testing.

Pathology is always necessary to finalize the diagnosis. A doctor can help determine which type of tests will be used and in what order.

Medical History Examination

The first step in diagnosing any form of cancer is gathering a medical history and conducting a full physical exam. A doctor will review their patient’s health and ask questions about their work and medical history.

During this stage, it’s crucial for patients to note any past exposure to asbestos to their doctor. Those who worked in certain industries — such as mining, construction, or the military — when asbestos was widely used are at a significantly higher risk of developing mesothelioma.

Mesothelioma Imaging Tests

Imaging tests are usually the first diagnostic tool used to detect possible signs of mesothelioma, including fluid buildup and cancerous growths. Doctors may use the following imaging tests to identify possible cancerous tumors or other masses within the body.

X-Rays

An X-ray uses electromagnetic radiation to create a picture of the inside of the body. It is typically the first test a doctor will use to see if a patient has mesothelioma.

Chest X-rays can reveal:

  • Calcium deposits
  • Thickening of the lung or abdominal lining
  • Fluid buildup in the lungs
  • Other abnormalities that may indicate mesothelioma

X-rays do not require surgery to perform and can be done relatively easily by doctors.

CT Scans

Similar to X-rays, a CT scan creates a comprehensive image of that body that can locate potentially cancerous growths.

The CT scan takes numerous images, creating a computerized view of the body from multiple angles and components inside of it. CT scans for cancer usually require contrast to outline different body organs.

PET Scans

Positron emission tomography (PET) is a type of imaging scan that uses a low-dose of a sugary radioactive substance to detect cancer cells. This substance will be injected into the patient’s body about one hour before the scan.

Cancer cells grow at a rapid pace, which causes them to consume a larger quantity of sugar than other cells. The PET scan uses the injected radioactive material to observe which cells (if any) are consuming more sugar — and, in turn, may be cancerous — and where these cells are located.

The scan can also show if these cells have begun to spread throughout the body.

PET-CT Scans

Some facilities have machines that are capable of performing a CT scan and a PET scan at the same time.

Because the two types of scans perform slightly different functions, a PET-CT scan can help doctors diagnose mesothelioma with greater accuracy. The CT scan component of this combination of imaging tests is usually non-contrast.

MRI Scans

A magnetic resonance imaging (MRI) scan is similar to a CT scan in many ways, but it uses radio and magnetic waves instead of light waves to see if cancerous tumors may be present.

If you receive an MRI, you can expect to lay inside a tube-like scanner for up to an hour while the scan occurs.

Echocardiogram

An echocardiogram is a specialized form of ultrasound that uses sound waves to take an image. After a gel is placed on the chest, a wand sends sound waves into the body to create a picture on a monitor.

Echocardiograms are frequently used to help confirm a pericardial mesothelioma diagnosis. A doctor may request an echocardiogram to see how well the heart is functioning or if they suspect fluid buildup around the heart.

While all the imaging tests listed above are important, the American Cancer Society (ACS) notes that these tests alone cannot confirm if someone has cancer.

Mesothelioma Blood Tests and Biomarkers

Mesothelioma increases the levels of certain substances within the blood, including fibulin-3, soluble mesothelin-related peptides (SMRPs). and other substances. These substances can be detected through various tests, in which blood samples are sent to a laboratory.

Commonly used blood tests for diagnosing mesothelioma include:

  • SMRP test
  • N-ERC test
  • Osteopontin test
  • MPF test

Blood tests are a cost-efficient and minimally invasive way to test for mesothelioma, which is why many cancer researchers are working on methods for improving blood tests as a diagnostic tool.

However, like imaging tests, blood tests alone are not able to diagnose mesothelioma, and they are not used as part of the diagnostic process in every case. If a blood test suggests a victim has this cancer, additional tests will be administered to confirm a mesothelioma diagnosis.

SMRP Test

The most common mesothelioma blood test is the SMRP test, which goes by its trademarked name MesoMark®. This test looks for the biomarker SMRP that develops in the blood if mesothelioma cells are present.

N-ERC Test

Like MesoMark, this test determines if a substance called N-ERC is present within the patient’s blood.

The N-ERC test is considered more accurate than the SMRP test for identifying cancer. However, it isn’t as helpful when diagnosing mesothelioma specifically since N-ERC may also be a sign of other types of cancer.

Osteopontin Test

Osteopontin is a naturally occurring protein that increases when a person has mesothelioma.

An osteopontin test can determine whether a patient has cancer but does not indicate what kind. Therefore, osteopontin tests that come back positive will require additional testing to confirm a mesothelioma diagnosis.

