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At modern days the CT (computerized tomography) scan is used more often. CT is a
special x-ray machine that shows sliced images of your body. CT scan of chest or
abdomen shows the swellings in organs, cavities, and lymph nodes. A contrast dye
may help to the scan. CT scans show pleural effusion, pleural thickening,
pleural calcification, spreading of tumor into chest wall. However, CT do not
really distinguish benign asbestos disease, lung cancer or mesothelioma. Doctors
also use CT scans for guiding needle aspiration of suspicious pleural masses. Thoracoscopy is the procedure when a surgeon makes small cut in your chest wall
between two ribs and looks through a thoracoscope (a tool with a video camera).
The biopsy (tissue sample) goes to a lab to check for cancer cells.
Bronchoscopy allows doctors to look inside the airways. A thin flexible tube
(bronchoscope) helps to get samples of tissue and send them sent to a lab for
testing for cancer cells.Mediastinoscopy checks mediastinum (the area in chest containing heart, great
blood vessels, lymph nodes, esophagus, nerves and so on). Mediastinoscopy allows
sampling lymph nodes in your body to look for metastases.
Laparoscopy is a surgical procedure when doctors look inside of your belly with
a small camera-fitted tube. The surgeons will biopsy suspicious areas. The
bioptate (the tissue sample) goes to the laboratory. A pathologist checks it
under a microscope. Laparoscopy leaves a small cut on the skin of your belly.
Another name of the same procedure is peritoneoscopy. The tool is named
peritoneoscope.Putting a needle into your abdomen and removing the fluid inside is named
paracentesis. Putting a needle into your chest and draining the fluid is named
thoracentesis.
MRI (magnetic resonance imaging) scan gives a sliced picture of the inside of
your body. It is better than X-ray or CT scan because there is no radiation of
your body. However it requires significant time. Sometimes it takes up to 20
minutes. And some people afraid to stay in the machine for half an hour required
for the test. Besides MRI has a limitation. The test requires avoiding metals in
your bodies (like metal joints and other metal implants). MRI is not a routine
test, so sometime it is not ordered. Magnetic Resonance Imaging is most commonly
ordered to determine the extent of tumor to plan the surgery. MRI also easier
than CT scans shows enlarged lymph nodes and surface of diaphragm and this is
important for surgical planning.Positron Emission Tomography (PET) came recently for diagnosing different type
of cancers and mesothelioma as well. PET uses special radioactive substances
that emit positrons. Localized mesothelioma is confined to the pleura. Advanced
mesothelioma spreads to the lungs, chest wall, abdomen and lymph nodes.
Pathological examination checks biopsy samples under the microscope It is
difficulty to diagnose mesothelioma sometime. The cells of the tumor may be of
many different types. These cells may look similar to other cancers. Peritoneal
cells may look similar to pleural mesothelioma or other types of lung cancer and
even ovarian cancer. Epithelioid type of mesothelioma is more common and
considered better for treatment more than aggressive sarcomatous type. Biphasic
mesothelioma is the mixture of both.Doctors and scientists also proposed some immunological makers to find
mesothelioma, however majority of the markers are not very specific. Just to
mention: Epithelial membrane antigen, CEA (carcinoembryonic antigen v very
unspecific, may happen in many different cancers), Calretinin, Mesothelin,
Cytokeratin, osteopontin and some others.
By
Aleksandr Kavokin, MD, PhD
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