Mesothelioma misdiagnosis occurs when a doctor mistakes mesothelioma for a different, less serious condition. Misdiagnosis of mesothelioma is common because the symptoms of the cancer often resemble other conditions such as a cold or the flu. A second opinion is recommended.
Dr. Andrea Wolf: Why is mesothelioma often misdiagnosed?
The diagnosis of mesothelioma is actually quite challenging.
It is often delayed, in fact. The patients will often present with somewhat non-specific symptoms such as chest pain or shortness of breath or even a cough, and they are found to have fluid outside of the lung but inside of the rib cage. And there are several processes that can cause this, and early on, the first steps to evaluate that are just draining that fluid out and sending it for sampling.
Unfortunately, the sensitivity of tests of that fluid to diagnose mesothelioma is not great, and so the diagnosis is frequently missed. So people will undergo repeated drainage of fluid and not get a diagnosis of cancer at all. Or if they are diagnosed with cancer, unfortunately there are some unique aspects to mesothelioma at a microscopic level that requires some expertise on the part of the pathologist or the person called a cytopathologist, who looks at cells, to evaluate.
In fact, with mesothelioma, it's often required that some tissue be evaluated, and that has a higher accuracy rate than just the fluid itself. And it really does require experience on the parts of the clinicians, a high index of suspicion on the part of the clinician evaluating the patient, and some expertise among the team--
the pathologists and cytopathologists who are looking at those samples.
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Dr. Andrea Wolf: Why is mesothelioma often misdiagnosed?
The diagnosis of mesothelioma is actually quite challenging.
It is often delayed, in fact. The patients will often present with somewhat non-specific symptoms such as chest pain or shortness of breath or even a cough, and they are found to have fluid outside of the lung but inside of the rib cage. And there are several processes that can cause this, and early on, the first steps to evaluate that are just draining that fluid out and sending it for sampling.
Unfortunately, the sensitivity of tests of that fluid to diagnose mesothelioma is not great, and so the diagnosis is frequently missed. So people will undergo repeated drainage of fluid and not get a diagnosis of cancer at all. Or if they are diagnosed with cancer, unfortunately there are some unique aspects to mesothelioma at a microscopic level that requires some expertise on the part of the pathologist or the person called a cytopathologist, who looks at cells, to evaluate.
In fact, with mesothelioma, it's often required that some tissue be evaluated, and that has a higher accuracy rate than just the fluid itself. And it really does require experience on the parts of the clinicians, a high index of suspicion on the part of the clinician evaluating the patient, and some expertise among the team--
the pathologists and cytopathologists who are looking at those samples.
Why Is Mesothelioma Misdiagnosed?
Mesothelioma is often misdiagnosed because its symptoms are vague and overlap with many more common conditions. Accurately diagnosing this cancer is challenging and most doctors have limited experience with it. Fewer than 3,000 cases are diagnosed annually in the U.S.
An accurate mesothelioma diagnosis requires a pathologist or cytopathologist. These doctors look at tissue and cell samples from a biopsy under a microscope to check for signs of cancer. It’s important these experts have experience with malignant mesothelioma.
Learn about your diagnosis, top doctors and how to pay for treatment in our free mesothelioma guide.
A 2023 study published in the Journal of Thoracic Oncology found 14% of mesothelioma diagnoses in countries with well-resourced pathology services. This misdiagnosis rate increases to nearly 50% in countries with limited pathology resources.
Other reports have found around 33% of women with pleural mesothelioma were initially misdiagnosed with ovarian cancer. This is partly because pleural mesothelioma can elevate cancer antigen 125, a blood protein linked to ovarian cancer.
Insight From a Mesothelioma Specialist
Mesothelioma misdiagnosis happens because the diagnosis of mesothelioma is actually quite challenging. There are some unique aspects to mesothelioma at a microscopic level that require expertise on the part of the pathologist or cytopathologist to evaluate. It really does require experience on the part of the clinician and the team.
Dr. Andrea Wolf, director of the New York Mesothelioma Program at Mount Sinai
Common Misdiagnoses of Pleural Mesothelioma
Pleural mesothelioma, which develops on the lining around the lungs, is often mistaken for other more common respiratory conditions like emphysema and pneumonia. People with mesothelioma may initially experience shortness of breath, a dry cough or chest pain, making it difficult to tell it apart from other respiratory conditions at first.