MPF Test

The MPF test is used to detect a protein often found in patients called megakaryocyte potentiating factor (MPF). While it’s not entirely clear how MPF works, scientists have noted very high levels of MPF in mesothelioma patients.

Did You Know?

The MPF test is a newer discovery that’s already being used while scientists continue to research and improve it.

Researchers are also looking into new biomarkers and other genetic factors as mesothelioma diagnostic tools.

Mesothelioma Biopsy

The only conclusive way to make a mesothelioma diagnosis is by performing a biopsy of tissue or fluid cells.

All biopsies follow the same general process: tissues or fluids are collected, sent to a laboratory, and then reviewed under a microscope.

Doctors typically start by taking a fluid sample from the affected area to look for cancer cells in this fluid, as fluid buildup is a common symptom of mesothelioma.

This still might not be enough to conclusively diagnose mesothelioma, though, as cancer cells may not be found in this fluid. The ACS notes that doctors usually need a tissue sample to confidently make a mesothelioma diagnosis.

From there, lab tests will be conducted by pathologists to see if the victim has mesothelioma and, if so, what type they have.

Learn more about the different types of mesothelioma biopsies below.

Thoracoscopy

With a thoracoscopy, doctors create a small incision in the chest and use video-assisted thoracoscopic surgery (VATS) to perform the biopsy using tiny tools guided by a camera.

Thoracoscopy is often the preferred type of mesothelioma biopsy because of its accuracy.

Fine Needle Biopsy

If a thoracoscopy isn’t possible, a fine needle aspiration may be used to collect the cell samples. This procedure uses a long, skinny needle to collect sample cells and is valued for its ability to access hard-to-reach locations within the body, including the lungs and heart.

Additional Types of Biopsies

Although thoracoscopy and fine needle aspiration are the two most common types of mesothelioma biopsies, other techniques may be used in some cases.

Additional types of biopsies include:

  • Endobronchial ultrasound needle biopsy: Through this test, doctors insert a tube down the windpipe of a sedated patient so they can examine the airway, biopsy adjacent lymph nodes, and collect tissue samples.
  • Laparoscopy: This test looks inside the abdomen to see if tumors have developed.
  • Mediastinoscopy: With this test, doctors take a sample of the area between the two lungs (the mediastinum). This test is normally done if doctors believe the cancer has spread to nearby lymph nodes in between the two lungs, according to the ACS.

Doctors can recommend which types of biopsies will work best to confirm a mesothelioma diagnosis.

Pulmonary Function Tests

If a patient has been diagnosed with pleural mesothelioma, their doctor may request pulmonary function tests to determine how well their lungs are currently functioning.

This test is important because pleural mesothelioma makes up around 80% of all diagnosed cases and it is often treated through lung removal surgery. If a pulmonary function test shows that both lungs are strong, the patient may be better able to undergo surgery that could extend their life.

Diagnostic Tests by Mesothelioma Location

Doctors require specific tools and techniques to make a mesothelioma diagnosis in different areas of the body.

Here are the common tests and tools used for each mesothelioma location:

  • Pleural mesothelioma: A variety of tests, including a CT scan, an ultrasound, or an MRI, can be used to help determine if cancer may be present and if it has begun to spread. A PET scan may also be used to help see if the cancer has spread throughout the body in some cases.
  • Peritoneal mesothelioma: Doctors typically start with a CT scan of the abdomen. Blood samples then may be taken to help rule out other conditions.
  • Pericardial mesothelioma: Tests such as an X-ray of the chest and an echocardiogram may be used to see if cancer tumors have started to develop around the heart. Unfortunately, due to its rarity, most cases of this type of mesothelioma are only diagnosed after the patient has died.
  • Testicular mesothelioma: Doctors may use X-rays and ultrasounds to diagnose this type of cancer. Testing for biomarkers can also help determine if it is present.

Biopsies are always performed after these tests are conducted, no matter what type of mesothelioma is suspected. As previously noted, a mesothelioma diagnosis can only be confirmed by taking a biopsy.

Preparing for Mesothelioma Diagnostic Tests

Each mesothelioma diagnostic test will require different preparations. While some tests (such as an X-ray) require little to no preparation, others (such as a blood test or an MRI) may require that patients do not eat for several hours beforehand.

For some tests, like a CT scan, patients will be asked to drink an oral contrast solution. They may also receive an IV contrast to help outline organs on the scans.

Before each diagnostic test, doctors will explain how a patient should prepare for each test and when they can expect to get their results back.

