• Surgery
• Chemotherapy
• Radiation

Because none of these treatments is very effective alone, multimodal treatment is often undertaken. Multimodal treatment employs surgery plus radiation and/or chemotherapy together when the disease is not too far advanced and the patient is healthy enough to tolerate it.

Other treatments intended to alleviate symptoms and pain include paracentesis and pleurodesis. These are discussed in the article on Pain Management in Mesothelioma.

Multimodal Treatment

Pleural mesothelioma is often diagnosed in its later stages when it has spread beyond the original tumor site. For patients receiving trimodal treatment with Stage 2 disease (lymph nodes involved), survival rates vary depending on the type of cancer cells. In one study, patients with the epithelial type had a 65% survival rate at 2 years versus 27% for those with sarcomatous or biphasic type. The 5-year survival rates were 27% compared to 0%.

Even when diagnosed in its earliest stages with the pleural tumor still localized (Stage 1), recurrence of the cancer following surgery is almost inevitable. Still, surgery combined with radiation and chemotherapy was successful in extending survival rates in early-stage patients. The median survival for patients with no lymph node involvement was 74% at 2 years and 39% at 5 years.

Another study of patients with localized peritoneal mesothelioma yielded a 79-month median survival rate following surgery and intraperitoneal chemotherapy. For patients with advanced disease, abdominal surgery is typically not considered adequate in removing the cancer cells. If performed, surgery is typically to help reduce symptoms and make the patient more comfortable, but does not significantly slow the progress of the disease.

Because pericardial mesothelioma is in the lining surrounding the heart, surgery is almost never a successful choice. If chemotherapy and/or radiation are chosen, it is often for palliative reasons (to reduce symptoms and make the patient more comfortable).

Types of Surgery

The objective of surgery is to remove the cancerous tumor and as much of the adjacent tissue as possible to which cancer cells are likely to have spread. In advanced stages of cancer, surgery is not an effective option because the cancer cells have become involved in too much tissue to be effectively removed or have spread to other parts of the body making local surgery pointless.

The two types of surgery for pleural mesothelioma are extrapleural pneumonectomy and pleurectomy

Extrapleural pneumonectomy is a radical procedure to remove part of the lung and its lining (pleura), the heart lining (pericaridium), and the diaphragm. This surgery is only effective when the disease is confined to the chest cavity.  When combined with chemotherapy and radiation, it is not a cure but it has the potential to increase survival by two to three years.  Because it is such an aggressive surgery, patients with weak heart or lung function are not candidates.

In very early stage disease when the tumor is still largely confined to the pleura, the surgeon may opt to perform a pleurectomy.  Because this procedure involves removing a limited amount of tissue from the lung surface, recurrence of the cancer is high. However, this may be the only option for patients too weak to undergo more extensive surgery. When combined with chemotherapy and radiation, this treatment can reduce the patient’s pain and provide modest improvement in survival.

Because a pertinoneal mesothelioma tumor can be in any part of the abdominal lining, the procedure for removing the cancerous tissue is simply called debulking (or cytoreductive) surgery. The outcome of this procedure is better when the surgeon is able to remove the majority of the tumor. For larger tumors, surgery may be ineffective and not recommended. 

Chemotherapy

Typical cancer chemotherapy involves taking powerful oral or intravenous medications that travel through the bloodstream to attack cancer cells. These systemic drugs often have nasty side effects such as nausea, fatigue, diarrhea and hair loss.

The standard chemotherapy drugs for mesothelioma and a few in late-stage clinical trials include:

• Pemetrexed (ALIMTA®)
• Ralitrexed (Tomudex®)
• Ranpirnase (Onconase®)
• Bevacizumab (Avastin®)
• Vinorelbine, gemcitabine
• Doxorubicin
• Cisplatin, carboplatin and oxaliplatin (platinum compounds)

These drugs have different side effects and their effectiveness can vary under different circumstances.  They are often used in various combinations and treatment schedules can differ significantly based on the treatment plan. Your doctor has to take these factors and your individual circumstances into consideration when determining the chemotherapy regimen that’s best for you.

