In many cases, a pathologist will take a tissue sample or biopsy to confirm whether asbestos lung cancer is present (Diagnosing Lung Cancer, CancerNet, National Cancer Institute).

Types of biopsies include:

Bronchoscopy: The doctor puts a bronchoscope (a thin, lighted tube) into the mouth or nose and down through the windpipe to look into the breathing passages. Through this tube, the doctor can collect cells or small samples of tissue.
Needle aspiration: A needle is inserted through the chest into the tumor to remove a sample of tissue.

Thoracentesis: Using a needle, the doctor removes a sample of the fluid that surrounds the lungs to check for cancer cells.
Thoracotomy: Surgery to open the chest. This procedure is a major operation performed in a hospital.

Mediastinoscopy: Using a lighted viewing instrument or scope, the doctor examines the center of the chest (mediastinum) and nearby lymph nodes. Tissue samples are taken from the lymph nodes along the windpipe through a small hole cut into the neck.

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Malignant mesothelioma, a rare form of cancer, is a disease in which cancer (malignant) cells are found in the sac lining the chest (the pleura) or abdomen (the peritoneum). Most people with malignant mesothelioma have worked on jobs where they breathed asbestos.

Like most cancer, malignant mesothelioma is best treated when it is found (diagnosed) early. You should see your doctor if you have shortness of breath, pain in your chest, or pain or swelling in your abdomen. If you have symptoms, your doctor may order an x-ray of your chest or abdomen.

Your doctor may look inside your chest cavity with a special instrument called a thoracoscope. A cut will be made through your chest wall and the thoracoscope will be put into the chest between two ribs. This test, called thoracoscopy, is usually done in the hospital. Before the test, you will be given a local anesthetic (a drug that causes you to lose feeling for a short period of time). You may feel some pressure, but you usually do not feel pain.

Your doctor may also look inside your abdomen (peritoneoscopy) with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is also usually done in the hospital. Before the test is done, you will be given local anesthetic.

If tissue that is not normal is found, your doctor will need to cut out a small piece and have it looked at under a microscope to see if there are any cancer cells. This is called a biopsy. Biopsies are usually done during the thoracoscopy or peritoneoscopy.

Your chance of recovery (prognosis) depends on the size of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope, how the cancer responds to treatment, and your age.

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Most asbestos lung cancer starts in the lining of the bronchi, the tubes into which the trachea or windpipe divides. However, asbestos lung cancer can also begin in other areas such as the trachea, bronchioles (small branches of the bronchi), or alveoli (lung air sacs). Although lung cancer usually develops slowly, once it occurs, cancer cells can break away and spread to other parts of the body.

The two most common types of lung cancer are small cell lung cancer (SCLC), in which the cancer cells are small and round, and non–small cell lung cancer (NSCLC), in which the cancer cells are larger. Sometimes a cancer has features of both types, and is called mixed small cell/large cell cancer.

Non–small cell lung cancer accounts for almost 80% of lung cancers. Small cell lung cancer accounts for about 20% of all lung cancers (American Cancer Society, Lung Cancer). Although the cancer cells are small, they can multiply quickly and form large tumors. The tumors can spread to the lymph nodes and to other organs.

Early–stage asbestos lung cancer may be asymptomatic (without symptoms). The methods used to diagnose asbestos lung cancer include imaging tests, biopsies, and taking phlegm (spit) samples. See Asbestos Lung Cancer Diagnosis.

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Symptoms of pleural mesothelioma (mesothelioma of the lining of the lung, known as the pleura) may include, but are not limited to, the following:

# shortness of breath (dyspnea) - hoarseness, difficulty swallowing, and/or coughing up of blood.
# pleural effusion - a build up of too much fluid between the pleura (linings of the lungs and chest); a pleural effusion may cause chest pain and difficulty breathing (dyspnea), however, many cause no symptoms and are first discovered during the physical examination or seen on a chest x-ray.
# pain in the chest - may sometimes be felt in upper abdomen, shoulder, or arm.

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The peritoneum also has two layers the inner (visceral) layer which is next to the abdominal organs and the outer (parietal) layer which lines the abdominal wall. 

Peritoneal mesothelioma causes the peritoneum to thicken and fluid to collect in the abdomen. This collection of fluid is called ascites and causes the abdomen to swell. Because pleural mesothelioma is more common and often spreads to the peritoneal cavity, it is sometimes necessary to determine if pleural mesothelioma is the primary cancer.

Picture Source - mesotheliomacenter.org 

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The pleural lining has two layers: the visceral (inner) layer is next to the lung and the parietal (outer) layer lines the chest wall. The pleura produces fluid that lubricates the space between the two layers, this allows the two layers to slide comfortably over each other as we breathe in and out. 

Pleural mesothelioma causes the pleura to thicken. This thickening of the pleura might begin to press onto the lungs or attach itself to the inside of the chest wall. In either case the expansion of the lung becomes progressively restricted by the tumour. Fluid, sometimes several litres, can collect between the two layers of the pleura; this affects the lungs ability to expand and causes the person to feel breathless. This is known as a pleural effusion. 

Picture Source - mesotheliomacenter.org 

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Because mesothelioma’s symptoms are not unique to it and the disease’s relative rarity, cases of mesothelioma misdiagnosed are not uncommon. A review of the patient’s medical history is an important part in assessing the risk of mesothelioma.

As a first step in diagnosing the disease, the doctor may order an x-ray of the chest or abdomen or a CT (or CAT) scan or MRI may be performed. Although mesothelioma typically cannot be seen on an x-ray, the tumor often causes a pleural effusion, or fluid collection between the lung and chest wall. This abnormal finding is associated with shortness of breath and warrants clinical followup. Lung function tests may also be completed.

ThoracoscopeThe doctor may look inside the chest cavity with a special instrument called a thoracoscope. A cut will be made through the chest wall and the thoracoscope will be put into the chest between two ribs. This test, called thoracoscopy, is usually done in the hospital. Before the test, the patient will be given a local anesthetic (a drug that causes a loss of feeling for a short period of time). Some pressure may be felt, but usually there is no pain.

The doctor may also look inside the abdomen (peritoneoscopy) with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is also usually done in the hospital. Before the test is done, a local anesthetic will be given.

If tissue that is not normal is found, the doctor will need to cut out a small piece and have it reviewed under a microscope to see if there are any cancer cells. This is called a biopsy. Biopsies are usually done during the thoracoscopy or peritoneoscopy.

Diagnosing mesothelioma is very difficult, and cases of mesothelioma misdiagnosed are unforunately not uncommon. It is important to share your case history of work experience (especially in shipyards and at construction sites) and asbestos exposure potential with your physicians if you feel mesothelioma is a risk. Asbestos fibres can also be carried into the home on clothing, inadvertantly exposing the deadly fibres, and the risk of mesothelioma, to family members.

A mesothelioma diagnosis is serious, but treatments are available. The chance of recovery (prognosis) depends on the size of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope, how the cancer responds to treatment, and the patient’s age. As with most types of cancer, early diagnosis is an excellent first step in fighting the disease.

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Mesothelioma (Asbestos Cancer) - Symptoms & Signs:

Shortness of breath (this is the primary symptom)

A persistent and productive cough

Chest tightness

Chest pain

Loss of appetite/weight loss

A crackling sound in the lungs while inhaling.

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Mesothelioma is a rare cancer which may affect the lining of the lungs (pleura) and the abdominal cavity (peritoneum).

Most mesotheliomas are caused by exposure to asbestos.

Most cases of mesothelioma are diagnosed 30 years or more after the first exposure to asbestos.

Mesothelioma occurs more often in men than in women.

Risk increases with age.

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