To diagnose mesothelioma, our specialists use a range of tests, including biopsies, imaging scans, and physical exams.
Early detection and correct diagnosis are key to favorable outcomes for mesothelioma patients. Because this cancer is rare and presents with symptoms similar to many other conditions, it is important to seek the right expertise as soon as possible (particularly if you or a loved one have experienced significant asbestos exposure). It is important to seek the right care in order to avoid delays, which may alter possible treatment options.
When attending a consultation, it is important to provide a comprehensive work history. Doctors are unlikely to suspect mesothelioma unless the patient describes a former job where asbestos exposure may have occurred.
Biopsies are the only testing method that can definitively diagnose mesothelioma. We use imaging scans to identify tumors and the spread of cancer, while blood tests can measure treatment response or identify biomarkers that may suggest disease.
How is Mesothelioma Diagnosed?
Endoscopic Biopsy
Endoscopic biopsies are commonly used to diagnose mesothelioma. An endoscope is a long, thin, tube-like instrument with a light and tiny camera that allows the doctor to see inside the body while the patient is under general anesthesia. Tools can be inserted through the endoscope to remove tissue samples for testing.
Needle Biopsy
Needle biopsies are non-surgical procedures that involve a long, thin needle that removes small samples of tissue or fluid for testing. Doctors typically use local anesthesia and may use ultrasounds or CT scans to provide imaging guidance during the procedure. Needle biopsies may also be used to collect samples from the lymph nodes in the area between the lungs to check for the spread of mesothelioma.
It is common for patients with pleural mesothelioma to undergo thoracentesis (chest fluid removal) during their initial diagnostic testing.
Surgical Biopsy
Surgical biopsies are the most invasive biopsy approach but may be necessary if tumors are difficult to reach. These procedures can either be done through minimally invasive or open surgical techniques.
Imaging Tests
Fox Chase’s radiologists use imaging tests to reveal the location and potential spread of mesothelioma. Types of imaging tests include:
- CT scan: Computed tomography (CT) scans provide 3D visuals of the body that can identify abnormalities within normal organs and tissues. These images are much more precise than regular X-rays and are an important tool in the diagnosis of mesothelioma.
- PET–CT scan: Positron emission tomography (PET) scans show how organs and tissues are functioning and are often used to detect cancer and abnormal cell activity. Patients receive a small dose of a radioactive drug (tracer) that can help identify tumors. A PET-CT scan combines the functional information from a PET scan with the anatomic information of a CT scan to help identify where tumors may be in the body.
- MRI scan: Magnetic resonance imaging (MRI) scans provide detailed images of bones and soft tissues that can distinguish between normal and potentially cancerous areas. MRI imaging is particularly useful in detecting the spread of mesothelioma into surrounding areas of the body.
- X-ray: This testing method produces basic 2D images of bones and soft tissues to identify abnormalities and help rule out other conditions. Chest or abdominal X-rays are the most common for mesothelioma and can reveal typical findings like pleural effusions or abdominal ascites (fluid buildup around the lungs or in the abdomen).
- Ultrasound: These tests produce live images of organs, vessels, and tissues to help identify tumors after a patient begins having symptoms. In mesothelioma, ultrasound imaging can identify pockets of pleural effusions and/or ascites that may need to be drained.
Stages of Mesothelioma
Staging mesothelioma and determining whether it has spread (metastasized) is important for complete diagnosis. Having this information helps Fox Chase specialists determine the best personalized treatment plan for each patient. Stages of mesothelioma include:
- Stage I: In this stage, tumors are only present in the primary location and there is no spread to the lymph nodes or metastasis.
- Stage II: There may be some spread of the primary tumor, but it has not metastasized or reached the lymph nodes. Most symptoms presented at this stage are minimal.
- Stage III: At this stage, the cancer has spread to various parts of the pleura or peritoneum and other nearby tissues (the diaphragm or pericardium). It may also have spread to nearby lymph nodes. Symptoms may include significant breathing difficulties and pain.
- Stage IV: In this stage, the cancer has spread far from the original site of the tumor.
How Soon Can I Expect Test Results?
It usually takes at least a few days to receive your test results, although the time varies for each patient. Your physician will provide you with your results as soon as possible, along with a thorough explanation of your diagnosis and answers to any questions you have. At that time, your physician will recommend potential procedures and possibly meeting with other specialists to provide a treatment plan tailored to your diagnosis.
What If I Have Already Been Diagnosed at Another Hospital?
If you have been diagnosed with mesothelioma, you’ll likely want to start treatment as soon as possible. However, because mesothelioma is a rare disease, it is a good idea to have another expert weigh in on your diagnosis and treatment options.
At Fox Chase, we routinely offer second opinions, which can help identify new treatment options that might be more effective for your condition. In fact, it is common for individuals to seek a second opinion for a cancer diagnosis, and some insurance companies even require it.
Coming to Fox Chase also means you will likely have greater access to clinical trials appropriate for your condition. Our designation as a Comprehensive Cancer Center by the National Cancer Institute (NCI) means we are part of a network of research centers where hundreds of clinical trials take place every day. The results of studies conducted by Fox Chase doctors have been crucial in advancing our understanding of cancer diagnosis and treatment around the world.
If you decide to seek a second opinion at Fox Chase, a nurse navigator will contact you to help coordinate your visit. The nurse navigator will help you obtain a copy of your medical records, imaging results, and pathology report to bring to your appointment.
Your Patient Care Team at Fox Chase
To design an individualized treatment plan for each patient, our mesothelioma team draws on the diverse experience of physicians and clinical staff specializing in surgical oncology, radiation oncology, hematology/oncology, diagnostic imaging, and pulmonary medicine. We work together to diagnose your cancer and help you make informed decisions about your treatment.
Our dedicated team also includes nurse navigators, social workers, and other specialized support staff. As a key part of your team, they will provide emotional support and coping strategies for you and your family when you need them most.
“We have a lot of experience diagnosing mesothelioma. Having access to world-class specialists is one of the many benefits of receiving care at a specialized cancer center like Fox Chase.”
— Jordan Anaokar, MD, Radiologist