Diagnosing Mesothelioma in Veterans

33% of all people diagnosed with mesothelioma are veterans, as every branch of the U.S. military relied on asbestos-containing products until the early 1980s.

If a veteran displays common mesothelioma symptoms, they should tell their doctor if they served in the military when asbestos was widely used. From there, doctors can help them to earlier narrow down the patient’s condition and make a proper mesothelioma diagnosis.

Further, veterans who receive VA Health Care may be able to access top mesothelioma specialists, including Dr. Robert Cameron and Dr. Avi Lebenthal, to figure out their treatment options after a mesothelioma diagnosis.

Future Mesothelioma Diagnostic Techniques

Specialists recognize that victims are more likely to have a longer survival time with an early mesothelioma diagnosis. That’s why researchers across the nation are working on new techniques in mesothelioma clinical trials for both earlier and more accurate diagnoses.

Did You Know?

Many future diagnostic techniques are focused on biomarkers, which use substances or processes to identify abnormalities in the body.

Biomarkers for cancer patients are complex, often using specific genes, cell growth patterns, proteins, or other molecular substances to indicate the presence of mesothelioma.

Mesothelioma Diagnosis Challenges

Even for experienced doctors, making a mesothelioma diagnosis is challenging since the symptoms can often mimic other diseases. Other factors, including the length of time it takes mesothelioma to develop, can also make it harder to diagnose this cancer.

Learn more about potential mesothelioma diagnostic challenges below.

Latency Period

Mesothelioma is unusual in that it takes 20-50 years after someone has been exposed to asbestos before noticeable symptoms arise.

This long time-lapse means that victims may not even remember being exposed to asbestos-containing products. Also, they may not initially realize that their mild, vague symptoms are related to mesothelioma.

Patients should always tell their doctor if they were exposed to asbestos, even if their symptoms are mild.

Misdiagnosis

Doctors may initially mistake mesothelioma for a wide range of more common, less dangerous diseases since each type of mesothelioma develops in a different part of the body.

Mesothelioma may be misdiagnosed as:

  • Bronchitis
  • Coronary artery disease
  • Chronic obstructive pulmonary disease (COPD)
  • Emphysema
  • Crohn’s disease
  • Irritable bowel syndrome (IBS)
  • Testicular infection
  • Other forms of cancer

This is why doctors use so many tests when making a mesothelioma diagnosis — they want to be completely sure of the disease so they can properly treat it. A mesothelioma misdiagnosis can have dangerous outcomes, including death.

Mesothelioma Stages

Staging also presents a challenge when making a mesothelioma diagnosis. In the early stages of mesothelioma, symptoms can be mild or even nonexistent, making an accurate diagnosis very difficult.

Most people are diagnosed in the later stages of mesothelioma after the symptoms have worsened. By then, treatment options are limited, and chances of long-term survival are decreased.

According to the ASCO, 13%-16% of patients diagnosed with early-stage mesothelioma will still be alive after 5 years. By contrast, 5%-10% of patients (or less) with late-stage mesothelioma survive 5 years after diagnosis.

Prognosis

A prognosis is the expected outcome that a disease will take and is usually given after a mesothelioma diagnosis is confirmed.

A mesothelioma prognosis is greatly affected by a mesothelioma diagnosis. For example, if the cancer is diagnosed after it has spread throughout the body, the prognosis will likely be worse.

That said, some have beaten the odds and surpassed an initially grim life expectancy. Doctors will be able to estimate — but not completely guarantee — the expected prognosis after a mesothelioma diagnosis for this reason.

Next Steps After a Mesothelioma Diagnosis

If you’ve been diagnosed with mesothelioma, you likely have questions about treatment options, top doctors, and more. Contact us today to discuss your next steps and how you can access life-extending medical treatments.

Learn more about how we can help.

Mesothelioma Support Team
Reviewed by:Dr. Mark Levin

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD has nearly 30 years of experience in academic and community hematology and oncology. In addition to serving as Chief or Director at four different teaching institutions throughout his life, he is also still a practicing clinician, has taught and designed formal education programs, and has authored numerous publications in various fields related to hematology and oncology.

Dr. Mark Levin is an independently paid medical reviewer.

Stephanie KiddWritten by:

Editor-in-Chief

Stephanie Kidd grew up in a family of civil servants, blue-collar workers, and medical caregivers. Upon graduating Summa Cum Laude from Stetson University, she began her career specializing in worker safety regulations and communications. Now, a proud member of the American Medical Writers Association (AMWA) and Editor-in-Chief of the Mesothelioma Justice Network, Stephanie serves as a voice for mesothelioma victims and their families.

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