Conditions Often Confused With Pleural Mesothelioma
Pleural mesothelioma can also cause difficulty breathing and pleural effusion, which is a buildup of fluid around the lungs. Other chronic lung diseases, infections and lung cancer can all have similar symptoms. Once your pleural mesothelioma diagnosis is confirmed, your doctor will create a personalized treatment plan for you.
The Right Mesothelioma Specialist, Without the Wait
We make getting expert care from the nation’s top mesothelioma specialists easy.
Peritoneal mesothelioma, which forms on the lining around the organs in the abdomen, is often mistaken for irritable bowel syndrome, gallstones and other cancers. Belly pain and digestive issues can also be associated with many other common conditions.
Peritoneal Mesothelioma Misdiagnosis Examples
Gallstones
Hernia
Irritable bowel syndrome
Other abdominal cancers
Ovarian cancer
A study in BMC Gastroenterology presented the case of a man with previous asbestos exposure. He had a rare type of mesothelioma called benign multicystic peritoneal mesothelioma. But he was first misdiagnosed with hydatid cysts in the liver and abdomen. He experienced belly pain and bloating. Imaging scans showed he had many cysts filled with clear fluid. When he didn’t respond to the treatment, his doctors did further tests.
Find a specialist if you’ve been exposed to asbestos and have symptoms associated with peritoneal mesothelioma. It’s important to be diagnosed as early as possible to begin treatment right away.
Tamron Little
Verified Asbestos.com Survivor
Survivor’s Early Misdiagnosis Delayed Treatment
Initially misdiagnosed with a fibroid tumor, a laparoscopy revealed Tamron’s peritoneal mesothelioma. Her doctor’s unfamiliarity with mesothelioma led Tamron to seek a second opinion from specialist Dr. Levine. He offered clear options and hope. Tamron tells us a second opinion with an expert was a crucial step in her journey to becoming an 18-year mesothelioma survivor.
Common Misdiagnoses of Pericardial Mesothelioma
Pericardial mesothelioma, which affects the pericardium or sac surrounding the heart, is commonly mistaken for heart disease and heart failure. This type of mesothelioma is very rare and shares symptoms with more common conditions. It often causes pericardial effusion, which is a buildup of fluid around the heart. It may cause chest pain and other heart symptoms. This makes it hard to diagnose early.
Conditions With Symptoms Similar to Pericardial Mesothelioma
Angiosarcoma
Cardiac tamponade
Cardiomyopathy
Congestive heart failure
Constrictive pericarditis
Coronary artery disease
Heart disease
Intra-atrial myxoma
Metastatic lung cancer
Tuberculous pericarditis
A 2023 case report described a woman with pericardial calcification. It’s a condition in which calcium deposits form in the heart’s outer sac. This first resulted in a diagnosis of constrictive pericarditis. Doctors found primary pericardial mesothelioma after a CT scan and a biopsy.
Blood tests, X-rays and CT scans can rule out other conditions, but they can’t diagnose pericardial mesothelioma. A biopsy to collect tissue samples for laboratory analysis is needed.
When to Question a Diagnosis
Your symptoms (chest pain, breathing problems, fluid buildup) persist or worsen despite treatment for another condition.
You have a history of asbestos exposure and new or worsening respiratory or abdominal symptoms.
Your diagnosis was based only on imaging or fluid tests without a tissue biopsy to confirm.
Source: If any of these apply, ask your doctor about getting a second opinion from a mesothelioma specialist.
How Can a Mesothelioma Misdiagnosis Affect You?
When mesothelioma is mistaken for another condition, it can have serious consequences. The hidden costs of misdiagnosis include delayed treatment and even costly incorrect therapies for your disease. The longer treatment is postponed from the onset of mesothelioma symptoms, the fewer effective options may be available to you.
Why an Accurate Diagnosis Matters
Enables proper treatment planning: You can access mesothelioma-specific treatments and clinical trials designed for their condition.
Ensures targeted care: Therapies you receive are specifically designed for mesothelioma rather than treatments for other diseases.
Improves treatment outcomes: Early, correct diagnosis allows doctors to begin the most effective therapies when they’re likely to be most successful.
Prevents unnecessary costs: Avoiding wrong treatments and redundant testing saves money that can be used for appropriate care.
Reduces emotional stress: A clear diagnosis helps you and your family understand what you’re facing and make informed decisions.