A new type of chemotherapy used in mesothelioma treatment involves applying heated cancer-fighting drugs directly to internal tissues during surgery – referred to as hyperthermic intraoperative chemotherapy. This type of treatment only occurs when tumor removal surgery is performed.  Its purpose is to apply high-dose chemotherapy directly to the tissues that may harbor microscopic remnants of cancer cells following surgery. The technique is effective and results in fewer drug-related side-effects to the patient. Nonetheless, standard chemotherapy treatment often follows.

Radiation

After surgery to remove a mesothelioma tumor, subsequent radiation therapy can significantly reduce the rate of local recurrence. Radiation inhibits a cell’s ability to divide and grow.  Healthy cells are able to rebound from the effects of a limited amount of radiation that is sufficient to kill cancer cells. Radiation therapy is intended to extend survival by slowing the recurrence of cancer, but it has also been found to have some short-term benefit in reducing pain.

Ordinary radiation therapy uses an external machine to direct a beam of radiation at the location were malignant cancer cells are likely to remain.  Treatment may be prescribed five days a week for five to six weeks. The short break in treatment each week gives the healthy tissue a chance to recover. Side effects can include sunburn-like reddening of the skin, inflammation of internal organs, and fatigue.

To reduce side effects, some treatment centers use 3-dimensional conformational radiation therapy (3D-CRT). This technique requires taking a full-set of CT scans of the area of the cancer. The resulting image data is fed into specialized computers that control the radiation delivery equipment.

Doctors and radiologists identify the precise areas in the scans to be targeted, and the 3D-CRT machine is able to deliver a very narrow beam to the designated areas with great accuracy.  During a treatment session, the beam is aimed at the body first from one direction, then another. Periodically changing the path by which the beam enters the body minimizes the radiation’s effect on healthy tissue while consistently penetrating the target area each time. This reduces collateral tissue damage and side effects, and improves the treatment effectiveness.

An even newer therapeutic technique is called intensity modulated radiation therapy (IMRT). This technique also uses CT scans fed into computer systems to control multiple simultaneous radiation beams aimed at the cancer area from different angles. Alone, each low-intensity beam doesn’t cause significant damage to the tissue it passes through.  At the location where the beams converge, however, the combined effect is much stronger.

Related Articles

• Pain Management in Mesothelioma
• Mesothelioma Symptoms
• Diagnosing Mesothelioma
• Cancer Staging for Mesothelioma
• How to Find Clinical Trials for Mesothelioma

References

Tan, Winston W., MD (2008), “Mesothelioma – Treatment and Medication.”  Retrieved Dec 27, 2008 from the Medscape.com web site: http://emedicine.medscape.com/article/280367-treatment.

University of Florida Shands Cancer Center (2008). “Radiation Therapy for Malignant Pleural Mesothelioma.” Retrieved Dec 27, 2008 from the University of Florida Shands Cancer Center web site: http://www.ufscc.ufl.edu/Patient/content.aspx?section=ufscc&id=30346.

Once the informed decision is made to explore clinical trial options, there are several ways to proceed.

• Discuss your interest in clinical trials with your doctor
• Search the clinical trial lists and databases
• Enroll in a clinical trial matching service

Talk to Your Doctor

Your doctor is probably aware of most of the clinical trials in your area that are recruiting patients in your situation, and he or she knows you well enough to know if you qualify for a particular trial or not. Moreover, your doctor can help you develop a realistic outlook on the merits of clinical trials in general, and the pros and cons of any specific trial.

Finding Clinical Trial Lists and Databases

While your doctor is probably aware of the majority of local clinical trials for mesothelioma treatments, he or she may not be aware of absolutely every one for which you might qualify. You may want to check the clinical trial lists and databases yourself.

If you do your own Internet search, you’ll discover searching for “mesothelioma clinical trials” yields hundreds of thousands of hits, the majority of which are general information articles posted on law firm Web sites. You’ll also encounter abundant information on trials that have long ago closed to new participants.  The few additional legitimate and up-to-date clinical trial listings we were able to find seemed to draw their data from one or more of the top five sites listed below.

