CLINICAL ASPECTS OF MESOTHELIOMA

Abstract

A clinical picture of mesothelioma was constructed by studying 327 cases; the cases analyzed died between 1 Jan. 1960 and 31 Dec 1969 and consisted of 267 pleural, 37 peritoneal and 23 cases which could have arisen in either site. The disease was similar in both. The mean age at death was 59.37 (.+-. SD 9.89) yr but ranged from 29-88 yr. The mode of onset was insidious in all but a few cases and the mean interval before reaching the hospital was 3.38 (.+-. SD 4.64) mo. for pleural and 3.08 (.+-. SD 3.22) for peritoneal cases. Patients usually noticed a dull non pleuritic pain first but suffered some breathlessness, lassitude and weight loss by the time they reached hospital. On examination there was little evidence of disease apart from the signs of pleural effusion or thickening or ascites. Clubbing and signs of asbestosis were rare except in the peritoneal cases who more frequently gave an occupational history of heavy exposure and showed the radiological consequences of this. At the time when these patients were investigated, dianostic procedures were unrewarding and many patients were only diagnosed in retrospect. The prognosis was somewhat better for patients shown to have mainly epithelial cell tumors, 17.89 (.+-. SD 18.26) mo., predominantly spindle cell lesions surviving on the average only 7.98 (.+-. SD 8.55) mo. and mixed tumors 11.3 mo. The criteria for the early clinical diagnosis are described with a view to facilitating the search for effective treatment.