If you recently got your pathology report back that said you have mesothelioma, you are probably wondering what to do and what is next. A mesothelioma diagnosis is definitely scary, but there is hope for people for this cancer.

The pathologist’s report says more than you have mesothelioma. It reports the type of mesothelioma you have, cell type, and much more. The pathologist’s report is vital because its details tell your doctors how to treat your mesothelioma most effectively.

Below is more information about mesothelioma diagnoses, pathology, and treatment options.

How Mesothelioma Is Diagnosed

If you have gotten a pathology report back that said mesothelioma, it is important to understand how the disease was diagnosed. Common diagnostic procedures for mesothelioma, which is caused by asbestos exposure, are: (Cancer.org)

• Imaging tests: Your pathologist will partially rely on several imaging tests to confirm a mesothelioma diagnosis. A chest X-ray is almost always the first test that is done by doctors. If anything unusual is seen, the doctor will perform other imaging tests. The most common tests to further explore possible mesothelioma tumors are CT, PET, and MRI scans.
• Blood marker tests: The American Cancer Society reports that blood levels of some substances, such as fibulin-3 and soluble mesothelin-related peptides, are higher in people with mesothelioma. Blood tests alone are not enough for your pathologist to confirm a mesothelioma diagnosis, but they can provide information about the possibility of the cancer’s presence. These tests also can indicate how well your organs are responding to cancer treatments.
• Biopsies: After imaging and blood markers tests show a possibility of cancer, your doctor will refer you to a surgeon for a biopsy. This procedure involves removing tissue or fluid from a tumor. These samples are checked by your pathologist to confirm if you have cancer, whether it is mesothelioma, and the cell type involved.

It is important to remember that only a pathologist with your biopsy can definitively diagnose mesothelioma and other types of cancer. (Mayoclinic.org)

Pathologists and Mesothelioma Diagnoses

Pathologists are physicians who focus on analyzing diseased tissues to diagnose diseases such as mesothelioma. These doctors specialize in studying how cells are altered by cancer and the consequences of these changes. (Asbestos.com)

Pathologists who diagnose mesothelioma are experts in the characteristics of asbestos-related tumors. They understand how to tell the difference between mesothelioma and other cancers by examining samples under a microscope, which is a vital step to diagnose and treat the cancer.

Below is more information about how pathology is used to diagnose mesothelioma.

Cellular Pathology

Visible anatomical characteristics of your tumor can help to diagnose the cancer, but it is necessary for the pathologist to study the types of cells present under a microscope. With a microscope, pathologists can differentiate mesothelioma cells from other cancer cells. They also can diagnose subtypes of mesothelioma by using the following methods:

• Histology: Study of tissue samples
• Cytology: Study of fluid samples

Histology involves studying tissue samples that are obtained through a biopsy. Histopathology refers to studying the cells in diseased tissue. For patients with mesothelioma, tissue from the tumor is often obtained through a thoracoscopy, which is 98% accurate in diagnosing mesothelioma.

A pathologist looking at tumor cells is the only certain way to confirm the type of cancer present. A subtype of histology called immunohistochemistry uses special types of stains to provide more details about a tumor. This helps doctors to treat the mesothelioma more effectively.

Immunohistochemistry

This is a special staining technique that histopathologists use to diagnose specific types of cancer. This process involves the use of antibodies applied to a tissue sample on a slide. The pathologist can then observe the characteristics of cellular proteins when they react to antibodies.

The International Mesothelioma Interest Group (IMIG) notes that a definitive diagnose of mesothelioma must have immunohistochemical testing.

One useful stain to diagnose mesothelioma is an antibody called pancytokeratin. This stain will usually be positive in asbestos-caused tumors and is reliable for a mesothelioma diagnosis.

But because most of these stains are not as accurate as single stains, physicians use a large panel of antibodies consisting of epithelial markers and mesothelial markers.

Cytologic Features

Cytology studies possible cancer cells from fluids or surface scrapings without getting tissue samples.

A pathologist can collect pleural fluid from a patient who is thought to have pleural mesothelioma. It is removed with a needle from the pleural space outside the lung. This technique is less expensive and test results come back faster than biopsies.

Cytology can show the presence of a single malignant cancerous cell, but it cannot tell the difference between a malignant tumor, a cancer that has not spread to other tissues, or an invasive tumor. Histological testing is still required to confirm if you have mesothelioma.

Pathologists Classify Mesothelioma Cells Into 3 Types

With histology, your pathologist will classify your mesothelioma cells into one of three general types based on what they look like under a microscope:

• Epithelioid: Polygonal, cuboidal, or oval in shape and may imitate noncancerous mesothelial cells. This cell type is the most responsive to treatment.
• Sarcomatoid: Spindle-shaped and less responsive to treatment.
• Biphasic: Contain epithelioid and sarcomatoid cells.

The pathologist determining your cancer’s cell type is key to proper treatment.

Pulmonary Function Tests

If your pathologist has diagnosed you with mesothelioma, your doctor may order pulmonary tests to determine how well your lungs are working. These tests can be especially important if surgery is being considered to treat your mesothelioma.

With pleural mesothelioma, surgery can be performed to remove part or all of the affected lung. It is important for your doctors to know how well your lungs are working. These tests may give the surgeon an idea of whether surgery could work for you and how much of the lung can be safely removed.

How Mesothelioma Is Treated

The pathologist’s work in diagnosing your mesothelioma and its type is vital because the cancer and cell type will dictate how the disease is treated. (Mayoclinic.org)

Depending on the type of mesothelioma, cell type, and stage, your doctors may recommend some or all of the following treatments:

Surgery

If the mesothelioma is in stage I or II, your doctors may recommend one of several types of surgery:

• Decrease fluid build up around the lungs: Pleural mesothelioma leads to fluid build-up around the lungs caused pleural effusion. This makes breathing painful and difficult. Your surgeon will insert a tube into the chest to drain the fluid.
• Remove tissue around the lungs: The surgeon may take our tissue around the lungs and ribs, called a pleurectomy.
• Remove a lung and surrounding tissue: Taking out a lung and the tissue around it may relieve the symptoms of cancer. This surgery can be paired with radiation in higher doses because there is no risk of damaging the delicate lung tissue.
• Peritoneal mesothelioma surgery: This is mesothelioma in the abdomen. Surgery can be performed that removes as much of the tumors as possible, followed by heated chemotherapy in the abdominal cavity.

Chemotherapy

Chemotherapy can be effective in killing mesothelioma cancer cells. Chemotherapy can be used prior to surgery to make the operation easier or after surgery to reduce the chance that cancer will come back.

Radiation

Radiation uses high-energy beams from X-rays or protons to kill tumors in the body. Radiation can be used after surgery to kill any cancer cells that remain. Or it can be used to reduce symptoms of cancer when surgery is not possible.

Other Treatments

Immunotherapy uses the body’s immune system to fight mesothelioma. Your immune system may not attack the cancer because the tumor cells produce proteins that blind the immune system cells. Immunotherapy may interfere with this process and help your immune system to fight the cancer.

Targeted therapy uses drugs that attack certain vulnerabilities in mesothelioma cancer cells. These drugs are not often used to treat mesothelioma. But your doctor could recommend this therapy based on the results of DNA testing of your tumors.

Summary

If your pathologist has confirmed your mesothelioma, there is hope because your doctors know the specific type of cancer you have and the most effective ways to treat it. Once you have your diagnosis, work closely with your medical team to understand how your cancer will be treated.