If you have been suffering from the symptoms of mesothelioma – a persistent or bloody cough; pain in your chest, side, back or abdomen; wheezing or hoarseness; breathing difficulties such as shortness of breath or gasping for breath; or an unusual level of fatigue – you should consult with your general practitioner, who will begin the process of evaluating your physical symptoms and occupational history, specifically your past exposure to asbestos. Asbestos is the primary cause of mesothelioma, which is a rare form of cancer that occurs after asbestos fibers become lodged in the lungs’ linings (pleura) and cause cell mutation.
Your primary care physician will perform a number of tests in order to confirm a diagnosis of mesothelioma, including x-rays to look for irregular pleural thickening or excess pleural fluid; a CT or MRI scan to show pleural thickening, or a PET scan, which involves an injection of radioactive glucose to reveal cancer cells. If any of these tests show an abnormality in the mesothelium, diaphragm or lungs, your practitioner will most likely order a biopsy.
This procedure, which extracts a small sample of the tissue which is considered potentially cancerous and evaluates it in a laboratory, involves several types of doctors. A surgeon will perform the biopsy, which is a relatively simple procedure that can be performed under local anaesthesia. The tissue sample is then examined by a pathologist, who can make a diagnosis of mesothelioma or another type of cancer.
Once the presence of mesothelioma is established, you will most likely be working closely with a medical oncologist. As you may know, an oncologist is a practitioner who specializes in the treatment of cancer. Many oncologists further specialize in a particular type or types of cancer, and you may be referred to an oncologist whose primary specialty is mesothelioma, so that he or she can give you the most up-to-date and specialized care possible. The oncologist will “stage” the cancer, or determine how advanced it is, and will then work with you to develop a treatment plan. This plan will take into account not only the stage of your cancer, but also your general health and your wishes. Some possible courses of treatment for malignant mesothelioma include surgery (but only in the initial stages of the cancer), chemotherapy, radiation or a combination of all three, which is called trimodality therapy. Patients whose mesothelioma is extremely advanced may opt not to pursue these kinds of treatment at all, for their side effects can be extremely difficult to endure, and their benefits may be negligible. For those patients, pain management and other palliative treatments to ease suffering and provide comfort may be the best options. Your oncologist will make recommendations about your treatment plan, based on the specifics of your situation.
If surgery is an option for you, you may be referred to a surgical oncologist, who specializes in the surgical resection (removal) of cancerous tumors and masses. Alternately, your medical oncologist may also provide surgical treatment. If the two are different, they will work closely together to provide you the best possible standard of care.
A radiation oncologist, similarly, is a cancer doctor whose primary responsibility is to administer radiation therapy. Part of the radiation oncologist’s responsibility is pre-treatment planning, which will craft an approach to maximize radiation delivery to the cancer in order to maximize the chance of killing the cancer, while minimizing the radiation exposure to normal tissue. Again, the radiation oncologist will collaborate with your medical oncologist or general practitioner in order to ensure superlative treatment of your mesothelioma.
Those patients whose health is not adequate to the rigors of surgery, chemotherapy or radiation may consult with a palliative care physician, or one who dedicates his or her practice to improving the comfort and overall quality of life to terminal patients. There are many methods by which to do this, including pain management medication; holistic pain management techniques such as acupuncture, massage and hypnosis; and emotional support.
In addition to these practitioners, who can be considered the first string of your care team, there are many other health care professionals with whom you will likely be dealing as you learn of your mesothelioma diagnosis and begin to undergo treatment and/or palliative care. Nurses; laboratory technicians; psychologists, psychiatrists or other counselors; social services liaisons; nutritionists, pharmacists and hospice care providers may all play a greater or lesser part in the treatment of your mesothelioma.