The National Institute for Health and Clinical Excellence (NICE) has produced guidelines for GPs on the referral of patients with suspected cancer. These recommend urgent referral for a chest x-ray for people with a history of asbestos exposure with any of the following symptoms:
- chest pain
- difficulty breathing
- unexplained symptoms such as shoulder pain, a cough or weight loss.
At the hospital, the doctor will take your medical history and carry out a physical examination.
You may be asked questions about any possible exposure to asbestos in your past, such as during jobs you’ve had or at places you’ve worked. This is called your occupational history. Don’t worry if you can’t remember all of the details at first. You can let your doctor know later about anything you remember.
Pleural mesothelioma often starts as a lot of tiny lumps (nodules) in the pleura, which may not show up on scans or x-rays until they are quite large. You may need a number of different tests to diagnose mesothelioma.
Chest x-rayBack to top
A chest x-ray checks for any abnormalities in your lungs, such as thickening of the pleura or fluid around the lungs. There can be other causes of these problems apart from mesothelioma.
CT (computerised tomography) scanBack to top
A CT scan takes a series of x-rays which build-up a three-dimensional picture of the inside of the body. The scan is painless but takes from 10–30 minutes. CT scans use a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You’ll be asked not to eat or drink for at least four hours before the scan.
A CT scan takes 10–30 minutes
You may be given a drink or injection of a dye which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you’re allergic to iodine or have asthma you could have a more serious reaction to the injection, so it’s important to let your doctor know beforehand. You’ll probably be able to go home as soon as the scan is over.
Positron Emission Tomography scan (PET Scan)Back to top
PET scans are a new type of scan and you may have to travel to a specialist centre for one. They are not always necessary but you can discuss with your doctor whether one would be useful in your case. PET scans can be used when x-rays and CT scans have not given a definite result.
A PET scan uses low-dose radioactive glucose (a type of sugar) to measure the activity of cells in different parts of the body. A very small amount of a mildly radioactive substance is injected into a vein, usually in your arm.
A scan is then taken a couple of hours later. Areas of cancer are usually more active than surrounding tissue and show up on the scan.
Pleural aspirationBack to top
Mesothelioma cells can irritate the pleura and cause a pocket of fluid to develop. This is called a pleural effusion. Your doctor can take a sample of this fluid to send to the laboratory as mesothelioma cells are sometimes present. The sample is taken by first using a local anaesthetic to numb the area. A needle is then inserted through the skin into the fluid and some of the fluid removed.
Peritoneal aspirationBack to top
Mesothelioma cells in the peritoneum can cause a build-up of fluid in the abdomen. This is called ascites. Mesothelioma cells are sometimes present so your doctor can take a sample of fluid and send it to the laboratory. It's similar to a pleural aspiration.
BiopsyBack to top
If you need a biopsy, your doctor will take a sample of tissue from the thickened pleura or peritoneum. A local anaesthetic is used to numb the area. A special type of needle is then passed through the skin into the tumour. The needle has a tip that can cut out a sample of the tumour.
There are several different ways that your doctor can obtain a biopsy.
Pleural biopsy
A biopsy of the lining of the lung can be taken by any of the following:
CT or ultrasound guided biopsy
The doctor uses an ultrasound or a CT scanner to position the needle accurately.Ultrasound uses sound waves to build up a picture of the organs in a part of the body. A small device is passed over the skin to show the doctor where the tumour is and guide the needle into the right place.
Thoracoscopy
This allows the doctors to look at the area of the pleura directly and also to look at other structures around the lungs and take further biopsies if required.You will be given either a general anaesthetic or a local anaesthetic with a sedative to make you drowsy. A small cut is made in the chest wall and the doctor puts a thin flexible tube with a light and camera at the end (thoracoscope) into your chest.
Your doctor can then take a biopsy of the pleura. Sometimes doctors use a video camera to perform procedures like pleurodesis – this is called video assisted thoracospcopy.
Peritoneal biopsy
A biopsy of the peritoneum can be carried out by:
Laparoscopy
This procedure allows the doctor to look at other structures in the abdomen and take further biopsies if required. You'll either be given a general anaesthetic or a local anaesthetic with a sedative to make you drowsy.
A small cut is made in the tummy wall and your doctor puts a thin flexible tube with a light and a camera at the end (laparoscope) into your abdomen. Your doctor can then take a small biopsy of the peritoneum.
CT or ultrasound guided biopsy
The doctor may use ultrasound or a CT scanner to position the needle accurately. Ultrasound uses sound waves to build up a picture of the organs in a part of the body. A small device is passed over the skin to show the doctor where the tumour is and guide the needle into the right place.
Your doctor may arrange for you to have other tests to see if the mesothelioma has spread. These can include:
Mediastinoscopy
This procedure is similar to the thoracoscopy. This time the small cut is made in the base of the neck. This test allows the doctor to examine the lymph nodes in the space between the lungs and take samples if necessary. It is usually done under a general anaesthetic.
Endobronchial ultrasound scan (EBUS)
You may have this test if your scans show swelling of the lymph nodes around your lung. You'll be given a sedative to make you drowsy. A thin flexible tube called abronchoscope is passed into your mouth and down into the windpipe (trachea).
An ultrasound probe, which uses sound waves to build up pictures of parts of the body, is attached to the bronchoscope. Your doctor can see inside the lungs and ultrasound pictures can show the size of a tumour and if any nearby lymph nodes are involved. A needle can be passed down the bronchoscope to take biopsy samples.
Having a biopsy can be uncomfortable but should not be painful. If you have any pain during or after the procedure let your doctor or nurse know as they can give you painkillers.
Studying the biopsy in the laboratory is the only way your doctors can make the diagnosis of mesothelioma. Sometimes, even after taking a biopsy, the doctors may still not be sure of the diagnosis because mesothelioma can be very difficult to tell apart from some other illnesses. In this situation, the biopsy samples may be sent to other laboratories to confirm the diagnosis, some of your tests may need to be repeated, or you may be referred to another hospital for a second opinion.
It will probably take several days for all of the results of your tests to be ready and a follow-up appointment will be arranged for you before you go home. This waiting period is likely to be an anxious time for you and it may help to talk things over with a close friend or relative.
You may want to call our cancer support specialists on 0808 808 00 00 to ask any questions you may have.
