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  • How is pleural mesothelioma diagnosed?

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    The earliest signs of pleural mesothelioma are often vague and similar to other conditions or diseases. If you are concerned, especially if you think you’ve been exposed to asbestos, see your GP.

    Diagnosis

    Usually you begin by seeing your GP or going to a hospital emergency room, perhaps for shortness of breath, chest pain or another symptom. The doctor will examine you, arrange for a number of tests and probably refer you to a specialist, usually a respiratory physician. Your doctor will also take a history of your general health and exposure to asbestos.

    Pleural mesothelioma can be difficult to diagnose. The symptoms of pleural mesothelioma are often the same as those of other diseases and mesothelioma cells can look similar to other types of cancer cells. This is why you are likely to have quite a few tests and there will be different health professionals involved in working out whether you have pleural mesothelioma.

    General tests

    Blood test

    You will have blood taken to check your overall health. A blood test will not show up mesothelioma but it can let your doctors know how your blood cells, liver and kidneys are working.

    Chest x-ray

    You will have a chest x-ray to look for any abnormalities in the lungs, thickening of the pleura and fluid in the space between the lungs and the chest wall. If abnormal growth or other changes are found you will need more tests to find the cause as these changes can also be due to other conditions.

    Draining fluid from the pleura

    In the early stages of pleural mesothelioma the pleura leaks fluid into the pleural cavity. This is called pleural effusion and it makes it hard to breathe. Most people with pleural mesothelioma will experience pleural effusion at some time.

    The feeling of breathlessness can be distressing and your doctor may drain some fluid to relieve this symptom before suggesting further tests or treatment.

    To drain the fluid your doctor numbs the area with a local anaesthetic and inserts a needle through the chest wall into the pleural cavity. An ultrasound scan is used to help the doctor guide the needle to the place where the fluid is. A sample of the fluid is sent to a pathologist for testing to see whether cancer cells are present or whether the pleural effusion is caused by some other disease.

    Draining the fluid from the pleura can be done during video-assisted thoracoscopic surgery or VATS along with a talc pleurodesis to prevent fluid building up again.

    Pleurodesis means closing the pleural space. The doctor inserts sterile talcum powder into the pleural cavity. The talcum powder causes an inflammatory reaction that helps close the space between the two layers of the pleura. After pleurodesis some people experience a burning pain in the chest for 24 to 48 hours. This pain can be eased with medication.

    A respiratory physician may also perform a pleurodesis under local anaesthetic using a fine tube to introduce the sterile talcum powder (slurry). You will lie down for a few hours and be asked to change positions regularly to help distribute the talcum powder throughout the pleural cavity.

     is a type of keyhole surgery. You will be given a general anaesthetic then small cuts will be made between your ribs and a camera will be inserted into the pleural cavity. Samples of the pleura are taken and the tissue is sent to the pathologist for examination.

    Aside from helping to diagnose pleural mesothelioma, VATS can be used to improve the feeling of breathlessness.

    After the VATS you may spend a few days in hospital. Soreness in the front and lower parts of the chest is common because the nerves between the ribs will have been irritated during surgery.

    CT scan

    A computerised tomography (CT) scan uses x-ray beams to create a detailed, three-dimensional picture of the inside of the body.

    The CT scan provides accurate information about the location and thickness of the tumour(s) in the chest. It can also show if the mesothelioma has spread to other organs.

    A CT scan is painless and takes about ten minutes. You will need to lie flat on a table that slides in and out of a large, round scanner. CT scans are usually done at a hospital or a radiology service. Before the scan an iodine contrast dye is usually injected into a vein in your arm to make the scan pictures clearer. You will be asked if you have any allergies to iodine.

    Biopsy

    A biopsy is the main procedure used to diagnose pleural mesothelioma. A doctor will remove a sample of pleural tissue for examination by a pathologist under a microscope.

    A biopsy can be taken in two ways: during VATS or CT-guided core biopsy. While either technique can diagnose pleural mesothelioma both have pros and cons.

    CT-guided core biopsy

    You will have a local anaesthetic and a needle will be passed between your ribs into the thickest part of the diseased pleura. A CT scan will be used to guide the needle into position. During the procedure you will need to lie still on a table, either on your back or front, for about 30 minutes.

    Other ways to diagnose mesothelioma

    In some cases a fluid sample rather than a tissue sample may be used to make a diagnosis because it’s easier to collect fluid removed while draining the pleural cavity.

    Combining results from the fluid samples with information from an x-ray and CT scan (that show the tumour present in adjacent tissue) can provide information for the diagnosis.

    What health professionals will I see?

    If you have pleural mesothelioma you will be cared for by a range of health professionals who specialise in different aspects of your treatment. The health professionals involved in your treatment will take a team-based approach by referring you to a multidisciplinary team. This multidisciplinary team will probably include some or all of the health professionals described below.

    general practitioner (GP)

    responsible for general health and coordinates specialist treatment

    radiologist

    specialises in reading x-rays, CT scans and other medical imaging

    respiratory physician

    investigates symptoms, begins the process of diagnosis, stages the cancer and determines initial treatment options

    interventional radiologist

    uses CT scan to guide instrument to the best position for draining fluid and removing tissue for diagnosis

    pathologist

    examines tissue under the microscope to determine the type and extent of the cancer

    nurses/nurse care coordinator

    supports you through all stages of your treatment and liaises with other health care staff to help organise care

    thoracic surgeon

    a specialist surgeon who conducts biopsy procedures and performs surgery

    medical oncologist

    prescribes and coordinates the course of chemotherapy

    radiation oncologist

    prescribes and coordinates the course of radiotherapy

    palliative care team

    (doctors, nurses and allied health professionals) assists with control of pain, nausea, depression and anxiety, as well as offering emotional and spiritual support

    dietitian

    recommends an eating plan to follow while you're in treatment and recovery

    psychologist

    provides emotional support and strategies to help deal with the impact of the disease

    community nurse

    visits you at home to give prescribed medical treatment, assesses your needs for supportive care and liaises with your GP and multidisciplinary team as required

    social worker

    provides counselling and support, links you to support services and helps with practical issues

    physiotherapist

    helps with maintaining and restoring strength and fitness during and after treatment

    occupational therapist

    assesses changes needed to your home and recommends equipment to assist with safety and mobility

    Information last reviewed June 2015 by: Theodora Ahilas, Principal, Maurice Blackburn Lawyers, NSW; Shirley Bare, Support Group Facilitator, Asbestoswise, VIC; Geoffrey Dickin, Consumer; Victoria Keena, Executive Officer, Asbestos Diseases Research Institute, NSW; Angela Kyttaridis, Social Worker, Concord Repatriation General Hospital, NSW; Jocelyn McLean, Mesothelioma Support Coordinator, Asbestos Diseases Research Institute, NSW; Kirsten Mooney, Thoracic Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, Department of Health, WA; Clin/Prof AW Musk AM, Schools of Population Health and Medicine, University of Western Australia, and Physician, Sir Charles Gairdner Hospital, Nedlands, WA; Dr Andrew Penman AM, Consultant, Asbestos Diseases Research Institute, NSW; Tanya Segelov, Partner, Turner Freeman Lawyers, NSW; Roswitha Stegmann, 13 11 20 Consultant, Cancer Council Western Australia, WA; Dr Mo Mo Tin, Staff Specialist Radiation Oncology, Chris O’Brien Lifehouse, NSW; and Prof Nico van Zandwijk, Director of the Asbestos Diseases Research Institute and Professor of Medicine, University of Sydney, NSW.

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