Tests
Usually you begin by seeing your family doctor who will examine you and ask about your general health. Your doctor will ask you about your symptoms. This will include what they are, when you get them and whether anything you do makes them better or worse.
Your doctor will ask you to lie down for a physical examination. The doctor will feel the area where there is pain or swelling. It may feel tender, or it may be possible to feel a lump. Your doctor will listen to your chest, to see if there are any signs of fluid collecting.
After your examination, your doctor may need to refer you to hospital for tests and X-rays. You may be referred directly to a specialist. Or your GP may send you to hospital for some tests first.
At the hospital
If you see a specialist, you will be asked about your medical history and symptoms. The specialist will then examine you by feeling the area that is painful or swollen. You may be asked to have blood tests to check your general health. Then your tests will be arranged in the out patients department.
If your doctor suspects you may have mesothelioma, you may have quite a few tests. This is because it can be difficult to diagnose. Many of the usual tests used to diagnose lung disease prove negative when used to diagnose mesothelioma. You may be asked to have
X-rays
CT scan
MRI scan
Bronchoscopy
Thoracoscopy
Mediastinoscopy
Fluid drainage
Laparoscopy
X-ray
You will almost certainly be asked to have a chest X-ray or abdominal X-ray. A chest X-ray can show up fluid collecting around the lung. An abdominal X-ray may show up a swelling or fluid in the abdomen (tummy).
CT scan
This is a computerised scan using X-rays. You may be asked to have a CT scan of your chest or abdomen. A CT scan can show abnormal swellings in body organs or lymph nodes. You may be given an injection of dye called ‘contrast’ before the scan. This helps to make the scan clearer to read.
MRI scan
This is a scan that uses magnetism to build up a picture of the inside of the body. MRI scans can be better than X-ray or CT scan for looking at the soft tissues of the body. You may be asked to have a chest MRI or an abdominal MRI, depending on which type of mesothelioma you are being investigated for.
MRI scans can be very noisy and some people who don't like small spaces find them difficult to cope with. Tell your doctor beforehand if you have any of these worries or fears. If you have any metal in your body, you cannot have an MRI scan.
Bronchoscopy
This is a test that looks at the inside of the airways. A tube called a bronchoscope is put into the airway. The tube has an eye piece so that the doctor can see into your airways. Biopsies (samples of tissue and cells) can also be taken during a bronchoscopy. These are sent to a laboratory for testing to see if there are any cancer cells present.
The test is usually done as an outpatient under local anaesthetic. This means you are awake for the test, but your throat has been numbed. Sometimes it is done with a general anaesthetic. If you have an anaesthetic, you may have to stay in hospital overnight. This depends on the time of day the test is carried out and your general health.
Thoracoscopy
This is a small operation usually performed by a specialist surgeon. It is done under a general anaesthetic. A small cut (incision) is made in your chest wall and a thoracoscope (a telescope like instrument with a video camera attached) is inserted through the hole. Using forceps the doctor can take a biopsy. This is then sent to a laboratory for testing to see if there are any cancer cells.
Mediastinoscopy
This is a test which examines the mediastinum. This is an area in the centre of your chest which contains
The heart
The main blood vessels
Lymph nodes
Sometimes in pleural mesothelioma, the lymph nodes that are in the chest are enlarged.
You have to have a general anaesthetic for this test and so have to stay in hospital for at least one night. The doctor makes a small cut at the base of the neck. He puts a small tube through the cut and into the mediastinum. He can look through this tube to examine the area. He can also take tissue samples which will be looked at under the microscope later to see if there are any cancer cells.
When you wake up, you will have a small dressing over the cut where the tube was put in. Don't be afraid to say if you are feeling sore. The nurses will be happy to give you a pain killer. Once you have got over the anaesthetic, you will be able to go home. This will probably be the day after the test.
Fluid drainage
Many people with mesothelioma have fluid around their lungs (a pleural effusion) or in their abdominal cavity (peritoneal effusion).
Fluid build up happens because cancer cells are irritating the pleura or peritoneum. This fluid can cause discomfort in the abdomen or difficulty breathing. If mesothelioma is the cause, it may contain cancer cells. To drain the fluid off, a needle is put into the chest or abdominal cavity and the fluid drained into a bag. A sample of the fluid will be sent to a laboratory for testing to see if contains cancer cells.
Laparoscopy
This is a small operation that may be used to diagnose peritoneal mesothelioma. A tube with a camera and a light is put into your abdomen through a small cut. Your doctor can look inside to see whether there is any sign of cancer. The doctor will take samples (biopsies) of any abnormal looking areas. These will be sent to the laboratory for examination under a microscope. Laparoscopy is done under general anaesthetic. You will have a small wound with a couple of stitches. Sometimes, the camera is put in through more than one cut, so you may have more than one wound.
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