Physical Examination
The first thing a doctor will do when seeing a patient with a new medical problem is to take the patient’s history. Any patient with asbestos exposure will point the doctor in the direction of the problem. Without knowledge of asbestos exposure, the doctor may find little or nothing on physical examination that would indicate the presence of a mesothelioma.The patient will be examined by the doctor. Most of the time, patients will be weighed and their blood pressure will be taken. A patient with shortness of breath, or severe pain, or feelings of lightheadedness and fatigue might have their respiratory rate and pulse checked.
A person with pleural mesothelioma might have a rapid respiratory rate. Pain as well as anemia makes the pulse (heart rate) faster. People with cancer have often lost weight.
The doctor will listen to the patients’ lungs. There may be areas where the doctor cannot hear the breath sounds. This can be because of a pleural effusion, or fluid between the chest wall and lung on one side or the other. There can be rattling or wheezing depending on whether or not there is mesothelioma in the airways, and also depending on whether or not the person has any other lung disease, like emphysema or asbestosis. There are other physical findings a doctor can pick up by tapping on the chest. The doctor will also check for any swelling of the lymph glands above the collarbones or in the armpits.
There are other clues to trouble in the lungs, which can include a slightly blue tint if the patient is not getting enough oxygen, and a deformity of the ends of the fingers called clubbing, which happens to patients with significant and longstanding lung disease.
Taking all these things together in a person with occupational or other exposure to asbestos, the doctor may be very suspicious of mesothelioma and go on to order additional tests with that in mind. Otherwise, the doctor may be looking to find the cause for what is obviously a problem with the lungs.
If a person with abdominal symptoms including nausea, vomiting, pain, bloating and swelling, or blockage does not know about asbestos exposure, it is very likely the doctor will not even consider mesothelioma at the time of the first examination.
The patient may have a very distended, rounded abdomen. The doctor may be able to tell by various maneuvers that the patient has fluid in the abdomen. That is a sign of mesothelioma, but is more often caused by liver diseases like cirrhosis. There may be masses that the doctor can feel. The doctor will also check the lower body for any swelling.
With these findings, the doctor would most likely send the patient for laboratory tests and an ultrasound, although a CAT scan would be useful, depending on the exact findings.
A patient with mesothelioma of the pericardium around the heart would appear to have heart failure. Even with a history of asbestos exposure, nothing in the physical exam would necessarily alert the physician. If it is clear that the patient has fluid around the heart in association with asbestos exposure, mesothelioma would be suspected. The fluid would be detected most likely by an echocardiogram.
Men with the very rare mesothelioma of a layer of cells near the testicles appear to have a hernia.
While the physical examination of every patient is important, in the case of mesothelioma, the diagnosis is unlikely to be made or even seriously considered until X-rays and other tests provide more information.
Dr. Kaplan