Cancer411 – Sponsored by two private non-profit foundations, this Web site allows you to search for mesothelioma-related trials in your home state or any other. Although it allows you to enter additional search criteria, it’s probably unnecessary.

Cancer.Gov – This National Cancer Institute database of more than 6,000 active trials can be searched by type of trial as well as by zip code and travel distance.

Cancer Trials Help – A service of the Coalition of Cancer Cooperative Groups, this Web site requires you to respond to a short questionnaire to help you find an applicable clinical trial. For question number 4, you have to choose “lung” cancer, and you will later have the opportunity to specify mesothelioma.
 
CenterWatch Clinical Trials Listing Service – CenterWatch is a medical information publishing company. Though they have an extensive listing of open clinical trials, it is not all-inclusive.  You’ll want to also check other lists. A nice feature is that in addition to having the choice of selecting only mesothelioma-related trials, you can also select your state or country to narrow the results to trials in your area.

ClinicalTrials.Gov – This service of the U.S. National Institutes of Health offers a simple and flexible search screen where you can search on criteria of your choice. Your best bet is to enter “mesothelioma AND yourstate” to find local trials. (Note that “AND” must be capitalized.)

Clinical Trial Matching Services

The power and convenience of the Internet has spawned new Web-based business models that help sponsors of clinical trials find and enroll participants. Some of these may charge a fee to sponsors for listing their studies or they may receive a fee for each participant that enrolls through the service.

The various services work in different ways. Some allow you to search listings and apply for enrollment on their site.  Others may require you to register first, providing them with information on your condition that helps them match you to studies you’re eligible for. When you register, if they have no current trials fitting your situation, they can notify you when a new trial is announced that would be applicable to you.

 American Cancer Society - The ACS Clinical Trials Matching Service requires you to register and provide information on your personal situation and medical condition.  It then returns a list of open trials matching your criteria.  Each time you log on thereafter, you’ll be presented with an updated list including any new trials that have been announced. For any trial you’re interested in, you can contact the study sponsor directly, or call the American Cancer Society toll free number to discuss it with a specialist.

EmergingMed – Though you can search this private company’s clinical trial listings without registering, it doesn’t give you a “mesothelioma” selection, and searching for lung cancer yields over 600 results. But by registering and completing a detailed questionnaire (which a caregiver can do for you), you can obtain results specific to mesothelioma. You can also register to receive updates by email when new, applicable trials are listed.

Acurian - This company provides a wide variety of patient recruitment services to clinical trial sponsors, including a clinical trial matching service. It uses the CenterWatch database, but does not provide a “mesothelioma” option for searching clinical trial listings, so you have to register.  Though registering requires entering quite a bit of personal information, Acurian has a very detailed and ethical privacy policy.

TrialX – This unique service tells you how many trial results you’re going to find even before you launch the search. When the results are displayed, you can then fill in the answers to some key questions and it eliminates any trials you’re not eligible for. By registering, you can also contact clinical trial sponsors to enroll, link to a Personal Health Record service, and receive email alerts when new matching clinical trials are announced.

Regional Cancer Centers – Each of the National Cancer Institute’s regional cancer centers is constantly involved in numerous clinical trials at any given time.  Simply find the cancer center nearest you, and enter “clinical trials” in the center’s Web site search window.

Selecting a Trial to Apply For

After doing your first search for mesothelioma clinical trials, you quickly discover that it seems to require at least two years of medical school to understand the eligibility criteria. If you encounter any trials that seem interesting, print the trial information or copy down the Internet address for your doctor to review for you.

Related Articles

• What to Expect from Clinical Trials
• Leading Medical Centers for Mesothelioma Treatment
• Treating Mesothelioma

New medical treatments are commonly drugs, but often also include medical devices, surgical procedures, and other types of therapies such as radiation therapy. Some trials may study combinations of several types of treatments.

The Reality of Clinical Trials

It can be easy for patients to place all their hopes on some potential miracle cure that might be discovered in a clinical trial they’re part of.

The reality is that only about 15% to 20% of all drugs that enter clinical trials are ultimately approved by the FDA as safe and effective. And even those finally approved may offer only limited improvement in quality of life or a few months advantage in survival.

