Tests of fluid and tissue samples
Removing fluid for testing
If you have a buildup of fluid in the body that may be caused by mesothelioma, a sample
of this fluid can be taken. The skin is numbed and a needle is put through the skin into the
fluid, which is drawn out and sent to the lab. The fluid is tested to see if there are cancer
cells in it.
This test has different names depending on where the fluid is:
· Thoracentesis removes fluid from the chest.
· Paracentesis removes fluid from the abdomen (belly).
· Pericardiocentesis removes fluid from the sac around the heart.
Finding cancer cells tells the doctor that cancer is present, but not finding any cancer cells
in the fluid does not always mean there is no cancer. In many cases, doctors need to get a
sample of the tissue (called a biopsy) to find out if you have mesothelioma.
Biopsy methods
For a biopsy, a small amount of tissue is taken out and looked at under a microscope to
see whether it contains cancer.
Needle biopsy: Tumors in the chest are sometimes sampled by needle biopsy. A long,
hollow needle is passed through the skin in the chest, between the ribs, and into the
tumor. A small sample can be removed to be looked at under the microscope. But
sometimes the sample is not big enough to tell for sure whether there is cancer. If this
happens, another kind of biopsy may be needed.
Endoscopic biopsies: An endoscope (scope) is a thin, tube-like tool used to look inside
the body. It has a light and a lens (or camera) on the end and tools that can be used to
remove tissue that looks like it may be cancer. There are a number of different types of
scopes. They are named after the part of the body that they are used to look at. For
instance:
· A thoracoscope is used to look inside the chest.
· A mediastinoscope is used to look at the space between the lungs.
· A bronchoscope is used to look at the lining of the lungs.
· A laparoscope is used to look inside the belly.
Open surgical biopsy: In some cases, surgery may be needed to get a large enough
tissue sample. This allows the doctor to remove a larger sample of tumor or, sometimes,
the whole tumor.
Testing the samples in the lab
No matter which approach is used to get them, biopsy and fluid samples are sent to the
pathology lab. There, a doctor will look at them under a microscope and do other tests to
decide whether cancer is present (and if so, what type of cancer it is).
It is often hard to tell whether it is mesothelioma by just looking at the cells from fluid
samples (or even tissue samples). So special lab tests that look at things like proteins may
be done, too.
Pulmonary function tests
Pulmonary function tests (PFTs) may be done after mesothelioma is found to see how
well your lungs are working. This is important if you might need surgery to take out part
or all of a lung. The doctors need to know how well the lungs are working before the
surgery. These tests can give the doctor an idea of how much lung can safely be removed.
For PFTs, you breathe in and out through a tube that is hooked up to a machine that
measures lung function.
Staging of mesothelioma
Staging is the process of finding out how far the cancer has spread. Staging is based on
the results of the physical exam, biopsies, and other tests which are described in the
section, “How is malignant mesothelioma found?” This is very important because your
treatment and the outlook for your recovery depend on the stage of your cancer.
At this time, there is a staging system only for mesothelioma around the lung (pleural
mesothelioma). The AJCC (American Joint Committee on Cancer) staging system uses
Roman numerals from I to IV (1 to 4) for the different stages. As a rule, the lower the
number, the less the cancer has spread. A higher number, such as stage IV, means a more
advanced cancer.
After looking at your test results, the doctor will tell you the stage of your cancer. Be sure
to ask your doctor to explain your stage in a way you understand. This will help you
decide on the best treatment for you.
Resectable versus unresectable cancer
To help decide about treatment, doctors often group mesotheliomas based on whether or
not it is likely that the cancer can be removed by surgery. If it can be removed it is called
resectable. If it cannot be removed it is unresectable. Whether or not the cancer can be
removed is based not only on the size of the tumor and how far it has spread, but also on
the mesothelioma subtype, where the tumor is, and whether the patient is healthy enough
to have surgery.
Even if the cancer can be removed, in most cases there are cancer cells that cannot be
seen and that are left behind after surgery. For this reason, many doctors advise using
other forms of treatment (like radiation therapy and/or chemotherapy) along with surgery
when possible.
Other factors that affect outlook
While the stage of this cancer is important in looking at a patient's chances for survival,
other factors should also be taken into account. Some that point to a better outlook
include:
· Being able to carry out normal tasks of daily life
· Younger age
· Epithelioid subtype
· Not having chest pain
· Not too much weight loss
· Normal levels of a substance in the blood called LDH
· Normal red blood cell counts, white blood cell counts, and blood platelet counts
Survival rates for mesothelioma
Some people with cancer may want to know the survival rates for their type of cancer.
Others may not find the numbers helpful, or may even not want to know them. Whether
or not you want to read about survival rates is up to you.
Mesothelioma is a serious disease. By the time the symptoms appear the disease is often
advanced. No matter what the extent of the cancer, it can be very hard to treat.
