The Clinical Aspects Of Mesothelioma

Our plain-English summary of The Clinical Aspects Of Mesothelioma, by P.C. Elmes, M.J.C. Simpson (1976).

The study

• Authors: P.C. Elmes, M.J.C. Simpson
• Published: Quarterly Journal Of Medicine 45(179):427-449, July (1976)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 001109. The article is still under copyright, so we describe it here rather than post it.

In plain English

This was a review of hospital records and autopsy reports for 327 people with mesothelioma; chest X-rays were viewed for 217. Each diagnosis had been accepted by a panel of pathologists, and all died between 1960 and 1969 in England, Wales or Northern Ireland. Of the tumours, 267 appeared to arise in the pleura (chest lining), 37 in the peritoneum (abdominal lining), and 23 could have arisen in either. In pleural cases onset was usually gradual, and first examinations found few signs. Finger clubbing was seen in 31 patients (9.5 per cent), and chest crackles suggesting asbestosis in six. Diagnosis was difficult: fluid cytology gave the correct diagnosis in 7 of 172 cases, and excision biopsy in 42 of 60. Peritoneal patients were significantly more likely to have had heavy asbestos exposure and had significantly shorter illnesses. On average, 15.6 months passed from first symptoms to death. Neither radiotherapy nor chemotherapy produced dramatic benefit. The authors concluded that mesothelioma must now be considered in middle-aged or elderly patients with a slowly developing pleural lesion, and that eliminating unnecessary asbestos exposure is the only reliable prevention.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective clinical case series based on hospital notes, radiographs and autopsy reports
• Who was studied: 327 people with mesothelioma accepted by the UICC/IARC Mesothelioma Panel who died in England, Wales and Northern Ireland between 1960 and 1969. Usable information was available for 327 of 468 cases, and chest radiographs were viewed for 217. There were 267 pleural, 37 peritoneal and 23 cases that could have arisen in either site.
• Exposure: Occupational asbestos exposure, graded as heavy, intermediate, probable, none or not known. No specific fiber types are named. The authors state that the occupational and environmental information was not analysed in detail in this paper.
• Main results:
  • Of the 327 tumours, 267 appeared to arise in the pleura, 37 in the peritoneum, and 23 could have arisen in either site.
  • In pleural cases the onset was insidious in 95 per cent.
  • On first examination, clubbing of the fingers was found in 31 patients (9.5 per cent).
  • Basal crackles suggesting asbestosis were found in only six patients (1.8 per cent).
  • Heavy asbestos exposure, and first exposure before age 20, were both significantly related to an earlier age at death.
  • Patients with peritoneal tumours were significantly more likely to have had heavy exposure.
  • Bilateral calcified pleural plaques together with obvious lung changes suggestive of asbestosis were seen in 29 (12 per cent) of the chest radiographs. All of these patients had a long history of exposure graded as heavy.
  • Cytology of pleural fluid, performed in 172 cases, gave the correct diagnosis in seven (4 per cent).
  • Excision biopsy, done in 60 cases, gave 42 (70 per cent) correct results. A limited open biopsy, done in 115 cases, gave 45 (38 per cent) correct results.
  • All but six of the 37 peritoneal cases were diagnosed after death.
  • Patients with primary peritoneal tumours had significantly shorter illnesses than patients with primary pleural tumours. The pleural group averaged 16.1 months (standard deviation 13.6 months).
  • Patients with mainly epithelial tumours survived longer (18 months) than those with mainly spindle-celled tumours (7.9 months). These figures are measured from investigation in hospital to death.
  • Patients who survived the first five months after referral without radical surgery lived an average of 16.3 months, which was not significantly different from those who had radical surgery.
  • Neither radiation nor chemotherapy produced a dramatic relief of pain or shrinkage of the tumour.
  • Metastases spread through the blood were recorded in 33 per cent of the autopsy reports.
• The authors' conclusion: The authors concluded that, because of its increased frequency, mesothelioma must now be considered when diagnosing any middle-aged or elderly patient with a pleural lesion of insidious onset. They also concluded that eliminating unnecessary exposure to asbestos is the only reliable method of preventing mesotheliomas.
• Limitations the authors state:
  • The series does not include all patients who died of mesothelioma in England, Wales and Northern Ireland in the period.
  • Apart from age, sex and date of death, information was available for only a proportion of patients, which makes statistical comparisons difficult.
  • Because deaths were confined to a 10-year period, a proper cohort analysis was not possible.
  • The link between extensive treatment and longer survival must be interpreted with caution, because only patients who had already survived unusually long were probably given extensive treatment.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Autopsy, Chest X-Ray, Pleura, Peritoneum, Clubbing, Fluid Cytology, Biopsy.

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