No patient should be discouraged from nurturing the hope that experimental treatments may extend quality of life and add to the time they have with family and friends. Ultimately, however, the greatest benefit of participating in a clinical trial is not what the participating patient gains. It’s what the patient’s participation adds to medical knowledge that will reduce the suffering and extend the quality of life for future patients.

Every patient today is benefiting from the knowledge gained from many thousands of patients who enrolled in past clinical trials. And clinical trial participants today continue paying it forward.

The Types of Clinical Trials

Clinical trials are classified by purpose.

• Prevention – finding the best ways to prevent a disease from occurring or re-occurring
• Screening – finding the best ways to detect a particular disease or condition
• Diagnosis – finding the best tests for determining if someone has a particular disease or condition
• Treatment – finding the best ways to improve quality of life and survival in patients with a particular disease or condition
• Supportive Care – finding ways to improve the comfort and quality of life for people with chronic illnesses

For the patient diagnosed with mesothelioma, only the treatment and supportive care trials are of benefit.

The Phases of Clinical Trials for Drug Treatments

Clinical trials for drug treatments are divided into stages to allow efficient testing of experimental drugs with the lowest risk to trial participants.

Phase 1: Is it Safe?

After laboratory and/or animal testing, the applicant submits a request to conduct trials with human subjects. Phase 1 trials enroll a very small number of participants (20 to 50) and focus on studying how the drug is metabolized and the how it affects the body at varying dosage levels. The goal is oriented more at gathering biological data and preliminary indications of side effects than it is on providing an effective patient treatment.

Participants accepted into Phase 1 trials for cancer drugs are often end-stage patients who have exhausted their treatment options. A very small number are initially studied for a short time while receiving the drug in very low doses. Subsequent small groups are given incrementally larger doses to better evaluate the drug’s effects. This phase of testing is usually completed within several months.

Patients in Phase 1 trials almost never receive any personal benefit from the drug because of the short duration of treatment and the low doses.

Phase 2: Does it Work?

In Phase 2 trials, the focus shifts toward studying the drug’s effectiveness in treating the disease. This study can involve up to a hundred or more patients and may take more than a year. The goals in Phase 2 are to:

• Measure how effective the drug is
• Determine the most effective dosage
• Continue to assess side effects and risks

Selection criteria for Phase 2 trial participants depend on the nature of the drug and the nature of the study. For cancer drugs, study participants will typically be those with the target disease but for whom currently available treatments have been unsuccessful. These patients may receive a therapeutic benefit from the experimental treatment.

Although it is more likely to occur in Phase 3, some phase 2 trials are randomized trials in which one group of patients receives the new medication while a “control” group receives a standard treatment.

Phase 3: Is it Better?

The objective of Phase 3 testing is to compare the new drug to the current standard treatment to determine if it offers better results or fewer side-effects. These tests can involve hundreds to thousands of patients in randomized trials. Randomized trials are double-blind when possible – meaning that neither the patient nor the doctor knows which participants are receiving the experimental drug. Placebos are never used in randomized trials when an existing treatment is available.

Patients in Phase 3 trials may or may not experience any benefit from participation. Random chance determines which treatment they receive – either the standard treatment or the experimental one. Plus, until the study is completed, no one knows which is better.

If the results of the Phase 3 study show the new treatment is even marginally better than others that are available, the study’s sponsor can apply to the FDA for approval of the new drug.

Phase 4: What More Should We Know?

After a drug has been approved by the FDA, further Phase 4 clinical trials may be conducted to answer additional questions.

• How much more effective (or cost-effective) is the new drug compared to other competing treatments?
• What other conditions is the drug effective in treating?
• What are the drug’s long-term effects (positive or negative)?

These studies may be conducted over many years and many thousands of patients. Because drugs in Phase 4 trials are already available to any patient, participants are not receiving any better treatment or care than non-participants.

