Carcinoma

“ A carcinoma is a malignant tumour, and the malignancy is made much worse by the stimulus of pregnancy with its increased blood supply. The maternal deaths from carcinoma of the uterus during pregnancy is, according to the latest and most favourable statistics, 30 per centum. The mortality of the children is from 50 to 63 per centum. ”

“ Conditions preceding the development of carcinoma cause primarily an increased proliferative power of the epithelium which, as the result of this change, in the large majority of cases grows down into the deeper tissues and destroys them, but in some cases the resistance of the deeper tissues is so great that it successfully counteracts the invasion or dissolving power of the epithelium and the latter may instead of growing downwards be forced to grow towards the outside of the skin, as we could observe in a case of multiple carcinoma of the skin. ”

“ It is simply because the sore on the face is obvious, plain, unmistakable evidence of something wrong; and the patient ordinarily gets into the surgeon’s hands early; that is, before the roots of the growth have spread and involved life itself. The difference in mortality between carcinoma of the lip and carcinoma of the womb is the difference between early operation and delayed operation. If uterine cancer or breast cancer were discovered as early as lip cancer, we’d save practically as many of the internal as we do of the external cases. ”

“ The affection is more common in females than in males, and rarely occurs in young persons. The countenance has the sallow hue peculiar to carcinoma, and in the advanced form of the disease becomes still more cadaverous from profuse discharge of matter and frequent hemorrhage.
The cellular tissue, anterior to the rectum, is liable to become the seat of tumour. Malignant medullary formations occasionally form here, causing most distressing symptoms; by displacing the bowel they may obstruct its canal, and simulate stricture or schirro-contraction. ”

“ It is most difficult perhaps to differentiate from a small ulcerated squamous-celled carcinoma, and the two indeed sometimes coexist, rendering the discrimination extremely difficult until the advanced progress of the carcinoma places the diagnosis beyond doubt. ”

“ Under artificial propagation cancer maintains all the characters of the original tumours of the primary hosts. Carcinoma and sarcoma agree in possessing all the pathological and cellular features of malignant new growths. ”

“ Tumors originate from many causes. Some are congenital and others grow in later life from an inherited tendency.
Any continued irritation which acts mechanically or chemically so as to maintain a constant, though slight, degree of undue vascularity of a part, such as the hot, rough stem of a clay pipe or a jagged tooth, favors the development of a malignant growth. Certain benign growths, such as warts or moles, are especially prone to malignant change. Age and sex also predispose to tumor formation.
Thus carcinoma is a rarity under thirty years of age ”

“ Malignant growths occur at a later age, mostly between the ages of 40 and 60, and attack males more than females. Carcinoma is far more common than sarcoma, and is generally of the squamous-celled variety. ”

“ All know that while primary carcinoma of the liver is very rare, its secondary or metastatic involvement is very common. The bones, lungs, spleen, kidney, and viscera generally are 130all often found to be the seat of metastases, and in general carcinosis, which has lasted some time, metastases will be found abundantly both in the lymphatics of many parts of the body and in many organs and tissues. Metastases in the lungs are not uncommon in breast cancer, as also metastasis in the bones of the thorax. ”

“ Eoughly we may however classify the various cancers in those derived from epithelial tissue (for instance of the skin, stomach, uterus, the various glands) which we call carcinomata and those derived from proliferating connective tissue cells. Connective tissue in any part of the body may give rise to cancer. These connective tissue cancers are called sarcoma. The growth of a cancer exerts injurious influences on the organism as a whole. ”

“ It is important that these facts should be borne in mind, for generalisations founded upon the study of carcinomata alone cannot be necessarily true in respect of all Cancer, unless the use of the term cancer be [15] restricted to the class technically known as carcinoma. To say that Cancer can be prevented if constipation is avoided is clearly misleading, when we remember that quite young children, nay, infants, may be the subject of sarcoma; unless of course we define cancer, as some would do, as the kind of growth that, ex hypothesi, is prevented when constipation is avoided. ”

“ About 20-35 per cent, of all women who die from cancer have cancer of the uterus. Cancer occurs also relatively frequently at the lip, tongue, rectum and skin, especially of the face. Sarcoma is much less frequent than carcinoma. The relative frequency of the different varieties of cancer in the most populous areas of the United States is (according to S. C. Dixon) as follows: mouth 3.2 per cent., stomach and liver 38 per cent., intestines 11.7 per cent., female generative organs 14.3 per cent., breast 8.5 per cent., skin 3.7 per cent. ”

“ H. stated that four years after operation 43 per cent remained free of the disease, eight years after only 16 per cent, and 20 years after only 2.5 remained free from the disease. There were a great many cases of carcinoma of the breast reported in which the patient died from metastasis in different organs without local recurrence 10, 15, and 20 years after the operation. The late metastases most frequently took place in the skeleton, which was due to the fact that skeletal lesions might continue a long time without causing clinical symptoms. ”

“ The only chance of a radical cure consists, he says, in making a complete excision of the part; but in doing this he forbids us to secure the arteries with ligatures, as they will occasion a recurrence of the disease. The part, he says, is loaded with a thick, black, or recrementitious blood. When the cancer is ulcerated, he disapproves of cutting and burning.
Celsus describes carcinoma as an immovable and unequal tumour, attended with swelling of the veins, which are pale or livid. ”

“ Just as Röntgen rays and certain chemicals, so may also light rays under certain conditions be the cause of cancer, especially in sailors, in whom sometimes the skin of that part of the body which is exposed to the light shows certain changes which lead gradually to the development of cancer. We notice also occasionally in old people and in rare cases even in young men in the face and on the hands, in parts therefore exposed to the action of the light rays, the development of multiple lesions, which in the course of time become transformed into carcinoma. ”

