Mesothelioma Awareness – Part 2: Problems of a Mesothelioma Diagnosis

Awareness // August 31, 2016
September 26, 2016 is Mesothelioma Awareness Day, and as part of a month-long awareness effort, the Mesothelioma + Asbestos Awareness Center is publishing a series of posts on various issues related to this deadly cancer. In our first post, we discussed how asbestos exposure leads to the development of mesothelioma. Today, we are talking about the diagnosis process, and how difficult it can be to even detect the disease.

One of the reasons why mesothelioma is so deadly is that it is hard to diagnose. For one thing, it’s an extremely rare form of cancer, with only about 3,000 people being diagnosed each year. As such, many people are uncommon with the seriousness of it, and how it can be detected.

Diagnosis Starts with Recognizing Mesothelioma Symptoms

Because this form of cancer is so rare, few people are aware of the symptoms of mesothelioma. In fact, in the early stages, symptoms can mimic much less malignant maladies. For example, pleural mesothelioma – that is, mesothelioma originating in the lining of the lungs – could initially manifest as simple fatigue or a persistent hoarseness. Likewise, peritoneal mesothelioma (which develops in the abdominal lining) could present as nausea or a pain in the abdominal area that might have a number of potential explanations.

The most important thing when experiencing potential symptoms of mesothelioma is to make sure that you go to the doctor and get them checked out. Don’t just assume that such symptoms will go away on their own. It is always best to discover the true medical cause behind pain, discomfort, and other symptoms, rather than waiting until they become severe or unmanageable.

This is especially true if you have a history of exposure to asbestos. As we discussed in last week’s post, asbestos exposure is the only scientifically proven cause of mesothelioma. If you have worked around asbestos, know of asbestos in your home or another place where you live, or even know whether you have been exposed secondhand by a relative or friend, make sure to mention that to your doctor when you have your symptoms checked out.

Detecting Mesothelioma Early Can Improve Prognosis

The prognosis for mesothelioma is, unfortunately, very poor overall. However, there are some things that people can do to improve diagnosis. One of those things is being diagnosed at an early stage (which is why getting symptoms checked out right away is such a big deal!).

Given the benefits of early detection, a lot of research in recent years has been given to finding better ways to tell if somebody has mesothelioma. Most of these efforts have been around discovering what are known as biomarkers, that is, substances in the blood which indicate that mesothelioma (or cancer in general) is present in the body. Blood tests known as “assays” are used to look for these biomarkers.

Unfortunately, the biomarkers that have been developed so far have not been entirely successful in finding mesothelioma early. In particular, the Mesomark assay has a relatively low sensitivity, which means that the effectiveness of the test is less than optimal. Although Mesomark has been approved by the FDA for mesothelioma testing, it cannot be used to diagnose mesothelioma on its own.

Recently, however, a new biomarker has been shown to successfully detect individuals who have mesothelioma. This biomarker, known as high mobility group box protein 1 (HMGB1), is so sensitive that it can even distinguish between people with mesothelioma and those who have been exposed to asbestos, but have not yet developed the deadly cancer. Although these results need to be verified with further tests, it is a very promising development in the early detection of mesothelioma.

All in all, biomarker assays currently represent the best opportunity for detecting mesothelioma early. Even if they can’t be used as standalone diagnostic tools, they can help point doctors in the right direction.

Biopsies Are the Only Way to Confirm Mesothelioma Diagnosis

In addition to biomarker assays, doctors can use other tools in the effort to determine a mesothelioma diagnosis. In many cases, these may include imaging tests such as X-rays, CT scans, PET scans, and MRI scans. These imaging tests vary in quality and usefulness, and ultimately they cannot provide a diagnosis on their own.

The only currently recognized way to confirm a mesothelioma diagnosis is through a biopsy. The purpose of a biopsy is to obtain a sample of cancerous tissue which can then be studied under a microscope by a pathologist to determine the type of mesothelioma (or other cancer) a person may have.

Due to the extremely invasive nature of biopsies, they are often used as a last resort. Doctors will typically try to rule out more common diagnoses first, using less invasive tests and procedures. However, when an oncologist suspects that mesothelioma is the culprit, they will ultimately have to take a tissue sample to verify their diagnosis.

The least invasive type of biopsy is known as a “fine-needle aspiration,” in which a long, thin needle is used to take same fluid from the area around the tumor. Ideally, enough cancer cells will be present in the fluid to make a diagnosis. If a larger sample of tissue is needed, the doctor may make a small incision, then use a tube with a scope in it to visualize the tumor and then take a sample directly. However, if neither the fine-needle aspiration or the endoscopic biopsies are sufficient, a more invasive surgery that opens up the chest or abdomen may be required to get a tumor sample.

Although biopsies can be painful, the ultimate goal is to understand what is causing the symptoms that a patient is feeling. This allows doctors to develop an appropriate plan of treatment – which we will talk about in the next part of our mesothelioma awareness series!