Related Articles

• How to Find Clinical Trials for Mesothelioma
• Leading Medical Centers for Mesothelioma Treatment
• Treating Mesothelioma

Among the most pre-eminent cancer treatment facilities in the United States are those designated as cancer centers by the National Cancer Institute (NCI). Selected for excellence in their research and treatment programs, these centers receive research funding from the U.S. government.  The results of their research are then shared between all of the NCI centers, as well as the medical community at large.  At these centers you should be assured of being cared for by a team of specialists who have access to the most up-to-date information on mesothelioma treatment.

The following list includes facilities of the National Cancer Institute and National Institutes of Health as well as NCI-designated cancer centers.

ALABAMA

• University of Alabama at Birmingham Comprehensive Cancer Center

ARIZONA

• Arizona Cancer Center

CALIFORNIA

• City of Hope National Medical Center
• Stanford University Comprehensive Cancer Center
• UC Davis Cancer Center
• UCLA Jonsson Comprehensive Cancer Center
• University of California, Irvine (UCI) Chao Family Comprehensive Cancer Center
• University of California, San Diego (UCSD) Moores Cancer Center
• University of California, San Francisco (UCSF) Comprehensive Cancer Center
• USC/Norris Comprehensive Cancer Center

COLORADO

• University of Colorado Cancer Center

CONNECTICUT

• Yale Cancer Center

DISTRICT OF COLUMBIA

• Lombardi Comprehensive Cancer Center at Georgetown University

FLORIDA

• H. Lee Moffitt Cancer Center & Research Institute

HAWAII

• Cancer Research Center of Hawaii

ILLINOIS

• Robert H. Lurie Comprehensive Cancer Center of Northwestern University
• University of Chicago Hospitals

INDIANA

• Indiana University Cancer Center
• Purdue University Cancer Center

IOWA

• University of Iowa Holden Comprehensive Cancer Center

MARYLAND

• Greenbaum Cancer Center
• National Institutes of Health Clinical Center
• Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

MASSACHUSETTS

• Dana-Farber Cancer Institute

MICHIGAN

• Barbara Ann Karmanos Cancer Institute
• University of Michigan Comprehensive Cancer Center

MINNESOTA

• Mayo Clinic Cancer Center
• University of Minnesota Cancer Center

MISSOURI

• Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University

NEBRASKA

• The University of Nebraska Medical Center/Eppley Cancer Center

NEW HAMPSHIRE

• Norris Cotton Cancer Center

NEW JERSEY

• Cancer Hospital of New Jersey at Robert Wood Johnson University Hospital

NEW MEXICO

• University of New Mexico Cancer Research and Treatment Center

NEW YORK

• Albert Einstein Cancer Research Center
• Herbert Irving Comprehensive Cancer Center
• Memorial Sloan-Kettering Cancer Center
• NYU Cancer Institute
• Roswell Park Cancer Institute

NORTH CAROLINA

• Duke Comprehensive Cancer Center
• University of North Carolina (UNC) Lineberger Comprehensive Cancer Center
• Wake Forest University Comprehensive Cancer Center

OHIO

• Case Comprehensive Cancer Center
• The Cleveland Clinic, Taussig Cancer Center
• Ohio State University Comprehensive Cancer Center
• University Hospitals Ireland Cancer Center

OREGON

• OHSU Cancer Center

PENNSYLVANIA

• Abramson Cancer Center of the University of Pennsylvania
• Fox Chase Cancer Center
• Kimmel Cancer Center
• University of Pittsburgh Cancer Institute

TENNESSEE

• St. Jude Children’s Research Hospital
• Vanderbilt-Ingram Cancer Center

TEXAS

• Cancer Therapy and Research Center
• Dan L. Duncan Cancer Center
• University of Texas M. D. Anderson Cancer Center

UTAH

• Huntsman Cancer Institute

VERMONT

• Vermont Cancer Center at the University of Vermont

VIRGINIA

• UVA Cancer Center
• VCU Massey Cancer Center

WASHINGTON

• Fred Hutchinson Cancer Research Center

WISCONSIN

• University of Wisconsin Comprehensive Cancer Center

Related Articles

• Diagnosing Mesothelioma
• Cancer Staging for Mesothelioma
• Treating Mesothelioma

Stage 1 describes a cancer that has been discovered early and has spread little or not at all from the original tumor site. Stage 4 describes a very advanced cancer that has spread to other locations and/or organs very distant from the original tumor. Cancer spreading to distant locations is called metastasis.  When it happens, the cancer is said to have metastasized.

