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The symptoms of mesothelioma often are the same as those of other diseases. This may make mesothelioma hard to diagnose. In particular, pleural effusion (fluid build-up in the chest cavity) may be found in several other diseases including lung cancer, heart failure and pneumonia. Early and precise diagnosis is important for successful mesothelioma treatment. However, doctors often are unsure if a person has mesothelioma, even after chest fluid has been removed and tested.

Experience counts

Mesothelioma is a rare disease, so it can be difficult to diagnose. Pathologists at UT MD Anderson have special expertise in diagnosing mesothelioma and its subtypes. Having an accurate diagnosis from the start can help doctors plan the best possible treatment plan.

Mesothelioma diagnosis

If you have symptoms that may signal mesothelioma, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your exposure to asbestos. One or more of the following tests may be used to find out if you have mesothelioma and if it has spread. These tests also may be used to help plan treatments and determine if treatment is working.

Biopsy

A biopsy is the only way to definitively diagnose mesothelioma. During a biopsy, a small tissue sample is removed and examined under a microscope for the presence of cancer cells. There are different types of biopsy for mesothelioma;

• Needle biopsy: Doctors insert a needle into the chest and either sample part of the tumor or drain fluid from the area. The fluid can be examined for cancer cells.
• Thoracoscopic surgical biopsy: During this procedure, a small incision is made in the chest. A tiny tube with a camera on the end is inserted, and a small amount of tissue is removed for examination.
• Thoracentesis: Fluid from around the lungs is drawn out with a needle and tested for cancer cells. Thoracentesis is used when imaging exams indicate the cancer is in the pleura, the membrane that surrounds the lungs and chest wall.

Imaging exams

Diagnostic imaging is used to look for cancer inside the body. These exams can help locate tumors, determine how far the cancer has spread, and track how the body is responding to treatment. There are many types of imaging exams. The ones used for mesothelioma include:

• Chest X-ray: X-rays use low doses of high-energy radiation that travel through the body to create an image. X-rays are used to image bone and can also help spot possible tumors. Chest X-rays are typically the first imaging exam used to help diagnose mesothelioma.
• CT scan: A CT scan uses an X-ray machine to take several pictures from different angles. These are combined to create a highly detailed image that can confirm the presence of a tumor.
• PET scan: During a positron emission tomography scan, or PET scan, a small dose of radiolabeled sugar is injected into a patient. A scanner shows where the body distributes the sugar, allowing for the creation of an image. Cancer cells consume more of this sugar than healthy cells, so this image can help doctors find cancer throughout the body. This is a routine test for determining the cancer¡¯s stage.
• MRI scan: Magnetic Resonance Imaging, or MRI, uses magnetic fields and radio waves to generate pictures of the body¡¯s soft tissue and organs. Doctors use MRIs to look for the spread of cancer to the brain.

Learn more about imaging exams.

Lung function test

Lung function tests are not used to diagnose mesothelioma. Instead, they help determine the condition of the patient¡¯s lungs. Patients whose lungs are working well are more likely to be good candidates for surgery.

In rare cases, mesothelioma can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.