The average survival times for people with mesothelioma have been between 4 and 18
months. But some people live much longer. Between 5 and 10% of people with
mesothelioma live at least 5 years after their cancer is found. These numbers are from
patients treated many years ago. Better treatments since then mean that the survival rates
for people now may be higher.
As a rule, survival times are likely to be higher for people with mesotheliomas that can be
operated on than for those with cancers that have spread widely.
While numbers provide an overall picture, keep in mind that every person is unique and
that statistics can't predict exactly what will happen in your case. Talk with your cancer
care team if you have questions about your own chances of a cure, or how long you might
survive your cancer. They know your case best.
How is mesothelioma treated?
This information represents the views of the doctors and nurses serving on the American Cancer Society's
Cancer Information Database Editorial Board. These views are based on their interpretation of studies
published in medical journals, as well as their own professional experience.
The treatment information in this document is not official policy of the Society and is not intended as
medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you
and your family make informed decisions, together with your doctor.
Your doctor may have reasons for suggesting a treatment plan different from these general treatment
options. Don't hesitate to ask him or her questions about your treatment options.
About treatment
After the tumor is found and staged, your doctor will talk to you about treatment options.
The main factors in choosing a treatment are the size and place of the tumor, whether it
has spread, your overall health, and your own preferences.
Because this is a rare cancer, it has been hard for doctors to compare the value of
different treatments. Since many doctors have little or no experience treating this disease,
you may be referred to a specialist at a large medical center. Treatment options may
include surgery, chemotherapy, radiation therapy, or more than one of these combined.
One problem with treating mesothelioma is that it does not grow as a single tumor.
Instead, it tends to spread along surfaces, nerves, and blood vessels. This makes it hard
for treatment to get rid of all of the disease.
You may have different types of doctors on your treatment team, depending on the stage
of your cancer and your treatment options. These doctors may include:
· A thoracic surgeon: a doctor who treats diseases of the lungs and chest with surgery.
· A radiation oncologist: a doctor who treats cancer with radiation therapy.
· A medical oncologist: a doctor who treats cancer with medicines such as
chemotherapy.
· A pulmonologist: a doctor who specializes in medical treatment of diseases of the
lungs.
Many other experts may be involved in your care as well, such as nurse practitioners,
nurses, respiratory therapists, social workers, and other health professionals.
Mesothelioma is rare, so if time permits it is a good idea to get an opinion from a doctor
who has a lot of experience in treating people with this cancer. A second opinion can give
you more information and help you feel better about the treatment choice you make.
Removing fluid for testing
If you have a buildup of fluid in the body that may be caused by mesothelioma, a sample
of this fluid can be taken. The skin is numbed and a needle is put through the skin into the
fluid, which is drawn out and sent to the lab. The fluid is tested to see if there are cancer
cells in it.
This test has different names depending on where the fluid is:
· Thoracentesis removes fluid from the chest.
· Paracentesis removes fluid from the abdomen (belly).
· Pericardiocentesis removes fluid from the sac around the heart.
Finding cancer cells tells the doctor that cancer is present, but not finding any cancer cells
in the fluid does not always mean there is no cancer. In many cases, doctors need to get a
sample of the tissue (called a biopsy) to find out if you have mesothelioma.
Biopsy methods
For a biopsy, a small amount of tissue is taken out and looked at under a microscope to
see whether it contains cancer.
Needle biopsy: Tumors in the chest are sometimes sampled by needle biopsy. A long,
hollow needle is passed through the skin in the chest, between the ribs, and into the
tumor. A small sample can be removed to be looked at under the microscope. But
sometimes the sample is not big enough to tell for sure whether there is cancer. If this
happens, another kind of biopsy may be needed.
Endoscopic biopsies: An endoscope (scope) is a thin, tube-like tool used to look inside
the body. It has a light and a lens (or camera) on the end and tools that can be used to
remove tissue that looks like it may be cancer. There are a number of different types of
scopes. They are named after the part of the body that they are used to look at. For
instance:
· A thoracoscope is used to look inside the chest.
· A mediastinoscope is used to look at the space between the lungs.
· A bronchoscope is used to look at the lining of the lungs.
· A laparoscope is used to look inside the belly.
Open surgical biopsy: In some cases, surgery may be needed to get a large enough
tissue sample. This allows the doctor to remove a larger sample of tumor or, sometimes,
the whole tumor.
Testing the samples in the lab
No matter which approach is used to get them, biopsy and fluid samples are sent to the
pathology lab. There, a doctor will look at them under a microscope and do other tests to
decide whether cancer is present (and if so, what type of cancer it is).
It is often hard to tell whether it is mesothelioma by just looking at the cells from fluid
samples (or even tissue samples). So special lab tests that look at things like proteins may
be done, too.
Pulmonary function tests
Pulmonary function tests (PFTs) may be done after mesothelioma is found to see how
well your lungs are working. This is important if you might need surgery to take out part
or all of a lung. The doctors need to know how well the lungs are working before the
surgery. These tests can give the doctor an idea of how much lung can safely be removed.
