Mesothelioma Diagnosis

A mesothelioma diagnosis can be a difficult process because the symptoms of mesothelioma may closely resemble those of other common illnesses. It is not uncommon for patients to experience symptoms for four to six months before seeking a doctor. Unfortunately, this time period can allow the mesothelioma to progress to later stages of development.

The initial assessment of a mesothelioma patient begins by obtaining a thorough medical history and conducting a physical examination. Analyzing medical history is standard, however when a doctor suspects mesothelioma, particular attention will be given to the patient's occupational history. In more than 90 percent of all cases, an occupational history will report exposure to asbestos. Once a mesothelioma diagnosis is suspected, imaging tests, biopsies and fluid sampling are generally conducted.

Imaging Tests

Chest X-Ray: The initial imaging study used to evaluate a patient with suspected mesothelioma is the chest x-ray. A chest x-ray is useful for determining the location of the mesothelioma tumor and for visualizing the extent of its spread. Features such as pleural thickening, pleural effusions (fluid collections), and irregular masses are readily visible on chest x-ray. Indeed, the majority of mesothelioma cases will reveal pleural thickening and pleural effusions. While not diagnostically specific for mesothelioma, these features serve to heighten suspicion for the presence of the condition.

CT Scan: A contrast-enhanced CT scan has become the primary imaging modality in the diagnosis of mesothelioma. CT scans can identify the presence of mesothelioma in its earlier stages. Its ability to provide imagery of anatomical structures is far superior to that of chest x-ray. In addition to revealing pleural effusions and pleural thickening, enlarged lymph nodes and pleural masses are more clearly identified with CT. Pleural plaques and calcifications are easily observed on CT, as well as the characteristic rind-like encasing of the lung. CT findings such as pericardial thickening and pericardial effusion are indicators that the tumor has spread to the pericardium of the heart.

MRI Scan: While x-rays and CT scans use radiation, MRI scans utilize powerful magnetic fields and radio waves to provide information about the mesothelioma tumor. Contrast-enhanced MRI scans are able to reveal early chest wall involvement of the tumor, an ability superior to that of CT scans. This is a key finding. A patient with an obviously unresectable tumor can be spared the trauma of unnecessary surgery. However, important staging information can be obtained in patients that are candidates for potentially curative resections.

PET Scan: PET scans provide different information than either CT or MRI scans. For example, PET scans can differentiate between benign and malignant tumors. In addition to providing specific information about tumors deemed unresectable, PET scans provide valuable anatomic and metabolic information about a tumor. A PET scan can also direct the doctor to the most appropriate biopsy site once imaging studies indicate that biopsy is warranted.


In conjunction with radiological suspicion, a tissue sample, or biopsy, must be obtained for a solid mesothelioma diagnosis. Three types of biopsies are common in mesothelioma diagnosis: incisional biopsy, excisional biopsy, and needle-aspiration biopsy. While all biopsies involve the removal of tissue for analysis, some techniques are more invasive than others are. Moreover, depending on the procedure, general, local, or no anesthesia may be necessary.

The incisional biopsy, or core biopsy, is deemed the least invasive and involves the removal of the smallest of tissue. However, a large portion of cases of pleural, peritoneal, and pericardial mesothelioma harbor cells not easily observed using incisional biopsy. In these cases, an excisional biopsy, or the removal of entire areas of tissue, is needed. An excisional biopsy may require a more complicated surgical procedure to retrieve the desired tissue specimens because the linings of internal organs are frequent sites of interest. A needle-aspiration biopsy involves the insertion of a relatively long, hollow needle to obtain a sample of cancer cells.

Next Steps

The next step following a definitive mesothelioma diagnosis is staging of the malignancy. Proper staging of mesothelioma is crucial to rational treatment planning. Mesothelioma is generally classified into one of four stages: Stage I, II, III, and IV, with the stage of the cancer's development increasing with each stage. Generally speaking, patients with stage I and II disease have potentially tumors that may operable. Unfortunately, most patients present with stage III. Patients with this stage and stage IV most benefit from focused palliative care.

A mesothelioma patient and their doctor will work together to detail a treatment plan to combat the cancer. Your doctor will recommend an oncologist (a doctor specializing in cancer) to determine the best treatment options available. offers a complimentary informational packet with details about treatment options and top doctors to mesothelioma patients and their loved ones who fill out the request form on this page.

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