Imaging Techniques
There are many available technologies that allow doctors to view, or image, organs and tissue that might show the presence of fluid or tumors.
A chest x–ray may show an unusual thickening of the pleura, lowering of the lung fissures (spaces between the lobes of the lungs), an accumulation of fluid in the lungs (pleural effusion), and/or an irregular mass in the chest cavity.
A CT (computed tomography) scan uses x-ray and computers to give more sophisticated and detailed pictures of the insides of our body than conventional x-rays. A rotating x-ray beam is used to take a series of pictures of the body from different angles. A computer combines the series of pictures to produce a detailed cross-sectional image of a specific part of the body. The CT scan allows a radiologist to see distinct aspects of the lungs and pleura.
Magnetic Resonance Imaging (MRI) uses a strong magnetic field and radiowaves to scan the body. There is no radiation involved. This imaging method produces a series of cross-sectional pictures. MRI scans are useful for viewing 'soft tissues' in the body and can show the extent of mesothelioma. New MRI techniques where surface imaging techniques are combined with quick breath-holding sequences and gadolinium contrast medium give images, which detect tumor growth in the pleura and thoracic wall better than the previous methods. MRI images tend to be quite clear and are superior to routine x–ray images.
Positron Emission Tomography (PET) scans use a camera that produces powerful images of the body’s biological functions. Because cancers and other disease processes metabolize sugars at a higher rate than normal tissues or organs, the PET scan uses tracers to indicate where there is abnormal metabolic activity and can pinpoint the regions of active disease. PET scans can also identify extremely small cancerous cells, indicate benign or malignant cells, and help determine whether treatment therapies are working.
Pathological Tests
Mesothelioma is diagnosed by pathological examination. Tissue is removed, put under the microscope, and a pathologist makes a definitive diagnosis, and issues a pathology report.
A tissue sample of a pleural or pericardial tumor can be obtained using a relatively new technique called thoracoscopy. A thoracoscope (telescope-like instrument connected to a video camera) is inserted through a small incision into the chest. The doctor can see the tumor through the thoracoscope and can use special forceps to take a tissue biopsy.
A laparoscopy can be used to see and obtain a biopsy of a peritoneal tumor. In this procedure, a flexible tube is attached to a video camera that is inserted into the abdominal cavity via small incisions. Fluid can also be collected during thoracoscopy or laparoscopy.
A bronchoscopy may be performed if pleural mesothelioma is suspected. In this process, the doctor inserts a flexible lighted tube down the trachea, and into the bronchi to check for masses in the airway. At that time, small samples of abnormal-appearing tissue may also be removed for testing.
Lymph nodes are collections of immune system cells that help the body fight infection. By examining the lymph nodes, the doctor can determine if the cancer has spread. During a mediastinoscopy, a patient has a lighted tube inserted under the sternum (chest bone) at the neck level and then moved down into the chest. The surgeon can see the lymph nodes and take tissue samples to check for cancer. This procedure can also help the physician determine if you have lung cancer or mesothelioma.
Pulmonary Function Tests (PFT’s)
PFTs encompass a wide variety of tests that evaluate the entire respiratory system. The tests are useful in the assessment and diagnosis of pulmonary disease and aid in determining a course of treatment. PFTs can be a simple peak flow measurement, or complex body plethysmography and ventilation/perfusion scans which are performed in hospitals and clinics. PFTs can also be useful in monitoring patient response to treatment.
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