For PFTs, you breathe in and out through a tube that is hooked up to a machine that
measures lung function.
Staging of mesothelioma
Staging is the process of finding out how far the cancer has spread. Staging is based on
the results of the physical exam, biopsies, and other tests which are described in the
section, “How is malignant mesothelioma found?” This is very important because your
treatment and the outlook for your recovery depend on the stage of your cancer.
At this time, there is a staging system only for mesothelioma around the lung (pleural
mesothelioma). The AJCC (American Joint Committee on Cancer) staging system uses
Roman numerals from I to IV (1 to 4) for the different stages. As a rule, the lower the
number, the less the cancer has spread. A higher number, such as stage IV, means a more
advanced cancer.
After looking at your test results, the doctor will tell you the stage of your cancer. Be sure
to ask your doctor to explain your stage in a way you understand. This will help you
decide on the best treatment for you.
Resectable versus unresectable cancer
To help decide about treatment, doctors often group mesotheliomas based on whether or
not it is likely that the cancer can be removed by surgery. If it can be removed it is called
resectable. If it cannot be removed it is unresectable. Whether or not the cancer can be
removed is based not only on the size of the tumor and how far it has spread, but also on
the mesothelioma subtype, where the tumor is, and whether the patient is healthy enough
to have surgery.
Even if the cancer can be removed, in most cases there are cancer cells that cannot be
seen and that are left behind after surgery. For this reason, many doctors advise using
other forms of treatment (like radiation therapy and/or chemotherapy) along with surgery
when possible.
Other factors that affect outlook
While the stage of this cancer is important in looking at a patient's chances for survival,
other factors should also be taken into account. Some that point to a better outlook
include:
· Being able to carry out normal tasks of daily life
· Younger age
· Epithelioid subtype
· Not having chest pain
· Not too much weight loss
· Normal levels of a substance in the blood called LDH
· Normal red blood cell counts, white blood cell counts, and blood platelet counts
Survival rates for mesothelioma
Some people with cancer may want to know the survival rates for their type of cancer.
Others may not find the numbers helpful, or may even not want to know them. Whether
or not you want to read about survival rates is up to you.
Mesothelioma is a serious disease. By the time the symptoms appear the disease is often
advanced. No matter what the extent of the cancer, it can be very hard to treat.
The average survival times for people with mesothelioma have been between 4 and 18
months. But some people live much longer. Between 5 and 10% of people with
mesothelioma live at least 5 years after their cancer is found. These numbers are from
patients treated many years ago. Better treatments since then mean that the survival rates
for people now may be higher.
As a rule, survival times are likely to be higher for people with mesotheliomas that can be
operated on than for those with cancers that have spread widely.
While numbers provide an overall picture, keep in mind that every person is unique and
that statistics can't predict exactly what will happen in your case. Talk with your cancer
care team if you have questions about your own chances of a cure, or how long you might
survive your cancer. They know your case best.
How is mesothelioma treated?
This information represents the views of the doctors and nurses serving on the American Cancer Society's
Cancer Information Database Editorial Board. These views are based on their interpretation of studies
published in medical journals, as well as their own professional experience.
The treatment information in this document is not official policy of the Society and is not intended as
medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you
and your family make informed decisions, together with your doctor.
Your doctor may have reasons for suggesting a treatment plan different from these general treatment
options. Don't hesitate to ask him or her questions about your treatment options.
About treatment
After the tumor is found and staged, your doctor will talk to you about treatment options.
The main factors in choosing a treatment are the size and place of the tumor, whether it
has spread, your overall health, and your own preferences.
Because this is a rare cancer, it has been hard for doctors to compare the value of
different treatments. Since many doctors have little or no experience treating this disease,
you may be referred to a specialist at a large medical center. Treatment options may
include surgery, chemotherapy, radiation therapy, or more than one of these combined.
One problem with treating mesothelioma is that it does not grow as a single tumor.
Instead, it tends to spread along surfaces, nerves, and blood vessels. This makes it hard
for treatment to get rid of all of the disease.
You may have different types of doctors on your treatment team, depending on the stage
of your cancer and your treatment options. These doctors may include:
· A thoracic surgeon: a doctor who treats diseases of the lungs and chest with surgery.
· A radiation oncologist: a doctor who treats cancer with radiation therapy.
· A medical oncologist: a doctor who treats cancer with medicines such as
chemotherapy.
· A pulmonologist: a doctor who specializes in medical treatment of diseases of the
lungs.
Many other experts may be involved in your care as well, such as nurse practitioners,
nurses, respiratory therapists, social workers, and other health professionals.
Mesothelioma is rare, so if time permits it is a good idea to get an opinion from a doctor
who has a lot of experience in treating people with this cancer. A second opinion can give
you more information and help you feel better about the treatment choice you make.
