Diagnosing Pleural Mesothelioma

An accurate, complete diagnosis is essential for treating mesothelioma. Because there is no routine cancer, the OSUCCC – James’s world-renowned cancer specialists and subspecialists reach across multiple disciplines and modes of treatment to offer patients the latest technologies and the most advanced procedures to understand mesothelioma at the molecular and genetic levels – the levels that drive each patient’s specific cancer. While there are currently no FDA-approved screening tests for pleural mesothelioma, the OSUCCC – James research specialists continue to develop and study blood-based tests for early detection.

The OSUCCC — James is home to world-renowned diagnostic experts in mesothelioma. If the disease is suspected, your OSUCCC – James specialists will examine you and ask you about your medical history, including information about symptoms and any risk factors you may have.

Depending on your symptoms, the experts will do a physical exam to check your overall health and look for signs of disease, like abdominal pain, swelling, lumps or anything else that seems unusual. Your general health habits, exposure to asbestos, and past illnesses and treatments will also be discussed.

After the examination, they may also conduct the following tests to form a diagnosis:

Complete Blood Count and Blood Chemistry Studies


A blood sample is taken to measure the amounts of certain substances such as antibodies (proteins) released into the blood. Your specialists look for higher or lower than normal amounts of certain chemicals or proteins, which can signal disease in the organ or tissue that produces it.

Imaging Tests


Imaging tests produce pictures of the inside of the body, and they can help the experts determine the extent of the disease. Tests may include:

  • Chest X-Ray
    A painless test that uses electromagnetic waves to create a picture of the inside of your chest that enables the OSUCCC - James diagnostic experts to examine the organs and bones more closely. Enlarged lymph nodes or other enlarged organs can usually be seen on a chest X-ray.

  • CT Scan (Computed Tomography Scan)
    A type of X-ray test that produces detailed, cross-sectional images of your chest and abdomen from different angles. This procedure is also called computed tomography, computerized tomography or computerized axial tomography. A CT scan can show evidence of a tumor.

  • PET Scan (Positron Emission Tomography Scan)
    A procedure in which nuclear medicine technology is used to finds spots of cancer activity in the body.

Biopsy


During a biopsy, your mesothelioma specialists remove a small piece of tissue so that a specially trained OSUCCC – James pathologist can examine the cells under a microscope for any signs of cancer, DNA abnormalities or certain proteins on the surface of cancer cells. This can confirm a diagnosis and help the experts determine what type of cancer it is and the best course of personalized treatment.

Procedures used to collect the cells or tissues include:

  • Fine-needle (FNA) aspiration biopsy of the lung: Removing tissue or fluid using a thin needle. An imaging procedure locates the abnormal tissue or fluid in the lung, then a small incision can be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid, and a sample is removed.
  • Thoracoscopy: An incision is made between two ribs and a thoracoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the chest.
  • Thoracotomy: An incision is made between two ribs to check inside the chest for signs of disease.
  • Open Biopsy: An incision is made through the skin to expose and remove tissues to check for signs of disease.
  • Cytologic Exam: Cells are examined under a microscope to check for anything abnormal. For mesothelioma, fluid is taken from the chest or from the abdomen so that a specially trained OSUCCC – James pathologist can check the fluid for signs of cancer.
  • Immunohistochemistry: A test that uses antibodies to check for certain antigens in a tissue sample. The antibody is usually linked to a dye that allows antibody to be localized under a microscope. This type of test may be used to tell the difference between different types of cancer.
  • Electron Microscopy: Cells in a tissue sample are viewed under a high-powered microscope to look for certain changes in the cells. An electron microscope shows tiny details better than other types of microscopes.

(Source: National Cancer Institute)

At the OSUCCC – James, the mesothelioma treatment team includes internationally recognized medical oncologists, surgical oncologists, radiation oncologists, thoracic surgeons, pulmonologists, geneticists, pharmacists, nutritionists and more.

Also on that team are cancer researchers who help sequence tumors to identify key molecules that fuel each patient’s cancer and who then develop drugs that target only those particular molecules.

Working together and across medical disciplines, this super sub-specialized team develops individualized, highly targeted treatment plans that specifically target the molecular and biological makeup of your individual cancer.

If you’ve been diagnosed with mesothelioma, would like a second opinion or would like to speak with a cancer specialist, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment.

Staging Pleural Mesothelioma

If you are diagnosed with mesothelioma, staging the tumor is just one of many ways your OSUCCC – James cancer experts can determine the amount and location of your cancer, and it can help them choose the most effective, personalized treatment options for your particular disease.

The staging classification remains the same through treatment.

The stages of mesothelioma are:

Stage I (Localized) is divided into stages IA and IB:


Stage IA: Cancer is found in one side of the chest in the lining of the chest wall and may also be found in the lining of the chest cavity between the lungs and/or the lining that covers the diaphragm. Cancer has not spread to the lining that covers the lung.

Stage IB: Cancer is found in one side of the chest in the lining of chest wall and the lining that covers the lung. Cancer may also be found in the lining of the chest cavity between the lungs and/or the lining that covers the diaphragm.

Stage II (Advanced)


Cancer is found in one side of the chest in the lining of the chest wall, the lining of the chest cavity between the lungs, the lining that covers the diaphragm, and the lining that covers the lung.

Also, cancer has spread into one or both of the following:

  • Lung tissue
  • Diaphragm

Stage III (Advanced)


Cancer is found in one side of the chest in the lining of the chest wall. Cancer may have spread to:

  • the lining of the chest cavity between the lungs
  • the lining that covers the diaphragm
  • the lining that covers the lung
  • the lung tissue
  • the diaphragm

Cancer has spread to lymph nodes where the lung joins the bronchus, along the trachea and esophagus, between the lung and diaphragm, or below the trachea,

or

Cancer is found in one side of the chest in the lining of the chest wall, the lining of the chest cavity between the lungs, the lining that covers the diaphragm, and the lining that covers the lung.

Cancer has spread into one or more of the following:

  • Tissue between the ribs and the lining of the chest wall,
  • Fat in the area between the lungs,
  • Soft tissues of the chest wall,
  • Sac around the heart.

Cancer may also have spread to lymph nodes where the lung joins the bronchus, along the trachea and esophagus, between the lung and diaphragm, or below the trachea.

Stage IV (Advanced)


Cancer cannot be removed by surgery and is found in one or both sides of the body. Cancer may have spread to lymph nodes anywhere in the chest or above the collarbone.

Cancer has spread in one or more of the following ways:

  • Through the into the peritoneum (the thin layer of tissue that lines the abdomen and covers most of the organs in the abdomen),
  • To the tissue lining the chest on the opposite side of the body as the tumor,
  • To the chest wall and may be found in the rib,
  • Into the organs in the center of the chest cavity,
  • Into the spine,
  • Into the sac around the heart or into the heart muscle,
  • To distant parts of the body such as the brain, spine, thyroid or prostate.

(Source: National Cancer Institute)

If you’ve been diagnosed with mesothelioma, would like a second opinion or would like to speak with a cancer specialist, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment.

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The James Cancer Hospital and Solove Research Institute

460 West 10th Avenue

Columbus, Ohio 43210

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