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Why Is It Hard to Diagnose Mesothelioma?

File, glasses and medications on the table

Mesothelioma is a rare cancer with a bad reputation. There’s not yet a reliable cure, and most people who receive a diagnosis will also hear their prognosis isn’t good. One big reason the prognosis is so often poor is that doctors frequently fail to diagnose mesothelioma until it has reached its later stages, spreading through the body.

But why is that the case? Doctors are always learning newer and better ways to diagnose and treat cancers. What makes mesothelioma so hard to diagnose? The truth is that there are several reasons doctors don’t diagnose it earlier.

There are multiple types of mesothelioma

Mesothelioma tumors vary according to both their location and cell type. The most common mesotheliomas reside in the pleura, the membrane that lines the lungs and chest cavity. Other common locations include the membranes lining the abdomen and surrounding the heart. Mesothelioma sometimes presents in the membrane around the testicles, but that is less common.

So, the first challenge is identifying cancers in these locations as mesothelioma, rather than as any more common cancer.

Then, there are three different types of mesothelioma based on the tumor cell types:

  • Epithelioid tumors grow from epithelial cells. These are the types of cells you’d find in your skin and the linings of your blood vessels, body cavities and hollow organs. The cells are relatively large and broad and respond reasonably well to treatment.
  • Sarcomatoid tumors are rarer than epithelioid tumors and are harder to treat. Sarcomatoid cells are longer and spindle-shaped.
  • Biphasic tumors contain a mix of both epithelial and sarcomatoid cells. Their responsiveness to treatment depends largely on the ratio of the two cell types.

Taken all together, this means that mesothelioma tumors don’t always look the same. This is a point several scientists made clear in the Journal of Clinical Medicine. Their review included multiple PET scans, CT scans and images from biopsies that highlighted the variety of mesothelioma tumors. The result is that doctors may not immediately recognize mesothelioma tumors, even when they’re looking for them. And mesothelioma patients with non-standard tumors may face extra challenges to get the treatment and legal recourse they are due.

It’s not always easy to recognize a history of asbestos exposure

The typical mesothelioma victim is an older male who worked a job that exposed him to asbestos. When the history of asbestos exposure is clear, doctors are more likely to look in the right direction. This is also true when the patient fits the “older male” profile. Because the disease often features a lengthy latency period of 20 to 30 years, most victims are 60 or more years of age.

Accordingly, doctors are more likely to test for other diseases when patients are younger, female or don’t know how they might have suffered asbestos exposure.

This makes it important to understand and address any possible second-hand exposure. In fact, a recent study from the CDC found that mesothelioma death rates were dropping among all but two groups—men over the age of 85 and women. From 1999 to 2020, while the overall death rate was dropping, the death rate for women rose.

Few of these women worked in “traditional mesothelioma industries,” such as construction, auto work, pipefitting or mining. Instead, the three most common careers for female asbestos victims were:

  • Homemakers
  • Elementary and middle school teachers
  • Registered nurses

Many likely suffered second-hand exposure from husbands or fathers who had worked with asbestos. Others may have suffered asbestos exposure as the asbestos-laden materials in their workplaces broke down.

Doctors might not always use the best diagnostic tools

The American Cancer Society addresses many tests doctors may use to diagnose mesothelioma. These include:

  • Physical examinations
  • X-rays
  • Echocardiograms
  • CT, PET and MRI scans
  • Blood tests
  • Fluid tests
  • Needle, endoscopic and surgical biopsies

The problem is that many of these tests are inconclusive on their own. Again, this relates to the fact that mesothelioma tumors don’t all appear alike. This means doctors may need multiple tests and tools to get a clear diagnosis. But those tests might not all be possible.

Older patients in the later stages of the disease may not have sufficient health to undergo surgery for a larger biopsy sample. And smaller samples may not yield the results the doctors need.

The symptoms are largely common to many diseases

When people go to doctors to understand what’s causing their symptoms, the doctors need to keep an open mind to consider all the possibilities. Even so, they know that certain symptoms or combinations of symptoms are more likely to point to one disease than to another.

In the case of mesothelioma, this can be a problem. Its symptoms are largely indicative of many more common diseases:

  • Chest pains
  • Shortness of breath
  • Coughing
  • Lethargy
  • Weight loss

Accordingly, because mesothelioma is rare, these “non-specific” symptoms are more likely to point to other diseases than to mesothelioma. Doctors won’t recognize the problem is mesothelioma until they start getting tissue samples. At the same time, delays in the diagnosis give the disease time to grow and spread.

A good diagnosis is critical

It’s important to remember that a good diagnosis means more than simply identifying the disease. A good diagnosis helps doctors understand how far the disease has progressed and what options they may have to combat it. It informs the treatment. It informs the adjustments that victims may expect to make. And it can affect a victim’s ability to claim compensation.

Nearly all mesothelioma cases tie back to asbestos exposure. This exposure typically came about because manufacturers chose to work with asbestos, even when they knew it could cause cancer. This means most victims can file legal claims for financial compensation. However, the Journal of Clinical Medicine says two doctors looking only at clinical evidence may offer differing opinions roughly 53% of the time. That’s why it’s critical that patients get diagnoses based on tissue samples and analysis.

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