In our exclusive 2025 survey of cancer patients, 14% of those ultimately diagnosed with mesothelioma reported being treated for the wrong condition before receiving the correct diagnosis. Thoracic surgeon Dr. Jeffrey Velotta tells us, “If you can catch mesothelioma earlier on, the idea is you can intervene and do more treatment, whether it’s surgery, chemotherapy, or immunotherapy. So the earlier we catch it, the more chances you have for living longer.”
Treated for the Wrong Condition
14%
of patients received treatment for another illness before being correctly diagnosed.
Source: The Mesothelioma Center at Asbestos.com, 2025
Requested Second Opinion
21%
of patients who sought a second opinion left with a completely new diagnosis.
How Do Specialists Accurately Diagnose Mesothelioma?
Specialists follow a multi-step, evidence-based process to identify mesothelioma. The key step in a mesothelioma diagnosis is a biopsy, which is needed to confirm a diagnosis. Mesothelioma doctors use these methods to distinguish this cancer from other conditions.
Tools Specialists Use to Diagnose Mesothelioma
Comprehensive medical historyand physical exam: Providers assess symptoms and review asbestos exposure, which is the leading risk factor.
Fluid analysis: Fluid from the chest, abdomen or heart is tested for cancer cells.
Imaging tests: X-rays, CT scans, MRIs and PET scans reveal abnormal growths, fluid buildup and help stage cancer.
Pathology and biomarker testing: Specialists use immunohistochemistry and molecular testing to differentiate mesothelioma from other cancers.
Staging workup: PET scans, CT and MRI assess cancer spread for personalized treatment planning.
Tissue biopsy: Biopsy is the gold standard for mesothelioma diagnosis, allowing a pathologist to analyze tissue for cancer cells and determine cell type.
Accurate diagnosis depends on coordination between oncologists, pulmonologists, radiologists and pathologists with direct experience with mesothelioma. This collaborative approach helps avoid misdiagnosis and enables targeted, effective treatments.
X-ray images of lungs with pleural mesothelioma (left) and pneumonia (right). Pneumonia is a common misdiagnosis of mesothelioma.
Getting a Second Opinion After a Mesothelioma Diagnosis
People who suspect they have mesothelioma should seek a mesothelioma second opinion from an expert. Once an experienced pathologist confirms a mesothelioma diagnosis, a specialist will develop a personalized treatment plan.
Mesothelioma survivor Kasie Coleman tells us that she experienced ongoing symptoms for more than a year and was repeatedly misdiagnosed. She was finally diagnosed with peritoneal mesothelioma in 2010.
Some people also seek second opinions about their treatment, advocating for themselves to help extend their life expectancy. Our team of Patient Advocates can help you find the right mesothelioma specialist for you and schedule your appointment.
A 2023 study showed 14% of mesothelioma diagnoses in developed countries are incorrect. While more than half of all mesothelioma patients in developing nations were misdiagnosed.
Limited experience in diagnosing mesothelioma and a tendency to make a definitive diagnosis without sufficient evidence leads to many misdiagnoses.
Patients with a history of asbestos exposure and symptoms consistent with mesothelioma should consult a specialist to avoid both delay in diagnosis and misdiagnosis that could prolong access to life-saving treatment and affect their overall survival.
Common Questions About Mesothelioma Misdiagnosis
Why is mesothelioma so difficult to diagnose?
Mesothelioma is a very rare cancer, which means few doctors have experience with it. Its symptoms are vague and like those of other, more common diseases, leading many doctors to initially misdiagnose someone with more common conditions. Further complicating matters, mesothelioma can develop decades after initial exposure to asbestos.
What diseases or conditions mimic mesothelioma?
Diseases that mimic mesothelioma include pneumonia, emphysema and the flu. Other conditions also include gallstones, hernias, irritable bowel syndrome and ovarian cancer. Doctors say abdominal pain, digestive issues and heart disease may resemble mesothelioma. So may lupus, tuberculosis and other cancers.
How can a mesothelioma diagnosis be confirmed?
A biopsy of the suspected tissue is the only way to confirm a mesothelioma diagnosis. A pathologist must then examine it. Doctors may also use imaging tests, like X-rays, CT scans and MRIs, to find any abnormalities. Blood tests for biomarkers can help diagnose mesothelioma.
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Professional Contributors Featured In This Article
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Dr. Raja Flores is chairman of the Department of Thoracic Surgery at Mount Sinai Hospital and a professor of surgery at the Icahn School of Medicine in New York City. He is a world leader in the treatment of pleural mesothelioma.
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