Mesothelioma is a really tricky illness. The symptoms can take years and years – up to 50 in some cases – to appear and when they do, they can be easily mistaken for a multitude of other illnesses. This makes both misdiagnosis and late diagnosis common and, if this happens, it can end in disaster for the patient. The nature of mesothelioma means that, in order for any treatment to be effective, it must be caught as early as possible. The bottom line is, the quicker the illness is diagnosed and treated, the better the prognosis.
Diagnosis will involve a battery of tests that can determine where the cancer is located and what stage it is currently at. The first step in the process is a visit to the GP. They should ask about your work history and whether there’s any chance you’ve been exposed to asbestos in the past. They will also ask you to detail the symptoms you’ve been experiencing, so it’s best to note down things as you experience them. This way, when you visit the doctor, you don’t forget to mention something that could be important.
If your doctor believes that you may have mesothelioma, they will refer you to a cancer specialist, called an oncologist, at your local hospital. They’ll carry out further tests to determine if the original diagnosis is correct and these tests will be different depending on where in your body the cancer is located. If mesothelioma is suspected in the pleural linings of the lungs, Macmillan Cancer Support details the following tests as those you’d be likely to receive:
- CAT scan – which can be used to confirm the location and extent of the cancer
- biopsy – which will test the tissue for the presence of cancer cells
- fluid sample, known medically as a pleural aspiration – this can help diagnosis, as there are often mesothelioma cells circulating in the fluid that builds up due to the irritation of the pleura
- chest x-ray – this can help show up any abnormalities in the lungs, such as a thickening of the lining of the lung or fluid beginning to gather around the lungs
The Different Stages of Mesothelioma
The diagnosis process not only informs the specialist of the location of the mesothelioma, but also what stage it’s at. The current system used to determine the stages is called the TNM system. This looks at three specific markers:
- T – how big the tumour is and where it’s located
- N – whether the lymph nodes located near-by have become infected
- M – if there are mesothelial cells in other parts of the body
As mentioned earlier, most cases of mesothelioma occur in the lungs, so the different stages detailed below refer to that area. If you are diagnosed with any of the other three types of mesothelioma, you will not be given a stage, as none have yet been established.
Stage 1 – When mesothelioma is at stage one, there will be few or no symptoms present. If your mesothelioma is discovered at this stage, it will almost certainly be by accident. This is particularly sad, as this is the time when any treatment would be the most effective. At this stage the tumours are still very small and only in one location. There are two parts to stage 1 – stage 1a and stage 1b. When the cancer is at stage 1, the tumours will only be on the external lining of the lungs and it moves into stage 1b when the tumours start to appear on the inner linings of the lung.
Treatment: At this stage, a combination of surgery and chemotherapy is the most effective treatment. The patient is still relatively healthy and can usually withstand the negative effects that both of these treatments have.
Stage 2 – Once the cancer starts to spread to other parts of the body, it can be described as stage 2. At this point the tumours have only spread to near-by areas. There may some symptoms, but again, these can mimic many other diseases, so the disease is rarely caught at this early stage. The tumours have now progressed onto the inner linings of the lungs and may also be appearing on the diaphragm.
Treatment: At this stage still consists of surgery and chemotherapy, with radiotherapy included too.
Stage 3 – This is when the tumours have spread to other areas of the body. Now they are all over the linings of the lungs, as well as on the chest wall and in the chest cavity, on the diaphragm and possibly the lining of the heart – the pericardium – too. At this stage, there may be more obvious symptoms, however, as has been mentioned on a number of occasions already, these symptoms can present for a number of different conditions. So, if you are in this position, and your GP is finding it difficult to come up with a diagnosis, think back into your past and see if there’s any possible way you could have been exposed to asbestos.
Treatment: The most appropriate treatments for this stage are the same as for stage 4 – chemotherapy, radiotherapy and surgery.
Stage 4 – When the disease has reached stage 4 it is in an advanced state and the tumours will be found throughout the body. It is possible that all the organs of the body have now been infected with cancerous cells and the symptoms will now be very visible and patients are now feeling quite ill.
Treatment: At this late stage, treatment options become limited. Surgery is out, simply because the tumours are spread too widely throughout the body for cutting them out to be effective. The other two options, chemotherapy and radiotherapy, are the only options and all they are really achieving is a slowing of the progression of the disease.
Getting the best person for the job is also really important. Research carried out into the effectiveness of the different treatments given showed that the competence of the person carrying out the treatment is more important that the type of treatment chosen. So when you are referred to a specialist, make sure that you use your rights and ask for the hospital you’d like to attend – it is your right. You can and should locate any centres specialising in treating mesothelioma as, according to the research highlighted above, “centres specializing in malignant pleural mesothelioma management have better results.”
Further in-depth information about mesothelioma, including the emotional effects,what your employer should be doing to protect you and possible future treatments can be found in Mesothelioma – What You Need to Know