The clinical aspects of mesothelioma.

Three hundred and twenty-seven cases of mesothelioma accepted by a panel of pathologists have been used to construct a clinical picture of the disease. The cases analysed died between 1 January 1960 and 31 December 1969 and consisted of 267 pleural, 37 peritoneal, and 23 cases which could have arisen in either site. Two hundred and sixty-eight were in men and 59 in women and the disease appeared to be the same in women as in men. The mean age at death was 59-37 (+/- SD 9-89) years but ranged from 29 to 88 years. The mode of onset was insidious in all but a few cases and the mean interval before reaching the hospital was 3-39 (+/- SD 4-64) months 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 diagnostic procedures were unrewarding and many patients were only diagnosed in retrospect. The prognosis was somewhat better for patients shown to have mainly epithelial cell tumours, 17-89 (+/- SD 18-26) months, predominantly spindle cell lesions surviving on the average only 7-98 (+/- SD 8-55) months and mixed tumours 11-3 months. The criteria for the early clinical diagnosis are described with a view of facilitating the search for effective treatment.