Mesothelioma and Pleural Disease Diagnosis

Mesothelioma and Pleural Disease Treatment at Penn Medicine

When treating patients with mesothelioma or pleural disease, Penn Medicine pleural specialists offer more treatment options than most other health systems across the country and around the world.

Penn Medicine's Mesothelioma and Pleural Program and Penn's Abramson Cancer Center in Philadelphia, PA bring together internationally renowned experts in medical, surgical and radiation oncology and pulmonology who collaborate in the diagnosis, treatment and research of mesothelioma and pleural disease.

Focus on Mesothelioma

Mesothelioma is a rare type of cancer that affects the lining of the chest or abdominal cavities. It is most often attributed to exposure to airborne asbestos particles and occurs in both men and women. Asbestos fibers are naturally occurring fibrous minerals that were commonly used in construction and thermal insulation as a fire retardant until the 1970s. Asbestos is still used in products, but regulations in place since the 1980s limit its use.

Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

Penn's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

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Diagnosing Mesothelioma and Pleural Disease

An accurate diagnosis is the key to providing patients with the high level of care that they require for mesothelioma or pleural disease. At Penn, specialists who have extensive experience diagnosing and treating these complex conditions employ the latest tests and tools to provide patients with a timely, accurate diagnosis.


Screening for Mesothelioma and Pleural Disease

Currently, there are no recommendations for screening for mesothelioma or pleural disease, like there are for breast or colon cancer. However, people who have been exposed to asbestos, or who are at an increased risk for mesothelioma and pleural disease, should speak with their physician about screening tests that may detect early signs of cancer.

Physicians at Penn Medicine also recommend that people who have been exposed to asbestos know the signs and symptoms of mesothelioma.

Mesothelioma and Pleural Disease Diagnostic Tools

Mesothelioma can be difficult to diagnose because its symptoms can be similar to those of other diseases. Pleural specialists at Penn Medicine have significant experience with this disease and employ the most advanced, minimally invasive techniques to obtain an accurate diagnosis.

Diagnostic tools used by Penn’s Mesothelioma and Pleural Program include:

  • Physical exam and history. Patients' overall health is assessed and they are examined for signs of the disease – such as lumps or anything else that seems unusual. Doctors also take a detailed patient history, looking at health habits and likelihood of asbestos exposure, as well as past illnesses and treatments.
  • Chest X-ray. This imaging tool is used to obtain pictures of the organs and bones inside the chest.
  • Computed tomography (CT) scan. A CT scan creates a three-dimensional X-ray of the inside of the body. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan is used to see if the tumor has spread to the surrounding tissue or organs. Sometimes, a contrast medium (dye) is used to provide better detail.
  • Complete blood count (CBC). A blood test assesses the number of red and white blood cells and platelets, hemoglobin in the blood, and how much of the blood is made up of red blood cells.
  • Sedimentation rate. This blood test measures the rate at which red blood cells settle in a test tube. The more red cells that fall to the bottom in one hour, the higher the sedimentation rate. A high sedimentation rate can indicate infection, autoimmune disease or cancer. This test is often done in combination with other diagnostic procedures to confirm a diagnosis.
  • Biopsies. Cell or tissue samples from an individual’s mesothelium (either pleura or peritoneum) are examined by a pathologist to check for signs of cancer. Procedures used to collect these samples include:
    • Fine-needle (FNA) aspiration. A thin needle is inserted into the abnormal tissue or fluid through a small incision and a sample of cells is removed. Doctors use advanced imaging technology to pinpoint the location of the biopsy.
    • Thoracoscopy. Doctors use thoracoscopy to view the interior of the chest and to obtain tissue samples. A small incision is made between two ribs, and a thoracoscope (a thin, lighted scope) is inserted into the chest.
    • Peritoneoscopy. A small incision is made in the abdominal wall and a peritoneoscope (a thin, lighted scope) is inserted into the abdomen to view the interior of the abdomen and to obtain tissue samples.
    • Laparotomy. An open surgical procedure in which an incision is made in the abdomen to examine the organs and tissue for signs of disease.
    • Thoracotomy. An open surgical procedure during which an incision is made in the chest allowing doctors to examine the area for signs of disease and if necessary – and possible – remove the affected tissue.
    • Bronchoscopy. Doctors use bronchoscopy to examine the trachea and large airways in the lung. The scope is inserted through the nose or mouth into the trachea and lungs. It may also have a tool to remove tissue samples, which are studied for signs of cancer.
    • Thoracentesis / Paracentesis. Fluid is taken from around the lungs or from the abdomen, and pathologists study cells under a microscope to check for abnormalities.

