The following medical news items are relevant to diagnosis and misdiagnosis issues for Mesothelioma:
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The patient history reveals occupational, family, or neighborhood exposure to asbestos fibers. Physical examination reveals characteristic dry crackles at lung bases. Chest X-rays show fine, irregular, and linear diffuse infiltrates; extensive fibrosis results in a “honeycomb” or “ground-glass” appearance. X-rays may also show pleural thickening and calcification, with bilateral obliteration of costophrenic angles. In later stages, an enlarged heart with a classic “shaggy” heart border may be evident. Computed tomography scan of the lungs also aids in diagnosis.
Pulmonary function tests show:
❑ Vital capacity, forced vita capacity, and total lung capacity — decreased
❑ Forced expiratory volume in 1 second — decreased or normal
❑ Carbon monoxide diffusing capacity — reduced when fibrosis destroys alveolar walls and thickens alveolocapillary membranes.
Arterial blood gas analysis reveals:
❑ Partial pressure of arterial oxygen — decreased
❑ Partial pressure of arterial carbon dioxide — low due to hyperventilation.
Source: Professional Guide to Diseases (Eighth Edition), 2005
A thorough medical history and physical examination should precede sophisticated diagnostic procedures. Useful tests for the early detection and staging of tumors include X-ray, endoscopy, isotope scan, computed tomography scan, and magnetic resonance imaging, but the single most important diagnostic tool is a biopsy for direct histologic study of tumor tissue. Biopsy tissue samples can be taken by curettage, fluid aspiration (pleural effusion), fine-needle aspiration biopsy (breast), dermal punch (skin or mouth), endoscopy (rectal polyps), and surgical excision (visceral tumors and nodes).
An important tumor marker, carcinoembryonic antigen (CEA), although not diagnostic by itself, can signal malignancies of the large bowel, stomach, pancreas, lungs, and breasts. CEA titers range from normal (less than 5 ng) to suspicious (5 to 10 ng) to suspect (over 10 ng). CEA serves many valuable purposes:
❑as a baseline during chemotherapy to evaluate the extent of tumor spread
❑to regulate drug dosage
❑to prognosticate after surgery or radiation
❑to detect tumor recurrence.
Although no more specific than CEA, alpha-fetoprotein — a fetal antigen uncommon in adults — can suggest testicular, ovarian, gastric, and hepatocellular cancers. Beta human chorionic gonadotropin may point to testicular cancer or choriocarcinoma. Other commonly used tumor markers include prostate-specific antigen to detect and monitor prostatic cancer, and CA-125, useful for monitoring ovarian, colorectal, and gastric cancers.
Source: Professional Guide to Diseases (Eighth Edition), 2005
❑Spinal and lumbosacral magnetic resonance imaging confirm spinal tumor.
❑ X-rays show distortions of the intervertebral foramina; changes in the vertebrae or collapsed areas in the vertebral body; and localized enlargement of the spinal canal, indicating an adjacent block.
❑ Myelography identifies the level of the lesion by outlining it if the tumor is causing partial obstruction; it shows anatomic relationship to the cord and the dura. If obstruction is complete, the injected dye can't flow past the tumor. (This study is dangerous if cord compression is nearly complete because withdrawal or escape of cerebrospinal fluid (CSF) will allow the tumor to exert greater pressure against the cord.)
❑ Radioisotope bone scan demonstrates metastatic invasion of the vertebrae by showing a characteristic increase in osteoblastic activity.
❑ Computed tomography scan shows cord compression and tumor location.
❑ Frozen section biopsy at surgery identifies the tissue type.
❑ Lumbar puncture may be normal, abnormal, or nonspecific. It may show clear yellow CSF as a result of increased protein levels if the flow is completely blocked. If the flow is partially blocked, protein levels rise, but the fluid is only slightly yellow in proportion to the CSF protein level. Cytology of the CSF may show malignant cells of metastatic carcinoma.
Source: Professional Guide to Diseases (Eighth Edition), 2005
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