How can malignant mesothelioma be diagnosed early?

... Question that we have is, can malignant mesothelioma be diagnosed early?

I think malignant mesothelioma can be diagnosed early, if you have known asbestos exposure. Recently we took care of a woman who had mesothelioma and she had ... her father had passed away from mesothelioma. Her biopsy came back positive. She has three other sisters, they all got tested, I think two of the three sisters were diagnosed early disease. So when I think when you have a family history, it's easy to kinda watch and screen. Often times it's a difficult diagnosis if it's just one person. You know, like Dr. DeSilva said, "If you're young or something just seems astray." But if there's any sort of family history, I think that's a big red flag.

Ellie?

Yeah, the exposure to asbestos, too, is proven. And you know the exposure could be anywhere from 20 to 50 years ago. So, you really have to kinda think about it. I think another point is, Memorial Day was yesterday. A third of all meso patients diagnosed in the United States are veterans. They're tracing that back to exposure to asbestos on the ships and all that. So, I don't think there's actually a test that you can say, "Okay, I'm gonna get an early test for mesothelioma." It's just a lot of warning signs and family history and, like Lisa was saying, like Dr. DeSilva was saying, when something doesn't make sense, that can be the reason. But there is no, per se, test to say, "okay, you're going to get mesothelioma in 20 years, 30 years, 40 years."

Alright, so going along with that, I guess, what kind of signs and symptoms should family members and people be looking for?

Well, pneumonia. A lot of times, people are diagnosed with pneumonia and they don't get better. We've also noticed ... seems like some people get injured. And then, they might fall or play tennis. We've had a couple people playing tennis or doing something, and they would fall, and end up with fractured ribs, and just never get better. So that's, the symptoms, like Dr. [DeSilva 00:02:53] was saying, it's shortness of breath, pneumonias that don't get better, pain, sometimes it's a dry cough.

Yeah.

An effusion.

Shortness of breath.

Yeah. And just, don't feel right. Some people just don't feel right. And pain, sometimes. But sometimes not. Sometimes people can present with pain, but sometimes people say they didn't know they had anything wrong with them, but their chest X-ray was ... there was something wrong with their chest X-ray. And that they also kept having pneumonias and it wouldn't go away.

Thank you. So, next, I guess, what is the typical treatment then for mesothelioma?

So ...

So ...

Go ahead.

So often the treatment is that, you go to your primary care physicians with, like Ellie said, chest pain, back pain, shortness of breath, dry cough. You might get a chest X-Ray, like Dr. DeSilva spoke about. There might be a pleural effusion or water around the lung, they might drain it. 50% might come back negative, but it re-accumulates and that kinda raises a red flag, and then they might have to go for a biopsy. And again, sometimes those biopsies come back negative, but usually they're followed with CT and MRIs. Once they're diagnosed, they have to figure out how advanced the mesothelioma is. Is it gone into the lymph nodes? And that's through a small incision through your ... right in your chest, and it just ... they stick a scope in. It's a very quick procedure under general anesthesia where they check to see if the lymph nodes have been involved.

If they have been involved, then they offer chemotherapy first to shrink back the tumor, and then they would opt to take you to the OR and see if they can remove the tumor from your lung. Maybe a pleurectomy or an extra-pleural laminectomy. And again, there are ... everybody's treated differently, just like everybody has different fingerprints. You know sometimes you take them to the OR and you think you're going to do one certain, sort of, procedure, and it's a different game plan once you're in there.

So you get chemo, or maybe you don't get chemo, and then you go to the OR and you can become an operative, and then you have to recover from that. And sometimes it's followed with chemo or radiation as well. It really does depend on how advanced the disease is, and what other kind of past medical history you have. Do you have a healthy heart? Do you have other [inaudible 00:05:44] that go along with it? So each person is treated very individualized. It's not like everybody who has mesothelioma is gonna get this procedure. It's very individualized according to what your needs are and what obstacles that you'll have to overcome.

Thank you.

So the question, the typical treatment, as Lisa was saying, in this day and age, there really isn't typical treatment. Everyone is treated differently. A lot of it also depends on your functional status. Your functional status is, can you take care of yourself? Can you participate in care? Are you able to cough and deep breathe? Are you able to [inhalate 00:06:30]? Are you able to [crosstalk 00:06:39] treatment? So, maybe, when people say typical treatment for meso, that's why you really need to go to see a specialist like Dr. DeSilva or many of the ones around the country. Because there's always something new happening with it. It's not stagnant. Two years ago, treatment might not be what they're doing right now. That's, again ... a lot of times people get diagnosed and they don't go to a meso center. You're not doing yourself any favors by not going, because especially in the United States, there's enough of them around, there's enough professionals that are dedicating to your life, and they are making gains in this so that you really should seek out somebody like a Dr. DeSilva or a center.

Anything, Lisa?

I agree, yes. Going to a specialist is key.

Yeah.

Once you've been diagnosed, you want to find somebody who is very well versed in this disease process.

Yeah. And like you were saying earlier, it's also a team. You want a whole team that's ... this is what they do, this is what they're function is ... this is what they're focusing on. They're up on the newest things. They know the clinical trials and they know what might work for you, whereas someone, a primary care physician who might just see it once or twice in their career and is relying on the latest published data, might not know that there are clinical trials, through no fault of their own, whereas the centers are much more specific and much more ...

Oh there he is.

Hello.

Hi Dr. DeSilva.

I'm back. I lost my connection as I drove in.

So we left at the early diagnosis, right?

Yeah, yeah. So ...

So really is, for us, the most important thing is staging. As we all know, the four stages are mesothelioma, one, two, three, and four stages. Through stage one and stage two are considered early stage. And really, unfortunately, most of the patients, when they show up, show up with advanced stage. What's important is early diagnosis. So you have to have a clinician or a physician or a family practicion or whatever it is that's seen that patient, early in the game, to be more invasive, more assertive, what it is that you want to be done.

A lot of times physicians are concerns that doing invasive procedures will add to the patient pain and suffering, which is not really true. We can do a biopsy today in an outpatient setting, same day, in and out of the hospital. Minimal pain, but have really good tissue diagnosis. And early diagnosis is the best treatment. That's what I tell. When it gets mesothelioma, early diagnosis is the best treatment, and that's followed by multi-[inaudible 00:09:59] therapy in early stage.

When they show up with advanced stage disease, three and four, then it's more challenge.

So I guess, then, my next question would be: How can one insure early diagnosis?

Right, so, you really have to be ... patients shouldn't take a "No" for an answer. That's where they ... one point that I try to make. I go around the state, in [Illinois 00:10:32], I give lectures about mesothelioma and I tell patients and I tell physicians, "Don't take no for an answer." If you do a puncture and a drainage of fluid, and the results is negative, but the pleural effusion doesn't go away, don't accept that as being negative. They have to step up your procedure. Either by a pleuroscopy or by a CT guided needle biopsy, ultrasound guided needle biopsy. You need to start invading the patients. Yes it's more pain and suffering, it's an invasive procedure, but the price is much better if you don't. I think, as soon as you get something suspicious and the diagnosis negative but the effusion doesn't go away, don't take that as a no answer. Just pursue other invasive procedures.