How Is Pleural Mesothelioma Diagnosed?

Diagnosis

To diagnose pleural mesothelioma, your doctor will ask about your symptoms, health history, and asbestos exposure. Based on your answers and a physical exam, a doctor may conduct various tests to confirm a pleural mesothelioma diagnosis and rule out other health problems. A definitive diagnosis can be made through a biopsy — removing a tissue sample and examining it for cancer cells. 

Tests may include:

  • Chest X-ray. X-ray images can show abnormalities in the pleura, the tissue that envelopes the lungs; changes in the lungs from asbestos exposure; or fluid collecting between the lungs and the chest wall.
  • Computed tomography (CT) scan. This provides a more detailed view of the lungs to determine the location of tumors, the stage of cancer (how far it has spread), and pleural mesothelioma treatment options.
  • Positron emission tomography (PET) scan. These images help tell the difference between cancer and scar tissue in the pleura and can reveal the spread of cancer to lymph nodes.
  • Magnetic resonance imaging (MRI) scan. Another imaging technique for showing in detail the location and spread of a tumor, especially spread to the diaphragm.
  • Blood tests. These are done to assess general health and sometimes to look for high levels of fibulin-3 and soluble mesothelin-related peptides (SMRPs), which may help diagnose pleural mesothelioma.
  • Surgical biopsy. This involves taking a sample of abnormal tissue from the pleura using a thin, tubelike instrument, or by open surgery to examine under the microscope.
  • Needle biopsy. During a biopsy, a sample of abnormal tissue is removed through a thin, hollow needle.
  • Thoracentesis. This involves withdrawing fluid from the chest using a syringe-like needle to test for cancer cells.
  • Lung function tests. These tests assess how well the lungs are working and help determine whether surgery is safe.

How Is Pleural Mesothelioma Treated?

Treatments

Treatment for pleural mesothelioma is based on the stage of your disease, how far it has spread, your overall health, and other factors. Treatment may include a combination of approaches. It may also have side effects. Even with treatment, pleural mesothelioma can come back (recur).

Surgery

When pleural mesothelioma is diagnosed early, surgery may cure the cancer in some cases. However, for most people, surgery is aimed at slowing the spread of the cancer and helping to relieve symptoms. The standard surgical procedures for pleural mesothelioma are:

  • Wide local excisions remove visible tumors and some of the healthy tissue around them.
  • Pleurectomy and decortication remove tumors, part of the lining of the lung and chest cavity, and other tissue.
  • Extrapleural pneumonectomy removes one lung, part of the chest lining, part of the diaphragm, and the sac that surrounds the heart (pericardium).
  • Pleurodesis drains fluid, then intentionally causes scarring that stops fluid from building up again.

At NewYork-Presbyterian, our skilled thoracic surgeons use minimally invasive surgical techniques whenever appropriate, resulting in smaller incisions, less discomfort after surgery, and a faster recovery for you. Our surgeons are highly experienced in using video-assisted thoracic surgery (VATS) and robotic surgery to remove tumors in the chest.

Chemotherapy

Chemotherapy uses strong drugs and chemicals to kill cancer cells or stop them from dividing. The drugs travel throughout the body when taken by mouth or given as an intravenous infusion. Chemotherapy can help shrink tumors and slow the growth of pleural mesothelioma when surgery is impossible. It also may be given before surgery to make the cancer easier to remove, or after surgery, to destroy any remaining cancer cells and help prevent cancer from returning.

Immunotherapy

Immunotherapy is a treatment that boosts your immune system’s ability to fight pleural mesothelioma. It can be given instead of chemotherapy in certain cases. 

Radiation

The most common type of radiation therapy for pleural mesothelioma uses high-energy radiation, such as X-rays, to destroy cancer cells. Radiation may be used before surgery to shrink tumors or kill any remaining cancer cells. It also can be given to ease symptoms such as shortness of breath, pain, or trouble swallowing. 

At NewYork-Presbyterian, people who need radiation to treat a pleural tumor benefit from our advanced radiation oncology techniques. We use 3D imaging to shape and target high doses of radiation directly to your tumor, killing cancer cells while sparing nearby healthy tissue and organs such as the heart. 

Targeted therapy

Targeted therapies use drugs or other substances to seek out cancer cells or cells that help the cancer grow. The monoclonal antibody bevacizumab is an example of a targeted therapy used to treat advanced pleural mesothelioma. Bevacizumab blocks the growth of blood vessels that feed a growing tumor. It is given in addition to chemotherapy.

Clinical trials

Clinical trials test whether new treatments are safe, effective, and better than standard treatments. Our researchers are directing clinical trials evaluating novel treatment approaches. Your pleural mesothelioma treatment team will let you know if you can receive an innovative investigational treatment by participating in a clinical trial.

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Trust NewYork-Presbyterian for Pleural Mesothelioma Treatment

At NewYork-Presbyterian, we specialize in the diagnosis and treatment of pleural mesothelioma. Our cancer experts offer the latest and most comprehensive treatments for pleural tumors. Contact us to make an appointment.