Malignant tumor

“ Tumors are usually divided into benign and malignant growths. In a general way the malignant tumors are painful; they do not move about freely but become fixed to the adjacent parts; their growth is more rapid; they often have no well-defined borders; frequently they return after removal; the skin covering them is often attached and cannot be moved readily without also moving the tumor. Malignant tumors are divided into cancers (carcinomata) and sarcomas (sarcomata) . Cancer is much more frequent than sarcoma. Cancer occurs more often in persons over thirty ”

“ A malignant tumor usually consists of tissues widely different from those in which it originates; its growth is rapid and therefore often painful; it infiltrates all the surrounding tissues, however resistant, even bone, because it is never encapsulated; it thus early becomes immovable; the overlying skin is apt to become adherent, especially when the breast is involved. ”

“ If a far advanced primary growth of cancer could be stained in its entirety with a black dye, and if the patient were transparent, we should probably see that the tissues round about the growth were dusky, and that a thin, smoky coloring extended through the lymphatic vessels to the veins into which they empty. As a malignant tumor increases in size at its original situation the nerve filaments are pinched, and pain is caused as a rule; but sometimes the growth will progress with little or no accompanying pain. ”

“ The well-known fact that any solid benign growth is liable to become malignant should be sufficient to induce surgeons to condemn the arbitrary expectancy which is so generally counseled and which so surely leads to disaster. Even if a particular tumor increases without showing signs of malignity, there can be no advantage in waiting until it shall have attained a great size, as the larger the tumor the more formidable the operation for its removal. ”

“ 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 it were generally known among intelligent people that great numbers of innocent tumors sooner or later become malignant, and that malignant tumors often simulate benign tumors and remain quiescent for a great while, the sufferers would unhesitatingly consent to the removal of these morbid growths in their inception, long before the possible advent of serious mischiefs, or when the cure might be effected by minor operations which would leave the smallest scars, especially in such parts as the face, neck, arms, or hands. ”

“ 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 ”

“ A third type of tumor, the semi-malignant, is intermediate between the first two, and includes some forms of sarcomic and of melanotic tumor, the painful subcutaneous tumor or tubercle, nævi, polypi, etc. Melanosis is commoner in horses than in the human subject, and chiefly in white or gray horses. Various tumors are inter-thoracic, affecting the heart, the lungs, etc. There are also tumors of the brain, of the liver, the rectum, etc.; and in women the uterus and the vagina are specially liable to be affected with tumor. ”

“ Cancerous tumors are very much more frequent in the female than in the male sex. The discrimination of malignant and benign tumors at the bedside is often so difficult that surgeons are justified in advising immediate extirpation and in relying upon the microscope to insure the diagnosis and establish the prognosis.
2. The liability to the transformation of benign into malignant tumors has long been recognized, but the histological demonstration of the phenomenon is modern. ”

“ The most malignant tumors are those which tend to become generalized as well as to spread locally. They recur locally, and appear in the nearest lymph-glands and at remote parts of the body. The disturbances produced by the malignant tumors depend less upon their mechanical relations than upon their tendency to destroy tissues and disturb functions. With their presence and progress in vital organs there is associated, from their manner of growth, a destruction of the cells of such organs, as the kidneys and liver, the lungs and heart. ”

“ The testimony of careful observors tends to show that the malignant tumors exceed the benign in frequency, and also that many malignant tumors remain stationary and seemingly harmless for one, two, six, eight years, and even for longer periods, then increase rapidly, and soon contaminate the system. ”

“ TUMOR, in surgery, any morbid parasitic growth, generally, though not always, attended by swelling. Tumors are primarily divided into two classes, the first innocent, including non-malignant, solid, benign, or sarcomatous, and the second malignant growths. Tumors of the first type occur in comparatively few tissues, and do not alter the adjacent parts unless the tumor produces pressure and partial inflammation; they have no tendency to ulcerate or slough, and, if extirpated by a surgical operation, they do not grow again. ”

“ In benign tumors the abnormal proliferation of cells takes place slowly, and they do not tend to immediate and rapid decay and deterioration.
In malignant tumors the "wild" cells, created in immense numbers, decay almost as rapidly as they are produced because the abnormal growths are devoid of normal organization. They have no established, regular blood and nerve supply, nor are they provided with adequate venous drainage. They are, therefore, cut off from the orderly life of the organism and doomed to rapid deterioration. ”

