Mesothelioma is difficult to diagnose. It's often hard to see on imaging scans, and it's rarely diagnosed before symptoms appear.
Having advanced diagnostic technology is helpful for a mesothelioma diagnosis, but it's only one part of the equation. Experts at Penn Medicine's Mesothelioma Program combine years of training and experience with the latest technology to make accurate diagnoses that lead to the right treatment.
How is Mesothelioma Diagnosed?
The first step of the mesothelioma diagnosis process is a physical examination. During this appointment, your doctor asks about your medical history, including potential asbestos exposure in your past. Learn more about mesothelioma causes, risks and prevention.
During the exam, your doctor uses a stethoscope to listen to your lungs, heart, and abdomen and check for common signs of mesothelioma:
- Pleural effusion (fluid buildup in the lungs)
- Ascites (fluid buildup in the abdomen)
- Pericardial effusion (fluid buildup in the sac around the heart)
In rare cases, if your doctor suspects mesothelioma of the tunica vaginalis (mesothelioma in the lining of the testicles), they may perform a physical examination of the groin area for symptoms that mimic a hernia.
After an exam, your doctor may order additional testing that can help confirm or rule out mesothelioma.
Imaging Tests for Mesothelioma
Our mesothelioma experts use the latest imaging techniques for more accurate mesothelioma diagnoses. Some of these techniques include:
- X-rays: X-rays are often the first step in a mesothelioma diagnosis. This technology produces pictures of your lungs that can show signs of mesothelioma or other lung diseases.
- Computed tomography (CT) scans: Computed tomography uses X-rays from many different angles to create detailed images of the lungs. The high-resolution images allow doctors to see the differences between soft tissues and fluid buildup (which often occurs with mesothelioma) with more clarity.
- Magnetic resonance imaging (MRI) scans: MRI uses magnetic fields and radio waves to create images of the body that help show the type and progression of cancer.
- Positron emission tomography (PET) scans: This nuclear medicine scanning technique uses a radioactive substance to create an image of organ and tissue function. This scan helps determine if cancer has spread.
- Echocardiograms: This ultrasound of the heart can show pericardial effusion (fluid around your heart) which is a symptom of pericardial mesothelioma.
Biopsy
Doctors often recommend a biopsy for anyone with mesothelioma symptoms or a history of asbestos exposure. A biopsy involves collecting fluid or tissue samples for examination under a microscope to check for cancer cells. It is the only definitive test for mesothelioma.
- Fluid biopsy removes bodily fluids for testing. Your doctor may remove fluid from your chest (thoracentesis), abdomen (paracentesis), or the sac around your heart (pericardiocentesis). Your doctor numbs your skin with local anesthesia. They insert a thin, hollow needle and use it to extract a small sample of fluid. If needed, an ultrasound or echocardiogram can help guide the needle placement.
- Needle biopsy removes a small bit of tissue for testing. After the skin is numbed, your doctor inserts a thin needle into the skin of your chest, between your ribs, and into your pleura. Imaging tests can help guide the needle.
- Endoscopic biopsy may help when a needle biopsy can't provide enough tissue for testing. During these procedures, your doctor inserts a thin tube with a light and camera into the part of the body that needs evaluation. For example, a bronchoscopy goes through the nose or mouth into the lungs.
- Surgical biopsy is an option if results from a different type of biopsy are unclear or if a needle biopsy is not recommended for medical reasons. Your doctor makes an incision in your chest or abdomen to take a sample of tissue and look for signs of cancer.
Mesothelioma Staging
Doctors use staging to describe the size and growth of a cancer. This information is crucial for determining the best mesothelioma treatment and clinical trials for you.
Unlike other cancers, mesothelioma is staged into broad categories depending on where the cancer is and whether it can be surgically removed. The categories include:
- Local and resectable: The cancer has not spread outside the area where it started and can be surgically removed.
- Local and not resectable: The mesothelioma has not spread outside its area of origin, but it cannot be surgically removed.
- Metastasized and not resectable: The cancer has spread to other areas of the body and cannot be surgically removed.
Why Choose Penn Medicine for Mesothelioma Diagnosis?
People travel from across the country to seek the expert care of our mesothelioma specialists and our:
- Vast experience and skill: Our team has years of experience diagnosing and treating this complex condition. We are skilled at using the latest tests, including endoscopic techniques, to accurately biopsy and diagnose mesothelioma. We take the time to explain what diagnostic and staging tests show and work with you to create the right treatment plan.
- Research-backed techniques and tools: Our physicians are also active researchers who participate in studies and clinical trials designed to advance the understanding of and treatment for mesothelioma. Our team helped develop TumorGlow® technology. This technique illuminates cancer cells during surgery to help surgeons identify and remove mesothelioma tumors with more accuracy. We offer TumorGlow and other innovative treatments like CAR T-cell therapy to select patients through clinical trials.
- Second opinions: Having an accurate diagnosis is the most important step towards the best possible treatment. Getting a second opinion will give you confidence that you are pursuing the right treatment for your specific cancer and circumstances.
Make an Appointment
Please call 800-789-7366 or make an appointment.