Diagnosing and staging of malignant pleural mesothelioma has always been a challenge. Malignant pleural mesothelioma is a rare disease but often, symptoms can mimic many more common diseases. Frequently, a patient’s symptoms can be present for months before a diagnosis is made.
After diagnosis, treatment can vary from patient to patient. Some patients are eligible for chemotherapy and supportive care while others with an earlier stage of the disease and better physical health might opt for aggressive multimodality regimes, including surgery, chemotherapy, and radiation. Currently at one major academic mesothelioma center, approximately 1/3 of the patients that are seen are candidates for surgery. That leaves the majority of patients with non-surgical options.
How is the decision made? And what does staging of mesothelioma do for patient options? These recommendations are made based on a staging system called TNM. T is for tumor and its size, N stands for nodes, and M for metastasis when lesions are found in other parts of the body. This staging is done to see what the prognosis might be, and for helping to decide what type of treatment the patient with the tumor might be eligible for. This staging is based on the tumor size, location, and what the scientists see under the microscope.
As part of the workup for diagnosing malignant pleural mesothelioma different tests are performed. One of the most common test is the CT scan. The CT can show valuable information particularly in the early diagnosis time to see if the tumor is resectable. The CT scan can show if the disease is limited to one lung, distant metastasis or whether there is involvement of the chest wall or involvement of the abdomen.
Some researchers have taken this information and investigated how the volume of the tumor can predict outcome and treatment. From the CT scans they assess the three- dimensional reconstruction of the tumor. This has helped researchers in the prognosis of overall survival. The second measurement that could potentially help with patient prognosis is the thickness of the disease in the fissures in between the lobes of the lung. Since everyone’ tumor is different this is a difficult staging system to implent due to the variability in the disease and the expertise of the radiologist interpreting it.
One of the researchers that is working on this staging system to help patients on what type of treatment is best for their particular stage of the disease is a Dr. Ritu Gill, a radiologist. Studying CT results of malignant pleural mesothelioma patients can give more precise options to the patients and aid in further research. Measuring malignant pleural mesothelioma is not straight forward because the pattern of MPM is irregular and inconsistent.
While the information from CT scans can be challenging to interpret, clinical trials can test these unique measurements and try to make them even more precise. In practice these findings can be used to monitor patient’s response to ongoing treatment and all over for workups of thoracic malignancy. This work takes the results of the CT one step further.
Although more research is needed, this work will help patients and their mesothelioma team in deciding the best possible treatment for that particular patient’s MPM.