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A pleural tumor is more frequently metastatic cancer (cancer that has spread from the place where it first started to another place in the body) than mesothelioma. It is important to distinguish between the two because they have vastly different treatment options.
It is also important to distinguish which subtype of mesothelioma a patient has (epithelioid, sarcomatoid, or mixed). Epithelioid mesothelioma is the more favorable subtype of mesothelioma and carries a greater chance of survival after surgery and multi-modality therapy. Sarcomatoid mesothelioma is composed of spindle-shaped cells, and these tumors tend to have a less favorable outcome.
There are a number of radiologic tests that we order while trying to establish the diagnosis, the stage (how advanced the cancer may be), and determine if surgery is feasible and in the best interest of the patient.
- CT scans of the chest
- PET scans help determine if there is any suggestion of disease in the other lung, in the abdomen, or in other areas of the body
- MRI can suggest invasion into the chest wall, mediastinum, or across the diaphragm into the abdomen
A small catheter is used to drain fluid from the pleural space. The fluid is sent for analysis to a pathologist to see if cancer cells are present. It is not uncommon that the pleural fluid is analyzed and does not indicate a diagnosis of mesothelioma, or even cancer at all – even if cancer is present in that space.
- CT scan
This can reveal the pleural abnormalities suggesting mesothelioma, but it does not give any definitive diagnosis. A biopsy is needed.
Through a very small incision in the chest wall, a videoscope is introduced into the pleural space and multiple biopsies are taken of the pleural surfaces. This often results in a definitive diagnosis of mesothelioma. At this point, the patient typically is referred to a thoracic surgeon with experience in treating patients with mesothelioma.