Diagnosing melanoma

Friday 30 September, 2011

Reviewed: Dr Malcolm Feigen, Senior Radiation Oncologist, Austin Health; Dr Paul Jenkinson, GP; Mary Duffy, Lung Nurse Specialist, Peter MacCallum; Prof Bill Musk, Respiratory Physician; Kathryn Turner, Social Worker, Slater & Gordon Lawyers ; Jane McDermott, Principal, Maurice Blackburn Lawyers; Asbestos Diseases Society of Victoria

On this page: Can we screen for mesothelioma? | Professionals you may see | How mesothelioma is diagnosed | Waiting for test results

Facing a diagnosis of mesothelioma is difficult. At first most people feel lost and uncertain about their future. Although better treatments and continuing research has improved outcomes for many people, it remains a difficult cancer to treat.

To get the best outcomes it is important you:

  • see the right specialist
  • gain a definite diagnosis
  • find out which treatment is best for your situation.

Can we screen for mesothelioma?

Screening means testing healthy people to detect a disease in its early stages. People being screened usually have no signs or symptoms of that disease.

For cancer screening to be effective there must be an accurate test that can pick up signs of early stage cancer, when treatment is more likely to cure the cancer. It is important the test doesn't give a positive result in people who do not have cancer (‘false positive'). At present there is no reliable screening test for mesothelioma.

However, if you know you have been exposed to asbestos and may be at a higher risk of developing the disease, talk to your GP. They may suggest you have regular tests every few years to check for signs of the disease. If you are at a very high risk your GP may refer you to a chest specialist for regular check-ups.

People with mesothelioma sometimes have high levels of certain proteins in their blood but this is not a reliable method to diagnose mesothelioma.

In the future we may be able to test for these substances to help with early detection of the disease. However, for now they can only be used to help monitor the disease in someone who has already been diagnosed. See the ‘Research into mesothelioma' section more about these tests.

Doctors and other health professionals you may see

If you have cancer, one or more specialists will advise you about treatment options. You should expect to be cared for by a team of health professionals from the relevant major fields (see following list). Ideally, all your tests and treatment will be available at your hospital. This may not be possible in some non-metropolitan areas.

Your GP will be kept informed about all your test results and treatment. They will be able to answer questions you may have in between appointments with your specialist doctors.

Health professionals who care for people with mesothelioma include:

  • Respiratory physicians: investigate symptoms, make a diagnosis and stage the disease
  • Thoracic (chest) surgeons: are responsible for some biopsies and removing cancers that can be operated on
  • Abdominal surgeons: are responsible for operating on peritoneal mesothelioma
  • Medical oncologists: are responsible for chemotherapy
  • Radiation oncologists: are responsible for radiotherapy
  • Dietitians: will recommend the best diets to follow during and after treatment
  • Specialist nurses: lung cancer nurses, palliative care nurses, district nurses
  • Your GP: will help you through all stages of your cancer
  • Psychologists: help people with emotional and social concerns
  • Speech pathologists: help people with speech and swallowing problems
  • Social workers, physiotherapists and occupational therapists: will advise you on support services and help you to get back to normal activities
    • Palliative care team: will assist with symptom management and emotional support for you and your family.

You may only see a few of these people. However, it is important to know you do have several health professionals supporting you through your treatment. Talking to them about your concerns can help you manage your disease and treatment in the best possible way.

How mesothelioma is diagnosed

Most people begin by seeing their GP. Your GP will examine you and ask you about your general health, family history and current symptoms. Your doctor may be able to feel lumps in the area where you are having pain or discomfort. If you are short of breath your doctor will listen to your chest for signs of fluid build-up. They may notice other symptoms you were not aware of.

If your GP suspects you may have mesothelioma they will ask you to have a series of tests or may refer you straight to a specialist. Depending on your symptoms this may be a lung specialist (for pleural mesothelioma) or a gastroenterologist (for peritoneal mesothelioma).

Mesothelioma can be difficult to diagnose. Even if you have symptoms and certain tests indicate mesothelioma, doctors may still not be sure. Because of this you may need to have quite a few tests so your doctor can be sure of your diagnosis. This is important so they can recommend the right treatment.

Blood tests

You will have blood taken to check your overall general health. These tests will not show up mesothelioma but they can let your doctors know how your blood cells, liver, and certain chemicals are working. Cancer can affect how blood cells normally work so any changes to your blood can give your doctor important information.

X-ray

You will most likely have an x-ray of your chest or abdomen. The x-ray will look for any changes, like thickening of the pleura or fluid on the lungs or in the abdomen. These changes can be caused by other conditions. If they are present you will need to have further tests to find out what is causing the problems.

