mesothelioma. How do doctors diagnose asbestos cancer? Part 2

Continuation of part 1.

If the effusion is suspicious for an infection or cancer, a sample of the fluid can give a clue as to whether the cause is benign or malignant. However, four out of five tests can miss cancer. Eventually, biopsy of the pleura by a needle or by a surgical procedure confirms the diagnosis of mesothelioma.

For abdominal mesothelioma, an abdominal x-ray checks the fluid in your belly.

Sometimes an x-ray may show not only effusions, but also masses or signs of asbestos accumulation, pleural plaques, and calcifications or scarring due to asbestosis and chronic inflammation.

Drainage of the fluid is done through a needle in the chest or abdominal cavity. The name is thoracentesis or pleural aspiration of the chest and abdoparacentesis or peritoneal aspiration in the tummy.

In modern days, computed tomography (CT) is used more frequently. CT is a special x-ray machine that shows cut-out images of your body. CT scan of the chest or abdomen shows the swellings in the organs, cavities and lymph nodes. A contrast medium can help with the examination. CT scans show pleural effusion, pleural thickening, pleural calcification, tumor spread to the chest wall. However, CT does not really distinguish benign asbestos disease, lung cancer, or mesothelioma. Doctors also use CT scans to guide needle aspiration of suspicious pleural masses.

Thoracoscopy is the procedure in which a surgeon makes a small incision in the chest wall between two ribs and looks through a thoracoscope (a tool with a video camera). The biopsy (tissue sample) is sent to a laboratory to look for cancer cells.

Bronchoscopy allows doctors to see inside the airways. A thin, flexible tube (bronchoscope) helps obtain tissue samples and send them to a laboratory to be tested for cancer cells.

Mediastinoscopy examines the mediastinum (the area of ​​the chest that contains the heart, large blood vessels, lymph nodes, esophagus, nerves, etc.). Mediastinoscopy allows samples of lymph nodes in your body to be taken to look for metastases.

Laparoscopy is a surgical procedure in which doctors look inside your abdomen with a small tube fitted with a camera. Surgeons will perform biopsies of the suspicious areas. The bioptate (the tissue sample) goes to the laboratory. A pathologist reviews it under a microscope. Laparoscopy leaves a small cut in the skin on your belly. Another name for the same procedure is peritoneoscopy. The tool is called a peritoneoscope.

Putting a needle into the abdomen and removing the fluid from it is called paracentesis. Placing a needle in the chest and draining the fluid is called thoracentesis.

A magnetic resonance imaging (MRI) scan provides a cutaway image of the inside of your body. It is better than an x-ray or CT scan because there is no radiation in your body. However, it requires significant time. Sometimes it takes up to 20 minutes. And some people are afraid to stay on the machine for the half hour required for the test. In addition, MRI has a limitation. The test requires avoiding metals in their bodies (such as metal joints and other metal implants). MRI is not a routine test, so sometimes it is not ordered. MRI scans are most commonly ordered to determine the extent of the tumor in order to plan surgery. MRI is also easier than CT and shows enlarged lymph nodes and the surface of the diaphragm and this is important for surgical planning.

Positron emission tomography (PET) recently appeared to diagnose different types of cancer and mesothelioma as well. PET uses special radioactive substances that emit positrons. Localized mesothelioma is limited to the pleura. Advanced mesothelioma spreads to the lungs, chest wall, abdomen, and lymph nodes.

Pathologic examination checks biopsy specimens under a microscope. It is difficult to diagnose mesothelioma at any time. Tumor cells can be of many different types. These cells may look similar to other types of cancer. The peritoneal cells can look similar to pleural mesothelioma or other types of lung cancer and even ovarian cancer. The epithelioid type of mesothelioma is more common and is considered better for treatment than the aggressive sarcomatous type. Biphasic mesothelioma is the mixture of both.

Doctors and scientists have also proposed some immunological markers to find mesothelioma, however, most of the markers are not very specific. Just to mention: epithelial membrane antigen, CEA (carcinoembryonic antigen √ very nonspecific, can occur in many different cancers), calretinin, mesothelin, cytokeratin, osteopontin, and a few others.

See also: [http://cis.nci.nih.gov/fact]http://www.nlm.nih.gov [http://www.nlm.nih.gov/medlineplus/mesothelioma]http://www.rdoctor.com

So, to recap, the tests used by doctors:

*X-rays

*CT scan

*Thoracentesis

*Paracentesis

*Thoracoscopy

*Bronchoscopy

*Magnetic resonance

*Mediastinoscopy

*laparoscopy

*All types of biopsy

Diagnosis is made after careful evaluation of complaints, physical examination, and imaging, in addition to biopsy.

Keywords: Diagnosis, asbestos cancer, malignant pleural mesothelioma, mesothelioma symptoms, peritoneal mesothelioma, lung cancer