NCCN Guidelines for Patients® | Malignant Pleural Mesothelioma - page 16

16
NCCN Guidelines for Patients
®
: Malignant Pleural Mesothelioma
Version 1.2012
Part 4: Treatment planning
Based on the tests in Part 3, your doctors will let you
know if you have mesothelioma. If you do, a team of
experts with experience treating mesothelioma should
plan your treatment. Your team may include a:
• Pulmonologist - expert in treating lung diseases,
• Diagnostic imaging specialist - expert in imaging tests,
• Radiation oncologist - expert in radiation treatment,
• Medical oncologist - expert in cancer drugs, and
• Surgeon - expert in operations to remove or repair
a part of the body.
Once mesothelioma is confirmed, your doctors will need
to know the stage of the cancer. The cancer stage is a
rating by your doctors, based on tests, of how far the
cancer has grown and spread. It is used to plan which
treatments are best for you. The recommended tests for
cancer staging are:
Recommended tests
Chest and abdominal CT with contrast,
PET/CT (
p
ositron
e
mission
t
omography/
c
omputed
t
omography),
Mediastinoscopy or EBUS-FNA (
e
ndo
b
ronchial
u
ltra
s
ound–guided
f
ine-
n
eedle
a
spiration),
Possible chest MRI (
m
agnetic
r
esonance
i
maging),
and
Possible VATS and/or laparoscopy
Chest and abdominal CT
If you have not already had a chest CT scan, it should
be done along with a CT of your abdomen. Contrast
should be used if possible. Contrast is a dye put into
your body to make clearer pictures during imaging tests.
These scans can show your doctors where the tumor is,
how big it is, and if it has spread. See page 11 for more
information about CT scans.
PET/CT
Like CT, PET is an imaging test that takes pictures of
the inside of your body. However, instead of showing
the shape of an organ or tumor, it shows how your cells
are using a simple form of sugar. To create the pictures,
a radiotracer first needs to be put into your body. A
radiotracer is matter with energy that is put into your
body to make pictures clearer. For mesothelioma, the
radiotracer used is FDG (18F-
f
luoro
d
eoxy
g
lucose). FDG
is made of fluoride and glucose (sugar). Cancer cells use
more FDG than normal cells and thus show up as bright
spots on pictures. For this test, you must fast for 4 hours
or more. PET is often used with CT. FDG PET/CT is
helpful for finding mesothelioma that has spread to lymph
nodes or distant sites. This test should be done before
talc pleurodesis. See page 29 for more information about
talc pleurodesis.
Mediastinoscopy
If your treatment may include surgery, a biopsy of the lymph
nodes in the mediastinum is often recommended. The
mediastinum is the area of the chest between the lungs.
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