About the diagnosis of mesothelioma.Question and answer. I heard that the members of the society said that it is necessary to visit the Department of Respiratory Medicine and Thoracic (Respiratory) Surgery in General Hospitals to diagnose mesothelioma? My family went to hospitals before being diagnosed with mesothelioma. The first hospital was a small hospital with 20 beds. The second hospital was a 100-bed private hospital with only a physician and no respiratory physician. It was treated for 4 months as tuberculous pleurisy, and it took half a year to be diagnosed with mesothelioma. I want to keep future people from being like us. What should I do?
Malignant pleural mesothelioma was diagnosed mainly by pleural biopsy in the late 1980s (although cytological examination of pleural effusion was also available). Respiratory medicine at a general hospital or university hospital with several hundred beds It was mainly diagnosed by chest (respiratory) surgery. Pleural biopsy under CT has been performed since the 1990s.
You said biopsy, what is it?
Abbreviation for living body examination (biological examination). A part of a living body is collected from a patient, and the tissue is examined by optical, electron microscope, chemical examination, etc. This is to help make the decision. Any tissue that provides the basis for diagnosing a disease, including skin, muscle, kidney, liver, spinal cord, lung, heart, gastrointestinal tract, and mucous membranes. A 1 mm x 3 mm x 1 mm tumor tissue was collected by placing a needle from the outside into the thoracic membrane (pleura).
What is CT (Computed Tomography)?
Computed tomography. A device using a computer that applies X-rays to the human body from various angles and visualizes the images in a three-dimensional manner. Compared to conventional X-ray photography, bones, liquid components, air, etc. can be represented as fine gray images, which were initially used to diagnose heads such as strokes and brain tumors. It is currently used for whole-body photography.
In the case of pleural mesothelioma, water accumulates in the chest, or the tumor is seen in X-rays, right?
(Answer) If pleural effusion or pleural tumor is suspected of chest radiographs and chest CT photographs, pleural effusions are rarely removed (puncture) at outpatient clinics, but most patients are usually hospitalized for examination. The possibility of lung cancer, pleurisy, tuberculosis, etc. is judged based on the results of tumor tests (markers) collected from outpatients and tests such as inflammation.
What are tumor markers?
It is a unique substance secreted by cancer tissue, which is detected in blood and urine, but it cannot be detected unless the cancer tissue becomes large to some extent, and since the amount of secretion is very small, mesothelioma is still It seems that it is weak to become the decisive factor of the diagnosis. It is being developed very hard. There are various tumor markers for lung cancer such as CEA and CYFRA, so check if they are elevated.
Well, first, do you narrow down various diseases?
The pleural effusion is checked for malignant or inflammatory. In many cases, pleural effusion can be judged only once, but if there is a strong suspicion of malignancy and the disease is derived from the pleura, a thoracoscope is planned.
If you continue to have suspected malignant pleural effusions, you will first want to make a decision within two months.
Has the pleural examination method changed since the late 1990s?
From the late 1990s to the 2000s, thoracoscopic pleural biopsy has become the mainstream for the diagnosis of malignant pleural mesothelioma. Thoracoscopic pleural biopsy is performed under general anesthesia in the operating room, so there are hundreds of beds in the general hospital with several specialists. Respiratory Surgery and Thoracic (Respiratory) Surgery, University Hospital Diagnosed by internal medicine and chest (respiratory) surgery.
Is thoracoscopic pleural biopsy difficult to understand?
An anesthesia of the whole body, a thoracoscope camera is inserted from the outside of the chest, and the tissue is examined by pinching the necessary part with forceps while looking closely at the outside of the lung (pleura). Because the pleura can be seen directly and the abnormal part can be collected directly, this is a test method that dramatically increases the accuracy of mesothelioma diagnosis. Started in the 1990s, it is now widely used in general hospitals and university hospitals with a focus on thoracic surgeons. The inspection time is around 1 hour.
Why do I have a diagnosis of mesothelioma?
The final diagnosis of mesothelioma is not a respiratory medicine or thoracic surgeon but a pathologist. In order for accurate pathological diagnosis to be performed, the hospital where you are hospitalized needs to be the hospital where the clinician is. Based on the above, we recommend diagnosis in respiratory medicine / thoracic (respiratory) surgery at a general hospital with hundreds of beds and in respiratory medicine / thoracic (respiratory) surgery at a university hospital. Of course, if there is one respiratory physician or surgeon who is familiar with asbestos-related diseases, a certain diagnosis is possible. External consultations with experienced pathologists are also often performed.
Pathological diagnosis seems to be a test that examines cells and tissues using a microscopic specimen. What is a pathologist? It is an honest surprise that doctors who do not contact patients play a major role.
The occupations of doctors who rarely interact with patients include radiation diagnosticians, anesthesiologists, and pathologists. Among these, pathologists are considered to be highly specialized occupations. This is because radiological image interpretation and anesthesia can be performed to some extent by ordinary clinicians (for example, surgeons), but few surgeons can make pathological diagnoses. Pathologists are resident in large general hospitals, university hospitals, and cancer centers nationwide. Because pathological diagnosis is indispensable for cancer treatment, there are many pathologists in specialized cancer facilities.
What kind of report will the pathologist make for a physician in respiratory medicine or thoracic surgery?
Prepare a preparation from the submitted tissue material, classify the disease pathologically, and submit a pathological diagnosis report (pathological examination report). Usually, HE staining is used for classification, but special staining and immunostaining may be performed. In particular, mesothelioma is rare and difficult to diagnose, so many types of immunostaining are often performed.
If the pathologist reports, is the diagnosis finished?
No, no. There are two stages of diagnosis: pathological diagnosis of whether or not malignant mesothelioma, and stage classification to determine how far the tumor has spread if malignant mesothelioma. The doctor in charge of the abdomen CT and bone scintigraphy (in order to diagnose whether cancer or malignant mesothelioma has spread to bones such as the ribs and spine) In one day, the examination such as bone scintigraphy to be examined), PET, etc., is because it also determines the extent of the tumor.
What is stage classification?
The stage classification is a classification determined to determine the degree of progression of mesothelioma. Check tumor progression by T (Tumor = tumor), lymph node metastasis by N (Node = node), and metastasis to other organs by M (Metastasis = metastasis). In the progression of mesothelioma, I. M.M. I. G. The classification is famous, and it determines the degree of progression of mesothelioma. Based on this classification, we will determine whether surgery is possible, so please ask your doctor about the stage classification.
Are there several types of malignant mesothelioma?
There are several types of malignant mesothelioma. Broadly speaking, there are three types: epithelial type, sarcoma type, and biphasic type with both characteristics. There are other fine classifications. Prognosis varies depending on the type, and epithelial type tends to have a long survival period, while the sarcoma type tends to have a short survival period.
What is the average number of days between the onset of mesothelioma and the diagnosis of mesothelioma?
There are reports of a minimum of 6 weeks, but it is difficult to determine the time because the onset time is often not specified.