Mesothelioma

Medical history and physical exam

Your care starts with a visit to the doctor, where you'll discuss your medical history and any risk factors for mesothelioma, such as asbestos exposure. During your exam, your doctor will listen to your heart and lungs, tap your abdomen or chest and look for signs of fluid buildup.

If you have symptoms of pleural mesothelioma, you may also have a pulmonary function test to check how your lungs are working. As mesothelioma shares symptoms with many other conditions, your doctor may order additional tests after your exam to help with diagnosis.

Imaging tests

While imaging tests alone can't diagnose mesothelioma, they can give your care team important details about your health and look for signs that might indicate mesothelioma. You will have access to several imaging tests, including:

• Chest X-ray: A chest X-ray gives your care team a closer look at your lungs. You may have this imaging test if you have symptoms of pleural mesothelioma.
• Computed tomography (CT): A CT scan combines multiple X-rays to provide detailed images of your body. This test helps find where mesothelioma may be located and the stage of mesothelioma after you are diagnosed.
• Echocardiogram: An echocardiogram is an ultrasound imaging test of the heart and shows signs of fluid in the sac around your heart. It helps with the diagnosis of pericardial mesothelioma.
• Magnetic resonance imaging (MRI): An MRI uses magnets and radio waves to create images of the body and look for signs of mesothelioma. Your care team sometimes uses this test to look for signs of mesothelioma spreading to the diaphragm.
• Positron emission tomography (PET): A PET scan uses an injection of radioactive sugar to help highlight any areas of cancer cells inside the body. It may help your care team tell the difference between cancer and scar tissue that has been seen on another imaging test.

Blood tests

There isn't a specific blood test to diagnose mesothelioma. However, high levels of certain substances in your blood could indicate the condition. Your doctor may also order other blood tests to check the function of your liver or kidneys.

Biopsies

If your exam, imaging or blood tests show signs of mesothelioma, lung cancer or another type of cancer, your doctor will order a biopsy to take samples of fluid or tissue. These samples are examined in the lab to look for cancer cells and diagnose your condition.

If you have fluid buildup, your care team can take a sample using a hollow needle. A thoracentesis procedure will take a fluid sample from the lining around your lungs. When fluid is taken from around the heart, it’s called pericardiocentesis; when taken from the abdomen, it's called paracentesis.

• Needle biopsies: Your care team may use a needle to take a small tissue sample in a mass or lymph node to help diagnose mesothelioma. Sometimes, imaging will be used to help guide the needle to the right spot.
• Endoscopic biopsies: If the area needing to be biopsied can't be reached using a needle, you may have an endoscopic biopsy to take samples. These procedures use a thin tube with a camera inserted into the body through small incisions. Thoracoscopy is used to take biopsies in the chest and laparoscopy is used to take biopsies in the abdomen.
• Open surgical biopsy: Sometimes, your care team may need to use a more invasive procedure with a larger incision to reach a mass, take samples or remove it. Thoracotomy is a surgical procedure that uses a larger incision in the chest, and laparotomy uses a larger incision in the abdomen.

Surgery

Surgery can be used to treat mesothelioma to remove as much of the cancer as possible. Though often, mesothelioma can’t be completely removed with surgery. The type of surgery that your care team recommends will depend on the location of your cancer and how much your mesothelioma has spread.

• Extrapleural pneumonectomy: This extensive and complex surgery aims to remove all the areas of cancer caused by pleural mesothelioma, like a pneumonectomy, where your surgeon will remove one of your lungs. An extrapleural pneumonectomy also removes the lining in the chest on that same side, part of your diaphragm, lymph nodes and, in some cases, the sac around your heart.
• Pleurectomy and decortication: During this surgery, known as P/D, your doctor removes the lining around the affected lung and the pleural coating around your lung and diaphragm on that side of the body.
• Debulking: Debulking surgery removes as many areas of cancer as possible in the lining of the lungs or abdomen, while leaving as much healthy tissue in place as possible. When used in the lining of the lungs, it may be called a partial pleurectomy.
• Pleurodesis: Pleurodesis is a procedure that removes fluid buildup and then uses chemicals to make scar tissue in the lining of the lungs. This process prevents any additional fluid from building up in the space.

Chemotherapy

Chemotherapy is often used in the care of mesothelioma. It’s sometimes given before, after or during surgery. If surgery isn’t an option for you, these cancer-killing drugs may be your primary treatment.

Two common types of localized chemotherapy given during surgery are hyperthermic intraperitoneal chemotherapy and hyperthermic intrathoracic chemotherapy. During these types of chemotherapy, a high dose of heated chemotherapy drugs is placed straight into the abdomen or the chest.

Radiation therapy

The primary type of radiation therapy for mesothelioma is external beam radiation therapy, which uses high-energy rays from outside the body to destroy cancer cells. When radiation therapy is delivered inside the body, it's called brachytherapy.

Radiation therapy is more common as a treatment option for pleural mesothelioma. When all the cancer can’t be removed by surgery, it may help destroy the cancer cells that remain or be used as an option to manage and reduce symptoms.

Immunotherapy

Immunotherapy helps your immune system find and attack cancer cells and typically has fewer side effects than chemotherapy. It could be a treatment option if you have pleural mesothelioma that can't be treated using surgery.

The primary type of immunotherapy drug approved to treat mesothelioma is checkpoint inhibitors. They help the body recognize cancer cells by blocking a specific protein in the cells.

Targeted therapy

Targeted therapies are drugs that target specific changes or attributes of mesothelioma cancer cells. One of the most common types of targeted therapy is monoclonal antibody therapy. In mesothelioma treatment, a monoclonal antibody targets a cancer cell’s protein that promotes blood vessel growth. By blocking this protein and stopping blood vessel formation, the therapy prevents the cancer cells from receiving vital nutrients needed to grow.