Symptoms of peritoneal mesothelioma are not necessarily unique to the disease, so diagnosing peritoneal mesothelioma requires more than an observation of symptoms. Most symptoms associated with abdominal mesothelioma accompany other, often less serious, medical conditions. Most peritoneal mesothelioma diagnoses are made when the malignancy is in an advantage stage and diagnosis, alone, takes on average four months.
Diagnosing Peritoneal Mesothelioma
The first step in diagnosing peritoneal mesothelioma is a physical exam and patient history. If your doctor does not ask about your work history and potential mesothelioma risk factors, let him or her know about your asbestos exposure. A history of asbestos exposure is an important clue for your physician or diagnostician and neglecting to mention this could delay diagnosis.
Following a physical exam and a patient’s description of their symptoms, the next step in diagnosing peritoneal mesothelioma is usually to get some type of imaging of the abdomen. An x-ray, CT (or CAT) scan, or MRI may be performed. Although mesothelioma cannot be definitively diagnosed by visual confirmation, tumors may be visible, or an excess of serous fluid may be seen. The three primary types of peritoneal mesothelioma tumor development seen are:
- “Dry-painful”The most common of peritoneal mesothelioma presentations, one large or several small but similarly located peritoneal masses are seen.”Wet”Associated with ascites and swelling, no solid masses but small nodules and plaques are visible in this type of peritoneal mesothelioma.”Mixed”A combination of both “wet” and “dry” types of peritoneal mesothelioma.
In cases where fluid has accumilated in the abdomen, paracentesis may be performed; a needle is inserted into the peritoneal cavity to drain the excess fluid from the abdomen. Usually, cytologic testing on this ascetic (peritoneal) fluid (where specialists examine the fluid for abnormal cells) is not considered effective to diagnose peritoneal mesothelioma.
The next step in effectively diagnosing peritoneal mesothelioma is the collection of a biopsy. A biopsy is required so that the tissues and cells in question can be examined at a microscopic level. A fine-needle aspiration biopsy is usually performed at first because they are minorly invasive and quite safe. Immunohistochemical staining of the biopsy is regularly performed on collected samples. Sometimes referred to casually as “immunos,” these tests use special substances that color proteins and markers that indicate cancerous cells.
Sometimes further testing is required to make a definitive diagnosis, whether because the initial biopsy testing was inconclusive or a fine-needle biopsy could not be taken because of the location of the tumor and/or fluid pockets. If this is the case, the next step performed is often a peritoneoscopy. During this procedure, a local anesthetic is administered and a small incision allows the doctor looks inside the abdomen with a special tool called a peritoneoscope.
During the peritoneoscopy, a larger biopsy sample may be collected for testing. Finally, if more tissue is required for testing, diagnositic surgery or “open” biopsy may be required.
Diagnosing peritoneal mesothelioma is very difficult, and cases of peritoneal mesothelioma misdiagnosed or undiagnosed are unfortunately not uncommon. It is important to share your case history of work experience (especially in shipyards and at construction sites) and asbestos exposure potential with your physicians if you feel mesothelioma is a risk. Asbestos fibres can also be carried into the home on clothing, inadvertently exposing the deadly fibres, and the risk of mesothelioma, to family members.
In addition to determing a diagnosis, many diagnostic test also help determine the stage the cancer is in, providing a better idea of a patient’s prognosis. The chance of recovery depends on the size of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope, how the cancer responds to treatment, and the patient’s age. Peritoneal mesothelioma is usually diagnosed when it has had time to advance; as with most types of cancer, early diagnosis is an excellent first step in fighting the disease.