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How is Mesothelioma Diagnosed?

MesotheliomaMesothelioma is a difficult diagnosis to make. The symptoms as presented are also symptoms of many more common diseases. Malignant mesothelioma makes up less than 1% of all the cancers diagnosed annually in the United States. To be given a diagnosis of malignant mesothelioma is most commonly done after extensive testing and elimination of other diseases. Malignant mesothelioma can be misdiagnosed, and it is recommended to get a second opinion from a mesothelioma expert at a mesothelioma center. The correct diagnosis and testing is essential to properly identify the type of mesothelioma, epithelioid, sarcomatoid, or mixed and to determine the stage of the disease and the makeup of the tumor.

The initial symptoms of pleural malignant mesothelioma can be shortness of breath, back pain, cough, fatigue, weight loss or fever. The initial symptoms of peritoneal mesothelioma can be abdominal pain, bloating, diarrhea or constipation, changes in bowel habits, feeling of fullness, night sweats or fever, unexplained weight loss, nausea or vomiting, fatigue.


 

When after initial work up and treatment a diagnosis of malignant pleural mesothelioma is suspected and referral to a mesothelioma center is made, the diagnosis is confirmed by several tests, exams, and conversations. Initially a detailed report of the symptoms, the patients past medical history and any past exposure to asbestos is conducted. Physical exam is conducted with attention to dullness to percussion on one side, decreased movement on the side of the chest involved and asymmetrical chest wall expansion during respiration. Blood tests that are ordered are specifically looking for markers in the blood. A tumor marker is a biomarker found in blood, urine or body tissues that can be elevated by the presence of cancer. Mesomark measures the amount of soluble mesothelin related peptides in the patients’ blood. It has been found that patients with mesothelioma have a higher concentration of this marker. Another marker CA-125 is also elevated with mesothelioma. SOMAmer is a blood test that can identify proteins that help identify biomarkers for mesothelioma. It also can be an indicator of how the disease is progressing. Blood tests are just one portion of the diagnosis, they cannot be relied upon solely to determine the diagnosis.

Chest X-rays are a 2-dimensional view that will show the buildup of fluid in your pleural space in malignant pleural mesothelioma. Pleural effusions are often found and if no pleural effusion a pleural mass or diffuse pleural thickening is noted. A Ct scan is a 3-dimensional view which is more detailed than an x-ray. It helps to stage the disease. An MRI will show any soft tissue involvement. A Pet scan using a radiopharmaceutical drug will allow the cancer to light up showing the location of the tumor. These are all tests used by doctors to support a diagnosis of malignant mesothelioma.

Pleural effusions are common in the diagnosis of malignant pleural mesothelioma. Draining of the pleural fluid and sending the fluid for testing is often done. The fluid is sent to undergo cytological testing. Cytology is the study of cells. The pathologist will study the cells under the microscope looking for characteristics indicative of mesothelioma. Features of the fluid that are indicative of malignant mesothelioma are a low nuclear to cytoplasm ratio. The cells edges are scalloped. Sarcomatoid cells are not usually found in the fluid. Pleural fluid has high doses of hyaluronic acid levels indicative of mesothelioma.

A biopsy of the pleura and the mediastinal lymph nodes is often performed to aid in a diagnosis. Video Assisted Thoracic Surgery- VATS- and the tissue that is obtained is adequate in approximately 98% of cases to confirm the diagnosis. Thoracentesis plus pleural fluid analyzed by cytology in 26% of cases. Thoracentesis plus a pleural biopsy in 39% of cases.

Immunohistochemistry panels is the process of selectively imaging antigens- proteins- in cells of the tissue section by use of markers that are either fluorescent dyes or enzymes. A panel of markers is needed for malignant mesothelioma as there is no one marker that is sensitive enough for the diagnosis. Pancytokeratin stains will stain positive in most cases of mesothelioma. Epithelioid mesothelioma commonly has the following positive markers calretinin, CK5/6, WT-1- Wilm’s tumor with nuclear staining, and D2-40 (podoplanin). WT-1 is an antigen that mesothelioma patients express within their tumor. WT-1 is a protein that regulates gene expression and causes cell growth. Mesothelioma patients can have a high level of this protein. The International Mesothelioma Interest Group- IMIG- recommends that if the cytology specimen is suspicious for malignant mesothelioma that it be followed up with a tissue biopsy. The IMIG also recommends that 2 mesothelial and 2 carcinoma markers be used in addition to panctokeratin to confirm the diagnosis. The following are some of the markers that can help confirm a malignant mesothelioma diagnosis, keratin is positive in 75 to 100% of mesothelioma diagnosis, mesothelin is positive in 100%, calretinin 100% positive and the staining shows nuclear and cytoplasmic staining, D2-40 86-100% along the cell membrane, WT-1 45-93% show mesothelioma with nuclear positivity.

Diagnosing malignant pleural mesothelioma is difficult, it should be done by a multidisciplinary team at a dedicated mesothelioma center.
 

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Did You Know?