“ These tumors are much more benign than the typical carcinomata—they grow very slowly and make ordinarily no metastases. But certain tumors are quite typical for young children. While in adults carcinomata are considerably more frequent than sarcomata, in children sarcomata are much more numerous than carcinomata. The most frequent seats of cancer in children are neither the gastro-intestinal tract nor the female generative organs, but kidney and adrenal, next the eye, brain, skin, cranium and liver. ”

“ Carcinomata may be suspected in cases in which there has been an hereditary predisposition to carcinomatous disease or the previous or concomitant existence of cancerous disease in the mammæ or elsewhere, particularly if the period of life is relatively advanced. The development of the tumor may be more slow than other forms of growth, and is associated with tendency to progressive emaciation in the absence of evidences of direct pressure on the oesophagus and the existence of cachexia. ”

“ An interesting study relates to the extension of the carcinomatous process in the skin; this occurs at first near, and then around, and even at a distance from the site of an operation, especially after removal of the breast. These nodules are at first small, and felt deep in or below the skin, and are not colored. They steadily increase in size, and when about that of a small pea, they become red and elevated a 131line or so. Later they may appear more numerous and even involve a large area, forming the so-called cancer en cuirasse, and may ulcerate. ”

“ It is safe to say that multiple tumors offer enormous difficulties in the matter of interpreting therapeutic results. At present we have in the wards of the hospital a patient with multiple metastatic carcinomas of the skin. ”

“ The tissue of a tumour from a woman, aged 61, was not attacked by the serum of a carcinomatous patient which decomposed carcinomatous tissues, although at the same time the coagulated tissue was decomposed by the serum of pregnancy. ”

“ Not only has the structure of carcinomatous tissue been examined chemically, but the blood and urine have been submitted to most painstaking investigation, and metabolism in general has been studied in almost all possible directions, in the search for the cause of cancer ”

“ The malignancy of cancer depends on the tendency which the epithelium has of invading the tissues in its neighbourhood, and on the capacity of the cells, when transported elsewhere by the lymph or blood-stream, of giving rise to secondary growths.
Cancer may arise on any surface covered by epithelium or in any of the secreting glands of the body, but it is much more common in some situations than in others. It is frequently met with, for example, in the skin, in the stomach and large intestine, in the breast, the uterus, and the external genitals ”

“ The situation of a malignant tumour exercises considerable influence on the rapidity, as well as on the mode, in which it causes death. Some cancers, such as that known as "rodent," show malignant features which are entirely local, while others, such as melanotic cancer, exhibit a malignancy characterised by rapid generalisation of growths throughout the body. Tumours that are structurally alike may show variations in malignancy, according to their situation and to the age of the patient, as well as to other factors which are as yet unknown. ”

“ From our study of inoperable and recurrent cancer, and of metastasis and the blood conditions in the disease, we see what a formidable task is before one who would attempt to lessen its morbidity and mortality. We see also how blind all have been who have so long looked to surgery to stay its progress. In my former lectures I collected and quoted statements from many surgeons of prominence in times past, and even some in quite recent times, all expressive of a belief in a constitutional origin of cancer, and many of them looking to a dietary cause. ”

“ It is probable also that some increase has taken place in consequence of the increased average duration of life; a larger proportion of persons now reach the age at which cancer is frequent.
The prognosis largely depends on the variety of cancer and on its situation. Certain varieties—such as the atrophic cancer of the breast which occurs in old people, and some forms of cancer in the rectum—are so indolent in their progress that they can scarcely be said to shorten life ”

“ Too often when a cancer is suspected or discovered it is taken as a foregone conclusion that the malady is hopeless, except as the results of the disease, that is the new growth, may be removed by the knife, X-ray, radium, caustics, etc. And after a surgical operation, as far as my observation goes, the patients are invariably left entirely to their own resources, with the hope, alas, too often futile, that the tumor will not regrow, but with no attempt to so guide the life that there shall not be the same tendency to a recurrent malignant new-formation. ”

“ If so advised by her physician or by a skilled surgeon, she should have an operation for the removal of the cancer, as it can be completely eradicated when operated upon in its early stages. If left to grow and develop it will get beyond the aid of even the most skillful surgeon. Early diagnosis plus surgery is the only hope for a cancerous person. Operation offers a most hopeful outlook for those afflicted with cancer. It is more important to make an early diagnosis in cancer of the breast than it is in appendicitis. ”

“ While the patient is still under the anaesthetic, a microscopical examination of the tissue, which can be made in a few minutes in a well-equipped hospital, will determine whether the growth is malignant. If so, the whole breast is taken off, and the patient, in all probability, saved. If not, sew up the wound, and the subject is none the worse. Much the better, in fact, for the most innocent growth may develop cancer by irritation. Thirty per cent, or more, of breast cancers develop in this way. ”

“ A cancer is a malignant tumour which originates in epithelium. The cancer cells are derived by proliferation from already existing epithelium, and they invade the sub-epithelial connective tissue in the form of simple or branching columns. These columns are enclosed in spaces—termed alveoli—which are probably dilated lymph spaces, and which communicate freely with the lymph vessels. The cells composing the columns and filling the alveoli vary with the character of the epithelium in which the cancer originates. ”

“ Once symptoms of this disease have recurred after efficient treatment, there is only one good reason for not looking and making certain, and that is when the risks of [76] looking exceed those of the lesion being malignant—that is to say, somewhere between ten and twenty per cent. At present, the risks of looking are about one in a thousand, and the risks of removal of a cancer about three per cent., taking all cases, most of which are at an advanced stage. ”