“ The malignant tumors, on the contrary, differ in their structure from the normal tissues of the body. Their growth is rapid and infiltrating rather than slow and concentric. Such tumors usually have a predominance of cells and thin walled blood-vessels. The former may be little else than nuclei enveloped in an easily destructible protoplasm, or they may be composed of multi-nucleated masses of protoplasm, and are then known as giant-cells. ”

“ In attempting to arrive at a conclusion as to the innocence or malignancy of any tumour, too much reliance must not be placed on its histological features; its situation, rate of growth, and other clinical features must also be taken into consideration. It cannot be too emphatically stated that there is no hard-and-fast line between innocent and malignant growths; there is an indefinite transition from one to the other. The possibility of the transformation of a benign into a malignant tumour must be admitted. ”

“ 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. ”

“ It so happens, however, that in a histological as well as in a clinical sense the term is appropriately applied to all but a very few of the malignant new growths that develop in the parts under consideration, if we adopt, as seems proper, the opinion of most modern pathologists, that cancer or carcinoma should only include those tumors "consisting of cells of an epithelial type, without any intercellular substance, grouped together irregularly without the alveoli of a more or less dense fibroid stroma." ”

“ But it is questionable whether these applications have any effect in preventing the future growth of the tumours.
The malignant form of the disease, even in a very early stage, is unmanageable: the tumours, if removed, are speedily reproduced, and the fatal termination may be accelerated by the interference. ”

“ 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; while others--such as the softer varieties of mammary cancer occurring in young women--are among the most malignant of tumours. ”

“ Once the skin is broken the tumour fungates through the opening. Sarcomas vary in malignancy, especially as regards rapidity of growth and capacity for dissemination. Certain of them, such as the so-called "recurrent fibroid of Paget," grow comparatively slowly, and are only malignant in the sense that they tend to recur locally after removal; others--especially the more cellular ones--grow with extreme rapidity, and are early disseminated throughout the body, resembling in these respects the most malignant forms of cancer. ”

“ We now know that so-called secondary cancers are the result of the spread of cancer cells from the original seat of the cancer to other parts of the body, and that this spread is much hindered by the ability of the lymph nodes to catch the cancer cells and hold them. Unfortunately sooner or later some of the cells will escape beyond the lymph nodes and so spread the malignant growth throughout the body, but until this happens the cancer is confined to the region where it started, and it is during this period that complete cure by surgical means is possible. ”

“ The distinction between carcinoma and sarcoma cannot always be made during life, nor indeed, without a microscopical examination, after death. It is of importance chiefly with reference to prognosis after operation for removal of the organ. A more rapid growth, a greater tendency to invade other organs, and a more marked cachexia would speak in favor of carcinoma, while a tumor gradually attaining a very large size, and not spreading beyond the kidney and its immediate envelopes, is more likely to be a sarcoma. ”

“ All operations on malignant tumours, in their advanced stages, are unwarrantable; they are necessarily painful and severe, and cruel because unavailing; they often, indeed, expedite the dissolution of the patient. If the integuments over the tumour have ulcerated, and if the lymphatics in the neighbourhood are diseased, the disease if removed will certainly be reproduced, and the succeeding tumour will be still more malignant. The operation ought, if at all, to be performed when the disease is in its incipient state, for then only can success be expected. ”

“ For it is now recognized that these wrongly placed tissue elements are very common anatomical or histological accidents, indeed it is claimed that they occur and exist in every individual: and the removal of isolated “embryonic rests” which have developed into cancer, does not by any means prevent the transformation of other similarly misplaced cells into malignant disease, as the frequent recurrence of cancer after operation demonstrates. ”

“ 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. ”

“ 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. ”

“ The frequency and rapidity of metastasis- formation varies greatly. As a general rule cancer of the breast is more liable than other forms of growth to be followed by widespread secondary deposits. On the other hand, in cases of cancer of the skin secondary infection is usually confined to the neighbouring lymphatic glands, and seldom occurs in any of the internal organs. 3. Termination of Malignant T umours.-In one or two well authenticated cases a malignant tumour has disappeared of its own accord without any treatment, and a natural cure may be said to have occurred. ”