  • Mesothelioma Facts
    Mesothelioma Facts
    The highest award of compensatory damages ever upheld on appeal in a mesothelioma case is $30.3 million.
  • Mesothelioma Facts
    Mesothelioma Facts
    The largest punitive damages verdict ever upheld on appeal in a mesothelioma case is $18 million.
  • Mesothelioma Facts
    Mesothelioma Facts
    There are over $30 billion in asbestos trust funds to compensate victims of mesothelioma and other asbestos-related diseases.
  • Mesothelioma Facts
    Mesothelioma Facts
    There are more than 50 bankruptcy trusts accepting claims to compensate victims of mesothelioma and other asbestos-related diseases.
  • Mesothelioma Facts
    Mesothelioma Facts
    There are many “asbestos dockets” that permit living mesothelioma patients to obtain a jury verdict in less than 1 year.
  • Mesothelioma Facts
    Mesothelioma Facts
    In 2015, more than 2000 mesothelioma cases were filed in the United States.
  • Mesothelioma Facts
    Mesothelioma Facts
    In some mesothelioma cases, settlements can be obtained in less than 1 year.
  • Mesothelioma Facts
    Mesothelioma Facts
    Thousands of different companies have been defendants in mesothelioma cases over the past 40 years.
  • Mesothelioma Facts
    Mesothelioma Facts
    According to a 2015 study of 77 peritoneal mesothelioma cases, the average life expectancy (median survival period) was 75.7 months, or over 6 years.
  • Mesothelioma Facts
    Mesothelioma Facts
    According to a 2015 study of 77 peritoneal mesothelioma patients, 73.8% were living after 3 years, and 65.3% were living after 5 years.
  • Mesothelioma Facts
    Mesothelioma Facts
    According to a 2015 study of 77 peritoneal mesothelioma patients, 64% were treated with HIPEC and cytoreductive surgery.
  • Mesothelioma Facts
    Mesothelioma Facts
    According to a 2015 study of 303 pleural mesothelioma patients, the average life expectancy (median survival period) was 18.4 months.
  • Mesothelioma Facts
    Mesothelioma Facts
    According to a 2015 study of pleural mesothelioma patients, 73.1% were still living after 1 year, and 22.9% were still living after 3 years.
  • Mesothelioma Facts
    Mesothelioma Facts
    In 2015, the largest number of mesothelioma cases were filed in the following 10 courts: (1) Madison County, IL; (2) Cook County, IL; (3) St. Louis, MO; (4) Los Angeles, CA; (5) New York, NY; (6) Philadelphia, PA; (7) New Castle County, DE; (8) Middlesex County, MA; (9)Middlesex County, NJ; (10) Kanawha County, WV.
  • Mesothelioma Facts
    Mesothelioma Facts
    The states with the largest number of diagnosed mesothelioma cases are: New York, New Jersey, California, Washington, Pennsylvania, Massachusetts, Virginia, Florida, Texas, Illinois, Wisconsin, Michigan and Ohio.
  • Mesothelioma Facts
    Mesothelioma Facts
    There are about 3000 mesothelioma cases diagnosed in the United States each year.
  • Mesothelioma Facts
    Mesothelioma Facts
    About 1 in 100,000 people in the United States will be diagnosed with mesothelioma each year in the United States.
  • Mesothelioma Facts
    Mesothelioma Facts
    More than 80% of all mesothelioma cases occur in the pleura (pleural mesothelioma).
  • Mesothelioma Facts
    Mesothelioma Facts
    Less than 20% of all mesothelioma cases occur in the peritoneum (peritoneal mesothelioma).
  • Mesothelioma Facts
    Mesothelioma Facts
    About 22% of all mesothelioma cases occur in women.
  • Mesothelioma Facts
    Mesothelioma Facts
    A history of asbestos exposure can be found in more than 80% of mesothelioma cases.
  • Mesothelioma Facts
    Mesothelioma Facts
    More than 30% of all mesothelioma patients in the United States were exposed to asbestos in the military.
  • Mesothelioma Facts
    Mesothelioma Facts
    Mesothelioma can be caused by laundering, or other household contact with, work clothing contaminated with asbestos.
  • Mesothelioma Facts
    Mesothelioma Facts
    Mesothelioma can be caused by work with (direct exposure) or around (bystander exposure) asbestos-containing products.
  • Mesothelioma Facts
    Mesothelioma Facts
    The average time between a person’s first exposure to asbestos and the development of mesothelioma (latency period) is more than 40 years.
 

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If you or a loved one has been diagnosed with mesothelioma, please contact us to see if we can help you get the compensation you deserve from the billions of dollars in asbestos trust funds available now for qualified asbestos victims. With just one call, you can put all our experience and success to work for you.

We have represented thousands of victims of mesothelioma and their families in virtually every State in the country and in decades of work have recovered billions of dollars in financial compensation for our clients.

Call us now at 1-888-568-1177, fill out the form on this page or chat with a live person. The consultation is free and it costs nothing upfront to hire the lawyers behind MesoLawyersCare. We only get paid if you collect a settlement or verdict and you will never receive a bill from us.

 

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