Aging and Disease

When a patient has symptoms suggesting malignant mesothelioma, a doctor starts with imaging techniques to confirm a diagnosis. X-rays and CT scans of the chest or abdomen are taken to identify any abnormalities, such as fluid collections, thickening of tissue, or growths, that may indicate underlying disease. Magnetic resonance images (MRI) or positron emission tomography (PET) images are taken to determine the extent of spread of a cancer; PET is most expensive but also the most accurate. Information from scans is used to plan appropriate treatment.

Once cancer is suspected, a tissue biopsy is needed to confirm the diagnosis. If the pleura or tissue lining the chest and lungs is involved, a thoracoscopy is performed, usually under local anesthesia. A small opening is made in the chest wall and an instrument called a thorascope, through which the surgeon can see into the chest, is inserted between the ribs. Tissue and fluid can be collected through this opening. Similarly, if the peritoneum or tissue lining the abdominal cavity and abdominal organs is involved, a peritoneoscope is inserted into the abdominal cavity to collect biopsy tissue. The biopsy tissue is then examined under a microscope to find out if the cells in it are normal or cancerous. Depending on the cell type, a diagnosis of malignant mesothelioma can be made. Malignant mesotheliomas are of three cell types: epithelioid, mixed and sarcomatoid. In general, epithelioid malignant mesotheliomas are the most common and carry the best prognosis; sarcomatoid ones are the most rare with the shortest survival time.

The next step is to stage the cancer as localized, advanced or recurrent. This may be done through a combination of imaging and surgical exploration. There are three staging systems in use, each with four stages: the Butchart System, the TNM System and the Brigham System.

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The most critical form of mesothelioma is the malignant form. Known as malignant mesothelioma, the primary causal factor is asbestos infection. According to the US National Cancer Institute, “Malignant mesothelioma is a disease in which cancer (malignant) cells are found in the sac lining the chest (the pleura), the lining of the abdominal cavity (the peritoneum) or the lining around the heart (the pericardium).”

Mesothelioma can be classified into three types - pleural mesothelioma, peritoneal mesothelioma and pericardial mesothelioma. Pleural mesothelioma refers to a cancer of the lining of the lung (pleura), peritoneal mesothelioma refers to a cancer of the abdominal cavity (peritoneum) lining, and pericardial mesothelioma is a cancer that occurs in the lining that surrounds the heart (pericardium). The subtypes of mesothelioma are of three basic types, one very aggressive, one least aggressive, and one lying between the two extremes.

Malignant mesothelioma can be diagnosed through several imaging techniques. These imaging techniques enable physicians to assess mesothelioma. Once mesothelioma is suspected, patients are advised to undergo several tests, like X-ray, Computed Tomography (CT) scan, Magnetic Resonance Imaging (MRI) scans, and Positron Emission Tomography (PET) imaging. The physician may also like to undertake special mesothelioma tests like thoracoscopy, peritoneoscopy and biopsy.

Learning about the stage of mesothelioma is a critical factor that helps physicians to decide the treatment plan. If the cancer is confined to the pleura, mesothelioma is considered localized. If the cancer spreads beyond the pleura and to other parts of the body such as the lungs, abdominal cavity, lymph nodes and the chest wall, mesothelioma is considered to be in an advanced stage.

The oft used and the oldest system for determining the stages of mesothelioma is the Butchart System. The Butchart System is based on the extent of the primary tumor mass available in a patient. This system divides mesothelioma into four stages. The TNM system, a slightly advanced system over the Butchart System, determines staging through variables of tumor in mass and the spread, the lymph node involvement and metastasis. However, the latest system is known as the Brigham System, where staging is done as per the respectability and lymph node involvement. In spite of such modern techniques, a definitive diagnosis of mesothelioma still remains possible through fluid diagnosis and tissue biopsy.

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