Mesothelioma has a poor prognosis. However, many studies of the disease have shown that early detection and diagnosis can significantly improve the chances of survival. Catching mesothelioma before it spreads can increase the effectiveness of treatments, as well as open opportunities to try more aggressive treatments that might not otherwise be available.
Following initial treatment for mesothelioma, patients enter a period of cancer recovery and survivorship. Cancer survivors may choose to participate in a survivorship care plan, which includes a summary of treatment and a detailed plan that includes follow-up appointments and surveillance for recurrent disease and treatment side effects. The overarching goal of a survivorship care plan is to ensure that patients with mesothelioma continue to receive care and support during recovery.
To support patients and families through this process, there is a dedicated mesothelioma support team consisting of social work, chaplaincy and patient liaison. These professionals provide counseling and spiritual support as well as practical help navigating care, housing and travel needs.
Even if no cancer cells are found in the fluid, a person might still have cancer. In many cases, doctors need to get an actual sample of the mesothelium (the pleura, peritoneum, or pericardium) to determine if a person has mesothelioma.
Pleural contamination with asbestos or other mineral fibers has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers). However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from , unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System.
Biopsy Procedures If imaging scans reveal any suspicious growths on the pleura or other structures of the chest, doctors must collect a tissue sample for further testing, and sometimes pleural fluid is collected and tested. The procedure to remove these samples is known as a biopsy, and there are several biopsy techniques doctors can use to make a diagnosis. Biopsy is the most effective procedure for diagnosing pleural mesothelioma. Samples can be collected using a needle or with other devices through open surgery. Regardless of approach, biopsy samples are sent to a medical specialist called a pathologist, who looks at samples through a microscope and performs other laboratory tests to determine if the patient has cancer, and if so, what type. In one biopsy technique called thoracentesis, doctors use a needle to collect a fluid sample from the pleural cavity of patients with pleural effusion. The sensitivity of this technique is less than 50 percent for pleural mesothelioma, meaning it accurately identifies patients with the disease less than half the time. A more effective technique called needle biopsy uses a long, hollow needle to extract a small tumor sample. In some cases, however, the tumor sample is not large enough and other techniques may be required. If a larger sample is needed, the doctor may perform an open surgical biopsy and remove some of the tumor through an incision in the chest. The most accurate and highly-recommended biopsy technique for diagnosing pleural mesothelioma is called video-assisted thoracic surgery (VATS) or a thoracoscopy. In this procedure, doctors put patients under general anesthesia before making one or two small incisions in the chest. Using a camera-fitted tool called a thoracoscope, the surgeon watches a video screen as he or she collects a sample of tumor cells. VATS can correctly identify patients with pleural mesothelioma with a sensitivity of 95 to 98 percent, and the procedure usually takes less than an hour. The recovery time with VATS is also significantly less than open surgical biopsy. It’s important to work with a mesothelioma specialist and a cancer center that has vast experience with pleural mesothelioma during the diagnostic process. The pathologists who work for these cancer centers have more experience correctly identifying pleural mesothelioma with biopsy samples. When an experienced pathologist is overseeing biopsy testing, the chance of a misdiagnosis is low. A second opinion with a specialist is highly recommended to patients who received a mesothelioma diagnosis from a cancer center or oncologist who doesn’t have extensive experience with mesothelioma. Pleural mesothelioma can be confused with adenocarcinoma, a form of lung cancer. Experienced pathologists know how to tell the difference. Sometimes, a second opinion can result in a more accurate staging diagnosis. Doctors and cancer centers experienced in mesothelioma can better discern imaging scans and other tests that can pinpoint a pleural mesothelioma diagnosis. Learn how to find cancer centers and doctors that specialize in mesothelioma treatment.
A 2012 study that analyzed more than 3,000 pleural mesothelioma cases reported on the discrepancy of staging based on clinical versus surgical staging. It showed clinical staging is most accurate for stage 3 and 4 cases. Around 80 percent of patients with clinical stage 1 cancer were found to have more advanced disease upon surgery, known as upstaging. About 65 percent of patients with clinical stage 2 mesothelioma were upstaged, but only 20 percent with stage 3 and none with stage 4 were upstaged.
Unfortunately, diagnosing mesothelioma takes a long time. While mesothelioma is widely talked about and publicized, it is still a rare condition. Even if patients have symptoms of mesothelioma, it may take several visits to a primary care physician for mesothelioma to be suspected. Several issues delay mesothelioma diagnosis, including nonspecific symptoms and a long latency period.
For patients with localized disease, and who can tolerate a radical surgery, radiation can be given post-operatively as a consolidative treatment. The entire hemithorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations. It can also induce severe side-effects, including fatal pneumonitis. As part of a curative approach to mesothelioma, radiotherapy is commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.