Staging Mesothelioma and Pleural Disease

Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's chance of recovery.

Once a diagnosis of mesothelioma is confirmed, staging of the disease is the next step in determining potential treatment options. Mesothelioma staging requires knowledge about where the tumor is located, how extensive it is in that location, whether the tumor metastasized to organs or adjacent tissues, and if it has spread to lymph nodes. Non-invasive staging is determined by the results of CT and/or MRI of the chest/abdomen/pelvis, PET scans and brain scans.

Invasive staging studies include various surgical procedures:

  • Bronchoscopy
  • Endoscopic ultrasound-guided bronchoscopy (EBUS)
  • Laparoscopy
  • Mediastinoscopy
  • Video-assisted thoracoscopic surgery

The International Mesothelioma Interest Group and Brigham & Women's Hospital have developed staging systems based upon a set of disease characteristics, which include:

  • T (tumor): What is the size, location and aggressive nature of the tumor in relation to nearby organs and structures?
  • N (lymph nodes): Are the lymph nodes involved and. if so, which ones?
  • M (distant metastases): Is there evidence of metastasis outside of the chest cavity?

Based on each of these three characteristics in combination, the stage of the mesothelioma is determined and, from this stage, a treatment plan is developed. A brief summary of each stage is described below:

Stage I: Mesothelioma affects the pleural space on only one side of the body but has not yet spread to other organs or the lymph nodes.

Stage II: Mesothelioma has spread more extensively within the pleural space or even into the lung itself and may also have extended into the diaphragm but has still not reached the lymph nodes or distant sites.

Stage III: Mesothelioma may have spread to the lymph nodes near the tumor, but would not have spread as far as the collarbone. It may also have spread into the chest wall, or even into the outer layer covering the heart, but has not yet spread to the other side of the chest or to distant sites.

Stage IV: Mesothelioma may have spread into the chest wall muscle, the ribs, the trachea, the esophagus, the spine, to the other side of the chest, or into the heart itself. Mesothelioma is also classified at Stage IV if it affects lymph nodes near the collarbone or has spread to distant sites.

Mesothelioma and Pleural Disease Treatment

Penn Medicine's pleural specialists develop personalized treatment plans for patients with mesothelioma and pleural disease, designed to give every patient the best possible outcome. Penn's treatment options for mesothelioma and pleural disease include:

  • Surgery
    • Extrapleural pneumonectomy
    • Indwelling pleural catheter (IPC)
    • Lung-sparing surgery
    • Minimally invasive surgery
    • Peritoneal cytoreductive surgery
    • Pleural sclerosis and fibrinolytics
    • Therapeutic thoracentesis
    • Thoracotomy
    • Video-assisted thoracoscopic surgery (VATS)
  • Radiation Therapy
    • Brachytherapy
    • Intensity-modulated radiation therapy (IMRT)
    • Photodynamic therapy (PDT)
    • Proton therapy
    • Volumetric-modulated arc therapy (VMAT)
  • Chemotherapy and Biologic Therapies
    • Combination chemotherapy
    • Immunotherapy
    • Targeted therapies
    • Gene therapy
    • Adjuvant therapy
  • Interventional Pulmonology Treatments
    • Endobronchial ultrasound-guided biopsy and mediastinal staging
    • Pleuroscopy and pleurodesis
  • Clinical Trials
  • Other Treatments
    • Integrative medicine and wellness
    • Palliative care
    • Penn Home Care and Hospice

Patients who come to Penn Medicine for their cancer care benefit from coordinated care across disciplines and modalities. The expertise of Penn's Abramson Cancer Center in cancer diagnosis, treatment planning and integrated medicine, helps patients who come to Penn Mesothelioma and Pleural Program receive nationally recognized care that leads to better outcomes and improved quality of life.

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Mesothelioma and Pleural Disease Survivorship

At Penn Medicine, significant research in the diagnosis and treatment of mesothelioma and pleural disease is giving patients with these conditions new hope for long-term survival.

To meet patients' varied physical, emotional and financial needs, Penn's robust network of navigation specialists includes social workers, stress management specialists, alternative medicine practitioners and clergy. Additionally, the support groups and survivorship programs at Penn provide patients and their families with a valuable network that serves to enhance and extend the quality of life following a cancer diagnosis.

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Suzi F. Garber

Suzi F. Garber, of Reading, PA., a neuroendocrine tumor patient at the Abramson Cancer Center, writes about her experience so that others might benefit from her story and become proactive advocates for themselves and their loved ones.

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