An x-ray is a simple test. You will be asked to stand in front of a machine with your chest or abdomen pressed to a plate and breathe in while pictures are taken. The radiation dose is low so it is not dangerous.

CT scan

A CT (computerised tomography) scan is a type of x-ray that takes pictures of the inside of the body. CT scans of the chest and the abdomen will show up swelling or fluid. The scan can detect the size and position of a mesothelioma. It can also help to show if the cancer has spread to the lymph nodes or to other organs.

This test takes about 30-40 minutes. To make the scan pictures clearer and easier to read you may have an injection of a dye into a vein in your arm. You may also be asked to drink a special liquid. It may make you feel hot all over for a few minutes.

You will be asked to lie on a table while the CT scanner, which is large and round like a doughnut, moves around you. Most people are able to go home as soon as their scan is over.

There is a small possibility of the injected dye causing an allergic reaction. Some people also have a strong metallic taste in their mouth. You should tell your doctor if you are allergic to iodine or contrast dyes, or if you are diabetic or have abnormal kidney function.

Pleural or peritoneal aspiration (fluid drainage/tap)

You may have a build-up of fluid either in your chest/lung area or abdomen. Fluid around the lungs is known as a pleural effusion. People with peritoneal mesothelioma may have fluid in the abdomen; this is called a peritoneal effusion or ‘ascites'.

The build-up of fluid happens because the cancer cells irritate the area. This extra fluid around the lungs or abdominal cavity can feel uncomfortable. If it is in your pleura you may begin to have breathing problems. Peritoneal fluid can cause swelling, tightness and pain.

Your doctor can remove the fluid from your chest or abdomen by using a local anaesthetic on the skin and putting a needle through the skin into the fluid. They will draw a sample of the fluid into a syringe. This can be sent to the laboratory to test for mesothelioma cells.

Removing the fluid can improve your symptoms. Sometimes further aspirations or taps are needed for comfort. Medications can be provided if you are experiencing pain or discomfort.

Biopsy

This allows the doctor to take a sample from any thickened tissue around the lungs (pleural area) or abdomen (peritoneal area). It is usually done as an outpatient procedure. You will have a local anaesthetic to numb the area of skin where the biopsy needle will go in. Depending on where your mesothelioma is, your doctor will gently guide the needle either through your chest wall or into your abdomen and into the tumour, guided by xray, CT or ultrasound pictures, and remove some tissue.

Your doctor may want to take a closer look to get the sample of tissue. If this is the case then you will probably need to have a general anaesthetic and a small operation. A small incision will be made into an area of skin and a thin flexible tube with a light and camera attached at the end will be inserted. The tube is called an endoscope. When it is passed through the skin of the chest it is called a thoracoscopy. Passed through the abdomen it is known as a laparoscopy.

Samples of tissue will be sent to the laboratory for testing. This may be the only sure way of diagnosing mesothelioma and ruling out other diseases.

Further tests

You may have some other types of scans. A bone scan can show whether cancer has spread to the bones. In this test, a small amount of radioactive substance will be injected into a vein.

It travels through the bloodstream and collects in areas of abnormal bone growth. A scanner measures the radioactivity levels in these areas and records them on x-ray film.

Positron emission tomography, also known as a PET scan, involves injecting radioactive glucose solution into the body. Because cancer cells use more glucose than most normal cells, the PET scanner may detect increased quantities of the radioactive glucose in those areas of the body where the cancer is. It scans the whole body, including the bones, but not the brain. It appears to be the most accurate method for detecting cancer spread to areas other than the brain.

Other tests that can show if the cancer has spread or if surgery is a treatment option for you include mediastinoscopy, pericardioscopy, endoscopic ultrasound scan and laparoscopy. Some may require you have a general anaesthetic and stay overnight in hospital. If you need any of these tests your doctor will discuss them with you.

Waiting for test results

Waiting for test results is usually a worrying time. You and those close to you are likely to feel very anxious about what will happen if you do have mesothelioma. It is only natural to think the worst. However, try to take things day by day. Some results may come back quite quickly, within a day or two, but others can take up to a week or more. This can feel like a very long time.

Talk to your doctors and nurses about how you are feeling. Get as much information as you can from them about when and how you will get your results. Knowing how long they will take can make it less stressful than just continuing to believe they might be back tomorrow or the next day.

Let those close to you know if you feel scared. They are probably feeling the same. Sharing your concerns can help a lot. You can try to support each other and reassure each other that feeling worried is normal during this time.

If you would like to talk to someone about how you are feeling call the Cancer Council Helpline on 13 11 20 and speak with one of the nurses.

Back to top

for