Neoplasm

“ Surgeons are fully agreed that the earlier a tumor is recognized and removed 178the better the prospect of ultimate success, and this is eminently true in regard to remedial measures other than surgical: for as we have seen, after a cancerous process is well under way its cells secrete a something which hastens the general depravement of the system, and quickens the growth of the neoplasm, and naturally greatly increases the difficulty of overcoming the dyscrasia. ”

“ Categories D37-D44, and D48 classify by site neoplasms of uncertain behavior, i.e., histologic confirmation whether the neoplasm is malignant or benign cannot be made. Use additional morphology codes with behavior code /1. ”

“ The most important conditions are: parotitis (epidemic and secondary) , chronic inflammation, calculi, cystic dilatation of ducts [ranula] , Ludwig’s angina, salivary fistula, granulomata (tuberculosis, syphilis and actinomycosis) , neoplasms (most common forms are the mixed tumors containing cartilage, fibrous connective-tissue and myxomatous tissue and cords or rows of cells regarded by some observers as endothelial, by others as epithelial; other less common tumors are adenoma, fibroma, carcinoma and sarcoma) . ”

“ The most important pathologic conditions are tuberculosis, syphilis, atrophy, compensatory hypertrophy, hæmorrhage, infarction, thrombosis of adrenal vessels, secondary tumors (melanotic sarcoma, carcinoma) , primary neoplasms (hypernephroma, accessory adrenals typical and atypical, lipoma, glioma, neuroma, sarcoma) , parasites (echinococcus) .
13. Kidneys. Right kidney weighs 110-145 grms., and measures 10-12 cm. long, 4.5-5.0 cm. broad, and 3-4.5 cm. thick. ”

“ 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. ”

“ Those tumors which grow rapidly and invade and destroy the surrounding tissue are called malignant tumors or cancers, but in a strict sense no tumor can be regarded as benign, for none can serve a useful purpose. A tumor after a period of slow growth can begin to grow rapidly. Tumors may arise in any part of the body, but there are certain places of preference particularly for the more malignant tumors. These are places where the cells naturally have a marked power of growth, and especially where growth is intermittent as in the uterus and mammary gland. ”

“ 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. ”

“ 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 ”

“ Formation of Secondary Growths, or Metastases.—In addition to this spread of growth by direct extension, another characteristic of malignant tumours is a tendency to dissemination, that is, to reproduce themselves in various parts of the body far removed from the original site; so that it is not unusual to find after death that a cancer of the breast has?given rise to secondary, or metastatic, deposits in the lymphatic glands, the lungs, the ribs and other bones, the brain and the abdominal organs. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ A frequent form of so-called malignant disease proves to be only a collection of altered epithelium-cells. Even cancer itself has no specific anatomical element, and the diagnosis of a cancerous tumor by the microscope, though tolerably sure under the eye of an expert, is based upon accidental, and not essential points,—the crowding together of the elements, the size of the cell-nuclei, and similar variable characters. ”

“ The tumour consists of a dense framework of fibrous tissue, with groups of cancer-cells in the spaces. The malignancy of the disease depends upon the cells, not upon the fibrous tissue. In young subjects the cells predominate, but in old ones the contraction of the fibrous tissue throughout the breast compresses and destroys the cells, and this sometimes to such an extent that there is at last nothing left at the site but contracted fibrous tissue, all trace of malignancy having disappeared. This variety of the disease is found in old people, and is called atrophic cancer. ”

“ An atypical tumor is one of epithelial or connective tissue origin in which, though the cells are the same as those in the tissue from which it grows, their arrangement is quite different. They are malignant.
The most important classification of tumors is that into benign and malignant.
A benign tumor is one in which there is no tendency to rapid growth; the symptoms are purely local, and the general health is not affected, except indirectly.
On the other hand a malignant tumor is one which takes on a rapid growth with a tendency to infiltrate or [Pg 153] adhere to surrounding tissues ”

“ It is possible that an injury may stimulate into active growth undifferentiated tissue elements or “rests,” and so determine the growth of a tumour, or that it may alter the characters of a tumour which already exists, causing it to grow more rapidly.
The popular belief that there is some constitutional peculiarity concerned in the causation of tumours is largely based on the fact that certain forms of new growth—for example, cancer—are known to occur with undue frequency in certain families. ”

“ 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. ”

“ Again, it is beyond doubt that occasionally a tumour, which for years has been void of the least taint of malignancy, may become converted into an active cancer. Moreover, certain tumours seem to lie on the border line, for example, rodent ulcers and cancers of the parotid gland. ”

“ 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. ”

“ These general features are associated with certain microscopical characters found in the tumours or ulcers, so that the nature of any growth—whether malignant or otherwise—can be sometimes determined by the surgeon or physician, and sometimes by the pathologist or microscopist alone, but, as a rule, is most certainly settled by the physician or surgeon acting in conjunction with the microscopist. Yet, and this is important, not every cancer does actually destroy life. ”

“ 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. ”

“ Malignant adenoma is a disease of the utricular glands which has been classed by some writers as a distinct disease, by others as a form of carcinoma. In it the gland-spaces are much enlarged, irregular, and joined to other gland-spaces. The columnar epithelial cells often fill the whole of the gland-space (Fig. 128) The cells, 222 however, never infiltrate the interstitial tissue, as in cancer. The muscular wall of the uterus appears to be destroyed by atrophy or by fatty degeneration.
The disease is malignant, it extends to the neighboring structures, and it destroys life. ”

“ Cancer may be described as the runaway growth of cells. The secretions of the pituitary gland serve to stimulate cell reproduction, so it was reasoned that destruction of this gland might well slow down growth of a tumor elsewhere in the body. ”

“ The knowledge that we now possess of the mode of growth of cancers gives us at least one important indication. If we have to deal with a neoplasia that grows at the periphery by gradual infiltration of the surrounding tissues, it is plain that, for pressure to be useful, it must be applied around the tumor rather than over it, where, by compressing and obstructing the capillaries, it would cause overfullness of those at the circumference. ”

“ The relation of cancer to epithelial tumors is regarded as similar to that borne by sarcoma to tumors composed of connective tissues. The growth of the epithelial elements into the neighboring parts is through paths determined by pre-existing or new-formed connective tissue. The active element of the cancer lies more especially in its epithelioid cells, and its growth takes place in an atypical rather than a typical manner. ”

“ Those practitioners who do not recognise the malignant disease, and operate for every tumour, and at all ages, have boasted of great success. But it is not so with those of mature experience. The disposition to malignant action often remains latent for many months, sometimes for many years, and at length becomes fully developed. The disease may return in the skin; the cicatrix hardens, ulceration occurs, and makes progress. Or tubercles form in the cellular tissue, enlarge, and involve the skin. Or the glands become tender and swell; and the swelling is often unattended with uneasiness. ”

“ 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." ”

“ When to Suspect Cancer and What to Do.—External or Exposed Cancer.—Cancer of the exposed or surface parts of the body, such as the skin of the lip, nose, cheek, forehead, temples, etc., is more readily recognized than internal cancer, and is therefore more liable to early operation and prompt cure. One rarely sees these forms of cancer in an advanced stage, because such cases are readily seen and recognized by physicians in the early stage of development, when operation can be sufficiently early to effect a lasting cure. ”