Imaging studies are the primary method for staging mesothelioma. By carefully examining X-rays, CT scans and/or MRIs, doctors can identify what other tissues, lymph nodes or organs are involved and how far the cancer has spread. In specific cases, blood tests and/or tissue samples can provide additional information useful in determining cancer stage.

In practice, pleural mesothelioma is the only mesothelioma with a defined staging system. The other types (peritoneal, pericardial, testicular) are so infrequent that they don’t have their own definitions for staging.  Therefore doctors may describe these cancers in just two stages – localized and spread (or advanced).

Doctors have a choice of three staging systems for pleural mesothelioma.

• Butchart System
• TNM System
• Brigham System

Butchart System

The Butchart staging system has been used the longest.  While many doctors have gravitated toward newer staging systems, some still use the Butchart definitions.

Stage 1 – Mesothelioma is in the left or right pleura (but not both), and may possibly have spread to the diaphragm on the same side of the chest.

Stage 2 – Mesothelioma has spread to any of the following: pleura on the opposite side, chest wall, lining of the heart, esophagus, lymph nodes in the chest.

Stage 3 – Mesothelioma has spread into the abdomen or abdominal lining, and possibly lymph nodes beyond the chest.

Stage 4 – Mesothelioma has spread through the bloodstream to other organs.

TNM System

This more recent staging system assesses stage based on the extent of the tumor (T), the degree to which lymph nodes are affected (N), and degree of metastasis (M). This system was devised by the International Mesothelioma Interest Group and adopted by the American Joint Committee on Cancer.

Stage 1 – Mesothelioma is in the left or right pleura (but not both). It may also have spread to the diaphragm, lining of the heart, or the lung on the same side.

Stage 2 – Mesothelioma has spread into nearby lymph nodes on the same side as the primary tumor. It may also have spread to the diaphragm, lining of the heart, or the lung on the same side.

Stage 3 – Mesothelioma has spread to any of the following on the same side of the body as the primary tumor: chest wall, ribs, muscle, esophagus, heart or other organs within the chest. Lymph nodes on the same side of the body may or may not be involved.

Stage 4 – Mesothelioma has spread to any of the following: any location in the chest on the opposite side from the primary tumor, any location in the abdomen, or any other location distant from the primary tumor.

Brigham System

This system developed more recently at Brigham and Women’s Hospital in Boston describes mesothelioma stages in terms of whether the cancer can be resected (surgically removed) and whether lymph nodes are affected.

Stage 1 – Mesothelioma tumor can be resected. Lymph nodes are not affected.

Stage 2 – Mesothelioma tumor can be resected. Cancer has spread to nearby lymph nodes.

Stage 3 – Mesothelioma is inoperable because it has spread too far into adjacent tissues and/or organs. Lymph nodes may or may not be involved.

Stage 4 – Mesothelioma has metastasized to other parts of the body distant from the original tumor.

Because the Brigham system has a unique purpose, doctors may use this system in addition to the TNM system.

Related Articles

• Diagnosing Mesothelioma
• Treating Mesothelioma
• Leading Medical Centers for Mesothelioma Treatment
• Pain Management in Mesothelioma

• Chest pain
• Difficulty breathing
• Shortness of breath
• Persistent dry cough

These symptoms are the result of the mesothelioma tumor causing fluid build-up between the two layers of the membrane surrounding the lungs, heart, or abdominal organs.  These membranes are known as the pleural mesothelium, peritoneal mesothelium, or pericaridal mesothelium respectively.

Pleural Mesothelioma

In pleural mesothelioma, this fluid build-up is called pleural effusion.  To determine what’s causing the plueral effusion, the doctor has several tests and procedures available.

Chest X-ray

With a chest X-ray, the doctor can easily see the fluid build-up and determine the symptoms are the result of “water on the lungs” as it’s sometimes called. But pleural effusion can be caused by many diseases, almost all of which are far more likely to occur than mesothelioma.

