How Will I Learn About My Biopsy Results, and How Can I Be Sure the Diagnosis is Mesothelioma?

After the pathologist has reviewed the fluid or tissue specimen he will issue a report stating the findings and diagnosis. This report will be provided to your doctor. Normally the physician or surgeon that performed the biopsy will receive the results. If you were referred to this physician by your primary care provider, the performing physician may prefer to have your personal physician relay the results to you.

You should not feel slighted should this happening. Many doctors I have spoken with feel that if the patient is more comfortable with his personal physician, he is more likely to ask the questions about mesothelioma treatment and seek out additional medical consultations.

As a precaution and for better understanding you should:

• Not accept the results of any pathological testing over the telephone;

• Schedule your follow-up appointment with your doctor when he is available to answer your questions;

• Bring with you a list of any questions you may have regarding your mesothelioma diagnosis;

• Ask your spouse or other family member to accompany you to the appointment so that you have not only their support but an extra pairs of ears to take in what your doctor is telling you.

And remember that as a cancer patient you have the right:

• To ask your doctor questions regarding your diagnosis and the procedures performed to obtain the diagnosis;

• To seek a second opinion from another qualified physician or expert;

• To receive complete information about your illness;

• To be informed of all mesothelioma treatment options, including that of chemotherapy, surgical intervention, radiation and other procedures as well as the risks and benefits associated with each;

• To choose your type of care including that of alternative medicine or palliative care, providing you understand all risks involved.

Lynn Collins has been helping mesothelioma patients and families for over 10 years. In this exclusive series she examines the book 100 Questions and Answers About Mesothelioma" by Harvey I. Pass, MD, Laura Roy, RN, and Susan Vento.

Common Mesothelioma Questions & Answers

Whether it is you or a loved one who has been given a mesothelioma diagnosis, the same common set of questions often pop into our minds. These are mesothelioma issues we've covered often on this blog, but they are so important, so critical, that they are worth revisiting from time to time. Covering the basics of mesothelioma is at the core of what we are trying to do in our effort to connect patients and families with critical information. As with any illness, you will learn a lot as you meet with doctors, but it is important to do your own research as well. Here are some common mesothelioma questions we've heard asked over the years by newly diagnosed patients:

What exactly is mesothelioma?
Mesothelioma is a rare form of cancer that attacks the mesothelium and is caused from exposure to airborne asbestos particles being inhaled and injested. Mesothelioma typically infects the pleura (lungs) or peritoneum (abdomen). The asbestos cancer forms around the lining of the organs. When infected by asbestos fibers, the cells of the mesothelium become abnormal and begin to divide at a rapid rate often causing malignant cells to develop and spread.

What causes mesothelioma?
Mesothelioma can be attributed to exposure to asbestos. Due to the long latency period of the disease, the asbestos exposure most often occurs decades prior to diagnosis, between 30-40 years prior in many cases. Many diagnosed with mesothelioma were exposed to asbestos in the workplace; however, the dangers of this exposure were also taken home to family members. Even low levels of exposure can lead to the development of mesothelioma. In addition, there are environmental exposures from deteriorating buildings and old asbestos construction materials to natural occurring asbestos in the earth being disturbed.

How is mesothelioma diagnosed?
If you have already received a mesothelioma diagnosis, then it may be a little less common to ask this question, but many family members and individuals in search of a second opinion are interested in understanding how mesothelioma is diagnosed. The symptoms of mesothelioma are similar to those of asbestosis, a non-cancerous yet life threatening inflammation of the lungs caused by exposure to asbestos, and lung cancer, making it difficult to identify. A complete patient history is required to determine a mesothelioma diagnosis including any exposure to asbestos. Of course, a physical examination is conducted as well as x-rays of the chest and abdominal area. A CT scan, MRI and biopsy are most often used to make a mesothelioma diagnosis.

What are the mesothelioma treatment options?
The treatment of mesothelioma varies from case to case. Factors that influence treatment options for mesothelioma include the location of the asbestos cancer, how far the cancer has developed, and the age and health of the individual diagnosed. Treatment options include surgery to remove the cells, radiation therapy, and chemotherapy. The National Cancer Institute sponsors clinical trails to advance the treatment options for mesothelioma. Unfortunately, there currently is no cure for mesothelioma.

The toughest question, one of the first questions any normal person thinks of, is that of life expectancy. This must be determined on an individual basis. Like treatment, it depends greatly on the type of tumor (pleural mesothelioma or peritoneal mesothelioma), the stage of the disease, and the overall health of the patient.

How are Biopsies Performed and Which One is Right for Me?

In the book 100 Questions and Answers About Mesothelioma the authors ask the following: "How are biopsies performed and which one is right for me?" In my years of working with people that have been diagnosed with mesothelioma, when reviewing their medical records I find that often majority of the time fluid obtained from a thoracentesis or paracentesis is inconclusive for a mesothelioma diagnosis.

While the removal of the fluid provides relief it is very difficult to secure a firm diagnosis of mesothelioma. Why? Because sometimes the abnormal cells are so slight that they are impossible to tell apart from benign, reactive mesothelial cells or other large cells that contain waste or foreign bodies. And, if no abnormal or malignant cells are found in the fluid the patient is often misdiagnosed.

Problems arise when the procedure does not yield sufficient cells to perform the special staining required to diagnose mesothelioma. Extracted fluid that is very thick tends to contain more cells making evaluation by way of immunohistochemical (IHC) or special staining easier to secure a diagnosis of mesothelioma.

The procedure to obtain fluid for cytological analysis requires a local anesthesia and a special needle to drain the fluid. This procedure can normally be performed in the doctor’s office.

A pleural biopsy consists of fluid and a small amount of tissue from the pleura. If the immunohistochemical staining (sometimes referred to as immunos) comes back as inconclusive, then more evasive procedures may be required to confirm a diagnosis. Your doctor may perform a thoracoscopy (a lighted scope with or without a camera). This involves making a small incision in your chest wall and placing a thin tube, called a thoracoscope, into your chest. This enables your physician to look inside your chest and obtain tissue samples. Not only can this procedure obtain tissue samples necessary to confirm a mesothelioma diagnosis it can also help your doctor determine the amount and whereabouts of the disease helping him to formulate a treatment plan.

If, through radiological observation, there appears to be more solid tumor than fluid, then your doctor will recommend an open biopsy. The incision is determined by the size of the thickened pleura and should be done by a thoracic surgeon with knowledge of mesothelioma. Normally a tissue sample measuring from 1 to 1½ inches in diameter is harvested to provide the pathologist adequate tissue to make a diagnosis.

You should follow your doctor’s advice on which procedure should be used for your diagnosis as he is the best one to determine your physical ability to undergo these diagnostic procedures.

Everyday - even this very minute - dedicated researchers are diligently working to advance our ability to diagnose mesothelioma through immunohistochemical staining and other special procedures less evasive in hopes that early detection may aide in the treatment of mesothelioma patients.

Lynn Collins has been helping mesothelioma patients and families for over 10 years. In this exclusive series she examines the book 100 Questions and Answers About Mesothelioma" by Harvey I. Pass, MD, Laura Roy, RN, and Susan Vento.