How is Mesothelioma diagnosed
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Welcome to the Mesothelioma Help Ask-A-Nurse interview session. We're privileged to be talking to a doctor and 2 nurses with mesothelioma experience.
Lisa Hyde-Barrett who has been a thoracic surgery nurse for nearly 25 years and has had the privilege of caring for countless mesothelioma patients over the years, offers key medical information to the readers.
Ellie Erickson has been working in the surgical intensive care unit at Brigham and Woman's Hospital since 1985. Before then she worked in the cardiothoracic ICU and the ICU float pool. She earned her diploma in nursing from the Mount Auburn Hospital School of Nursing in 1978 and earned her BSN from Worcester State College in 1982.
Dr. DaSilva [inaudible 00:01:05] at Layola University Medical Center and Professor of Surgery at the Stritch School of Medicine in Chicago. He is the co-director of the Lung Cancer Program and the Director of the International Mid-Western Mesothelioma Program, Cardinal Bernardin Cancer Center.
So we'd like to first start off by asking you Dr. DaSilva, what program you're currently working on?

So my program is really a comprehensive program. We have both chest, thoracic, pleural mesothelioma, as well as abdominal mesothelioma. Under a larger umbrella that we've got regional therapy treatment for mesothelioma. Regional therapy really means [inaudible 00:01:54] chemotherapy applied to both the chest cavity, abdominal cavity with another surgeon by the name Papas. He's the general surgeon. I'm the thoracic surgeon in the program.
To our knowledge, it's probably the first program to be so comprehensive [inaudible 00:02:13] mesothelioma care in the mid-west and we're very proud of it because many programs have thoracic or just have abdominal but most of the programs do not have a purely thoracic or abdominal combined. So we're happy about that and that's what were working on creating, which we heard before a team approach. So we have a multi-disciplinary clinic with medical colleges, radiational colleges, thoracic radiologists. Afraid to say most of them are seasoned, they're very experienced radiologists, which is so important in the detection of mesothelioma [inaudible 00:02:59]. We also have a dietician, we have 2 nurses who help us to navigate the system.
So we're begging to put all that team together. The chemotherapy perfusion part of it, it's been already in place even before I got here by Dr. Papas and they use the same system that I used at the [inaudible 00:03:23] when I was at the [inaudible 00:03:22]. So for me, really it's the same procedure. We're just creating and uniting, putting together those two areas, the abdominal and the thoracic together under one umbrella. So we're very happy with that program.

Thank you for that. I guess the next thing we'll do, we'll jump right in and whoever wants to answer this can take it away.
The first question we have is, how is mesothelioma diagnosed?

It's a very good question. Most of the patients, they present with what we call either a dry cough that's caused by a pleural effusion or shorting of breath. They just get short of breath because the effusions pushing on the lung. Effusion is water around the lung, right, so for those who are not clear what effusion means, it's just water around the lung pushing onto the lung.
So most of the patients present with that. They get treated for a while, it doesn't go away and when they re-present a few months later it may be too advanced of stage. So for us the most important diagnose is a very, synced into the mesothelioma clinician. What I mean by that, is someone who has a high index of suspicion. Something doesn't look right for pleural effusion. Patients too young or there's no [inaudible 00:04:50] or something's not really clear why the patient has an effusion. Should pursue aggressive diagnosis and most of the places they do a, let's say a thoracentesis, a drainage with a needle, negative.
Well we know that 50 percent of the effusions will be negative anyways, so we recommend more aggressive therapy approach, diagnostic approach such as biopsy, [inaudible 00:05:15], pleuroscopy, with a camera into the space and then biopsy it. So the really, clue for it, is patient presents with sort of not clear reason why they have an effusion and they should jump at it instead of saying well it's a cold or it's pneumonia that's resolving, pursue further diagnostic modality.

Do you plan on doing the abdominal and thoracic together or just following the patient or how many cross over?

What we're planning to do is if they come in predominantly with abdominal disease, then we'll take care of the abdominal disease first and then follow the patients and see if anything were to develop in the chest. On the other hand [inaudible 00:06:17] if they present with chest disease predominantly then we'll do the chest first and follow them knowing that the percentage of patients that will present with abdominal metastases or spread through the abdomen and then treat them when that happens.
So by having the program set up so that we can see the patients together, we keep close eye, myself from the chest point of view and Dr. Papas from the abdominal point of view, both looking at the scans very closely and I think that's best for the patient because I'm not an abdominal surgeon. I've been trained as a general surgeon but that's all he does is abdominal cancer surgery. So he's more accurate as it's diagnosed in cancer than I am in abdominal and vice versa the chest. So well do the chest first if the disease is predominately in the chest or [inaudible 00:07:18] the abdomen first if the disease is predominantly in the abdomen.

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