• Pneumonia
• Lung infections
• Tuberculosis
• Congestive heart failure
• Kidney disease
• Bowel disease
• Pericarditis
• Liver disease
• Pancreas disease
• Rheumatoid arthritis
• Lupus
• Lung tumor
• Blood clot in the lung

Depending on how advanced the disease is, the X-ray may also show signs of plaque, calcification or scarring that can be indicative of asbestosis – an asbestos-caused disease that frequently occurs in advance of mesothelioma.  Additionally, the X-ray may reveal a mass that could indicate a possible tumor.

Thoracentesis

To narrow down the potential causes, the doctor must take a sample of the fluid.  The procedure, a thoracentesis, involves using a local anesthetic and inserting a needle through the skin into the pleural space to withdraw a small amount of fluid.  Examination of the fluid classifies it as transudate or exudate.

• Transudate is a clear fluid and can signal congestive heart failure or kidney, bowel, or liver disease, or an inflammation of the membrane surrounding the heart (pericarditis).
• Exudate is a cloudy fluid indicating an infection, tumor, blood clot in the lung, or any of the other remaining diseases on the list.

Knowing the possibilities, the doctor can explore the patient’s signs and symptoms more closely to determine which are the more likely possibilities and order the appropriate follow-up tests.

Scans

If the signs begin pointing toward some type of tumor or other visible disease process, the doctor will use a more detailed imaging method such as a CT scan, MRI, or PET scan to gather additional information for diagnosis.

CT Scan. Computerized tomography (CT) can provide further evidence of mesothelioma, but it may not be definitive.  From a CT scan alone, the doctor may not be able to effectively distinguish mesothelioma from  asbestos pleural disease or a lung cancer tumor that has spread to the lung lining.

MRI. Magnetic resonance imaging (MRI) provides more detailed images of internal structures, allowing the doctor to more clearly see any tumors and their locations, as well as assess other internal conditions that may determine whether surgical treatment is feasible.

PET Scan. Rather than showing structures within the body, positron emission tomography (PET) reveals biological functioning.  Using slightly radioactive substances that are absorbed during biological processes, the PET scan can show the location, or degree, or efficiency of these processes. Rather than for diagnosis, PET is used more in determining the stage of the mesothelioma tumor for deciding on treatment options. 

Thoracoscopy

As the evidence mounts of a tumor on the mesothelium, the doctor must ultimately collect a tissue sample from the tumor to make a definitive diagnosis.  Knowing the location of the suspect mass from earlier scans, the doctor uses a thoracoscope to look inside the chest through a small incision while the patient is under a local or a general anesthetic. After pinpointing and examining the mass, the doctor takes a small biopsy for laboratory examination.

Pathology

The pathologist examining the tissue sample must first distinguish the tumor cells to determine what kind of cancer cells they are. When mesothelioma is determined, the cells can be examined further to determine if the cancer is sarcomatous, epithelial, or biphasic.

If the doctor took tissue samples from more than one location, the presence or absence of cancer cells in different locations can help determine to what degree the cancer may have spread. This information can be useful in determining the cancer stage, which is important in determining an appropriate treatment strategy.

Peritoneal and Pericardial Mesothelioma

When mesothelioma attacks the membrane surrounding the abdominal organs rather than the lungs, the disease is referred to as peritoneal mesothelioma. Though pleural mesothelioma is most common, peritoneal mesothelioma occurs in about 25% of cases. If the doctor needs to drain excess fluid collecting between the two layers of the peritoneum, the procedure is called peritoneocentesis. The procedure for the internal examination is peritoneoscopy and the device used is a peritoneoscope. 

Mesothelioma of the membrane surrounding the heart (pericardial mesothelioma) only occurs in 5% to 10% of cases, but diagnosis is similar.

Related Articles

• Asbestosis – The Disease
• Cancer Staging for Mesothelioma
• Treating Mesothelioma
• Leading Medical Centers for Mesothelioma Treatment
• How to Find Clinical Trials for Mesothelioma