Straight Talk about Mesothelioma, a blog series created by Michael T. Milano, M.D., Ph.D., a radiation oncology specialist, as a resource for mesothelioma patients and their loved ones.


Mesothelioma symptoms can vary widely from person to person. One patient may suffer from extreme fatigue, while another battles a constant cough. And, because mesothelioma symptoms mimic other diseases of the chest, such as lung cancer, your mesothelioma specialist will rely on very specific testing before making a final diagnosis.

The initial part of the diagnosis starts with a physical exam. For example, your doctor will be checking for abnormalities in your breathing sounds (by listening to your chest), lumps (i.e. lymph nodes or masses of the chest wall), as well as other indicators. Your doctor then will likely order chest x-rays and CT scans to pinpoint abnormalities. The results of those tests determine what further testing is done. The next blog in this series goes into more detail on these different types of tests.

Your specialist will make a final diagnosis in one of three ways:

  • Analysis of fluid in your chest
  • Biopsy from a needle
  • Biopsy using a thoracoscope, a type of tiny camera at the end of a flexible tube
  • Biopsy from an open surgical procedure

Many specialists prefer one of the two types of biopsy. To confirm that a tumor is, in fact, mesothelioma, the tissue sample is analyzed under a microscope and additional tests are performed to distinguish the tumor from other types of diseases.

Determining the stage of the mesothelioma

Once it is determined that you do, in fact, have mesothelioma, your specialist will want to know to what degree — or stage — it has advanced. This requires yet more tests, which can include:

  • Chest x-ray
  • CT scans of the chest and abdomen
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET scan)

Not all patients will need all of these tests.

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Stages of Mesothelioma

Your specialist will then have all the information necessary to assign a stage to your mesothelioma. There are four stages, with stage IV mesothelioma the most advanced. Here’s how the stages of mesothelioma break down:

  • Stage I: The cancer exists only in one area.
  • Stage II: The cancer has spread beyond its initial location, such as from the lining of the chest to a lung or the diaphragm.
  • Stage III: The cancer has spread further still, and may have progressed to the lymph nodes.
  • Stage IV: This is the most advanced stage of the cancer. At this stage it has spread within the chest and/or to other areas in the body outside of the chest.

Next blog in this series: “Types of Diagnostic Tests You May Have”