How Is Mesothelioma Diagnosed?

Biopsies are the only tests that can confirm a mesothelioma diagnosis. Doctors extract tissue samples during a biopsy, examining them under a microscope to detect cancer cells. The highly accurate thoracoscopy biopsy boasts a 98% diagnostic rate for mesothelioma. Additional tests aid in staging tumors and monitoring treatment response.

In general, the steps for testing for mesothelioma include:
  • Biopsies
  • Blood tests
  • Imaging tests
  • Physical exam

The Patient Advocates at The Mesothelioma Center say many patients they speak with have told them they were diagnosed after going to the hospital for what they thought was an unrelated symptom.

Mesothelioma survivor Wendy M. Phillips told The Mesothelioma Center that she went to the hospital with a swollen arm and was initially told she had a blood clot. Further testing revealed mesothelioma tumors were blocking her lymph nodes.

All in all, this was a three-month journey to a correct diagnosis.
Wendy Phillips

Testing for Mesothelioma

The different types of tests used to diagnose mesothelioma include biopsies, imaging scans, blood tests and physical exams. The results of other medical tests, such as routine blood work or chest X-rays, may indicate the need for cancer testing that eventually leads to a mesothelioma biopsy. The diagnostic process isn’t linear for everyone, and the order of tests varies significantly.

Process of how mesothelioma is diagnosed
Accurately diagnosing malignant mesothelioma takes several steps and involves a variety of tests.

The first step in diagnosing mesothelioma is typically a physical exam. Based on your asbestos exposure history, your doctor will look for symptoms of mesothelioma. Doctors use imaging scans to identify the location and size of tumors. Mesothelioma blood tests are not accurate enough to diagnose the disease.

“Most people who reach out to the Patient Advocate team about diagnosing mesothelioma are looking for a second opinion,” said Patient Advocate Dr. Snehal Smart. “We can help connect them with mesothelioma specialists and arrange appointments and treatment if they do receive a confirmed mesothelioma diagnosis.”

What Happens During a Mesothelioma Biopsy?

A biopsy is the only definitive way to find out if a patient has mesothelioma. During this procedure, small samples of fluid or tissue are taken from the patient and looked at under a microscope to check for cancer cells. These samples help doctors diagnose the type and stage of the cancer so they can plan the best treatment.

Biopsy options include:
  • Fine Needle Aspiration or Cytology: For tissue samples that are hard to obtain
  • Laparoscopy: Best for peritoneal mesothelioma
  • Mediastinoscopy: For biopsies of the lymph nodes and around the windpipe for pleural cases
  • Thoracoscopy: Most accurate for pleural mesothelioma

The process differs for each type of mesothelioma biopsy, including the lengths of hospital stays, but doctors always provide anesthesia to reduce pain. You may need to monitor the incision site for signs of infection after the procedure.

Pathologists look at biopsy samples under a microscope to see what types of cancerous cells are present. They use immunohistochemical testing and other pathology techniques to identify mesothelioma cells.

How Doctors Determine Stages of Mesothelioma Cancer

Doctors use the same diagnostic procedures, such as biopsies and imaging tests, to stage mesothelioma cancer.

  • Biopsies and Imaging Tests: Reveal location and size of mesothelioma tumors
  • Imaging Scans: Show location and size of tumors in tissues, lymph nodes and other organs
  • Tissue and Lymph Node Biopsies: Confirm location and spread of tumors

Blood tests do not play a role in staging mesothelioma. 

Imaging scans often occur before biopsy procedures to help determine where to collect tissue samples.  Some patients may receive a biopsy before imaging. Results of these tests commonly take several days to weeks depending upon how busy the center is. Most patients learn about their stage when they are told they have a mesothelioma diagnosis.

If we could diagnose patients a year earlier, we could start treatment earlier. Then we’d put them in protective mode where we monitor, rather than manage, advanced tumor growth.
Dr. Jeffrey Velotta
Thoracic surgeon at Kaiser Permanente Oakland Medical Center

Imaging scans help to visualize tumors and track their response to treatment. The gold standard for mesothelioma imaging is a combination PET-CT scan with contrast dye. MRIs can also show whether metastasis or spreading has occurred.

“I did get used to the routine of going in for scans, but I still experienced ‘scanxiety,’” said peritoneal mesothelioma survivor Tamron Little, who used positive thinking to overcome anxiety. “Think positive thoughts. I know this may seem cliché, but it works. Thinking positively will take your mind off the scan.”

Why Is Mesothelioma Difficult to Diagnose?

Diagnosing mesothelioma is difficult because symptoms often mimic more common illnesses. The initial symptoms of mesothelioma also can resemble lung cancer and other chest issues. This is important for people with a history of asbestos exposure to know because they should discuss the possibility of a mesothelioma diagnosis with their doctor at the first sign of symptoms.

The decades-long latency period between asbestos exposure and development of mesothelioma means 20 to 60 years may pass before symptoms arise. Patients may not mention asbestos to their doctor because they do not remember the exposure. As a result, their doctor might not consider mesothelioma as a possible diagnosis. 

Getting a second opinion from a mesothelioma specialist is important because many primary care physicians and oncologists have never encountered mesothelioma. Sometimes they misdiagnose mesothelioma as a less severe disease or another cancer.

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What to Do After a Mesothelioma Diagnosis

Deciding on treatment is the most important first step after a mesothelioma diagnosis. Treatment for mesothelioma may include surgery, chemotherapy, radiation therapy or immunotherapy.

The treatments your doctor recommends depend on where the tumors formed, their cell type and stage of progression. Doctors specializing in mesothelioma provide access to innovative therapies and clinical trials

Receiving a mesothelioma diagnosis can feel overwhelming to patients and their families. One of the best coping strategies is to build a mesothelioma support network. Reach out to family, friends, neighbors and community members. A strong support system will help you get through the challenges of a mesothelioma diagnosis.

Ask your cancer center if there is a social worker who can help you access local family resources. It may also have a therapist available for counseling. Inquire about cancer support groups as well. Talking with others who understand your challenges is a healthy way to process stress.

Survivor Story
Joe Barna Mesothelioma Survivor

Survivor Enjoys Exciting New Chapter

Survivor Story

Joe Barna, diagnosed with pleural mesothelioma in April 2018, got married just 13 months after his diagnosis, defying the grim six-month prognosis. After undergoing successful pleurectomy and decortication surgery in August 2018, Joe’s checkups have shown no recurrence. Now, Joe and his wife Theresa embrace a life together, cherishing moments and planning for a bright future.

Read Joe’s Story

Common Questions About Diagnosing Mesothelioma

What should you do if you think you have mesothelioma?

If you have a history of asbestos exposure and develop mesothelioma symptoms, make an appointment with your primary care physician. If they believe you need further testing, they will refer you to a specialist.

How long does it take to get a mesothelioma diagnosis?

The average time from initial symptoms, such as shortness of breath or chest pain, to a mesothelioma diagnosis is approximately three months.

How do you prepare for a mesothelioma biopsy?

Stop taking any blood-thinning medication at least five days before a biopsy. Wear loose clothing to the appointment, and plan to have a designated driver take you home. Do not eat or drink anything six hours before your appointment. Plan to spend several hours undergoing the biopsy. Some biopsies, such as thoracoscopy, require at least a one-night stay in the hospital.

Why is it important to get a second opinion?

Seeking a second opinion from a mesothelioma specialist is important because they have expertise in diagnosing and treating the disease. A specialist may offer a more accurate diagnosis and recommend better treatment options than a general oncologist.