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Making a Diagnosis

There are three main types of mesotheliomas of the chest:

  • Epithelial mesothelioma: sheet-like cells

  • Sarcomatous mesothelioma: spindly type cells

  • Biphasic: a mixture of the previous two

The majority of patients who present with mesothelioma will have symptoms including:

  • Coughing and shortness of breath, either sudden in onset due to the development of fluid in the chest (pleural effusion), or a gradual development evidenced by a patient's inability to perform the same amount of work or exercise as normal.

  • Chest pain, occurring when the tumor on the pleura begins to invade the muscles on the inside of the chest wall.

  • Possible weight loss

Diagnosis of mesothelioma usually begins when a chest X-ray reveals fluid in the chest. In the majority of cases, the X-ray is followed up with a Computerized Tomography (CT) scan. The CT scan can show multiple slices of the chest and is able to visualize fluid, as well as thickened, nodular areas inside the chest.

An actual diagnosis of mesothelioma can be confirmed in one of three ways:

  1. Chest fluid is tapped and analyzed by a cytologist

  2. A direct biopsy of the pleura

  3. A biopsy of the pleura using a thoracoscope (a lighted tube with a camera attached)

Biopsy is preferred, as using cells from the fluid makes diagnosis difficult. To confirm that the tumor is mesothelioma, special stains must be performed in order to distinguish mesothelioma from lung cancer or other diseases in the chest.

Once a diagnosis has been confirmed, the staff of experts in NYU's Thoracic Oncology Program can assist with treatment options.