Clinical Presentation and Natural History of Mesothelioma

Malignant Pleural Mesothelioma Clinical Presentation Demographics and General Characteristics There is uniformly a preponderance of males in all clinical series (Table 24.1) (2–8). This could be related to more common exposure to asbestos, the most important etiologic factor, in males. Men account for 68% to 79% of all cases of pleural mesotheliomas. Mean and median age at diagnosis are usually between 54 and 59 years, with a very wide range. In fact, pleural mesothelioma can occur at any age, even in children. In a review of 80 cases of malignant mesothelioma in children, mean age was 9.7 years and 59% were boys (9). History of possible asbestos exposure was noted in two children. In addition, one patient had received radiotherapy for Wilms’ tumor, and another one had a history of exposure to isoniazid in utero. For pleural mesothelioma, the right side is more commonly involved, accounting for about 55% to 65% of cases. This could probably be explained by the preferential inhalation of asbestos fibers in the right lung. Clinical Symptoms and Diagnosis Typically the onset of symptoms is gradual and insidious (Fig. 24.1). Since the most common initial manifestation of pleural mesothelioma 380 A.P. Chahinian 381 Table 24.1 Clinical characteristics of patients with pleural mesothelioma First Author Ratzer (7) Chahinian (3) Brenner (6) Adams (4) Ruffie (8) (Reference) Year 1967 1982 1982 1986 1989 No. of Cases n = 31 n = 57 n = 123 n = 92 n = 332 Age (years) Mean/median Med. 54 Mean 58 Med. 56 Mean 59 Mean 59 Range 13–70 24–75 5–77 28–80 22–88 Sex M (%)/F (%) 68/32 78/22 68/32 77/23 79/21 Initial symptoms (%) Dyspnea 6 37 29 59 29 Chest pain 71 33 37 69 33 Both dyspnea and pain 19 26 28 Cough 13 16 24 27 3 Hemoptysis 6 0 1 Hoarseness 0 3 1 Dysphagia 0 1 Weight loss 14 24 29 Fever 9 33 3 Asymptomatic (%) 4 4 3 Pleural effusion (%) 74 95 79 84 right (%)/left (%) 65/45 66/34 58/42 55/42 Symptoms to diagnosis Median 2 mos 3 mos 3.5 mos Range 0–50 mos 0.5–24 mos Delay >6 months (%) 25 28