Tumescence

“ Tissues appear to be most liable to cancer when, having attained maturity, they enter upon the phase of decadence or involution, and this phase is reached by different tissues at different periods. It is not so much, therefore, the age of the person in whom it occurs, as the age of the tissue in which it arises, that determines the maximum incidence of cancer. Cancer of the stomach appears and attains a maximum frequency earlier than cancer of the skin; cancer of the uterus and mamma is more frequent towards the decline of reproductive activity than in the later years of life ”

“ 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. ”

“ 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. ”

“ It not infrequently happens that the development of a tumour is preceded by an injury of the part in which it grows, but it does not necessarily follow that the injury and the tumour are related as cause and effect. 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 effect of a tumor upon its bearer depends upon its character and situation. Pain is very commonly present, and is due to the pressure which the growing tumor exerts upon the sensory nerves. Pain may, however, not be present or appear only at the last. A condition of malnutrition and emaciation often results due to the passage into the blood of injurious substances formed in the tumor, or to the destruction of important organs by the growing tumor. The growth of a tumor in the intestine may obstruct or close the canal and thus interfere with nutrition. ”

“ 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. ”

“ They only threaten life when growing in the vicinity of vital organs, and then only in virtue of their situation--for example, death may result from an innocent tumour in the air-passage causing suffocation, in the intestine causing obstruction of the bowels, or in the vertebral canal causing pressure on the spinal medulla.
_Malignant tumours_ usually show a marked departure from the structure and arrangement of the normal tissues of the body. Although the cells of which they are composed are derived from normal tissue cells, they tend to take on a lower, more vegetative form ”

“ A fatty tumour is to be diagnosed from a cold abscess and from a cyst. The distinguishing features of the lipoma are the tacking down and dimpling of the overlying skin, the lobulation of the tumour, which is recognised when it is pressed upon with the flat of the hand, and, more reliable than either of these, the mobility, the tumour slipping away when pressed upon at its margin. ”

“ Both men and women are subject to piles; but women more particularly during the last stages of pregnancy, in which the womb presses on the rectum in relieving the bowels by stool. These tumors can plainly be felt, as they extend up the rectum an inch or more in severe cases. When these tumors burst and bleed, the patient is much relieved; but when the pain is severe, it is apt to produce fever. Many persons are constitutionally subject to this disease through life. It is generally, however, brought on by costiveness, or irregularity [Pg 26] in relieving the bowels. ”

“ 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 mass of the tumour having been dissected free, the écraseur is applied to the pedicle or the cord. Enucleation of the tumour may be very difficult on account of the presence of numerous ramifications or attachments, but the closest attention must be given to removing every fragment if a fresh local growth is to be avoided. In the event of fragments being left, a fresh growth is certain to occur.
Generalisation, which may extend to all the viscera (lymphatic glands, liver, spleen, lungs, pleura, peritoneum, heart, etc.) ”

“ 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. ”

“ 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. ”

“ 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. ”

“ If all persons over forty years of age were routinely examined once every six months to see that they had not cancer, or a precancerous condition, and if these when found were promptly dealt with, then cancers of the rectum, tongue, lip, breast, skin and uterus would cease to be the plagues they are at present. ”

“ The question of the origin of tumors or new growths is also an extremely important one; and it is undoubtedly true that many tumors arise where there was a previous inflammation, this being especially the case in tumors of the rectum. Why such a growth should arise in some cases and not in others is as yet unknown, though microbes are held by many to play an important rôle. ”

“ A tumour is a swelling or new production, and not a part of the original composition of the body. Blood may have been effused, and the coagulated part, becoming organised, is increased in size by deposits from the vessels which enter it; or perhaps the blood, the coloured part of it at all events, is taken up and lymph is deposited, which, if not also removed, “undergoes further changes of a secondary nature, and remains a parasite or new structure.” Its structure and growth are modified according to the action which its own vessels assume, independently of the surrounding vascular system. ”

“ Tumors are independent. For instance, their nutrition bears no relation to the nutrition of the body. A lipoma, or fatty tumor, in the subcutaneous tissue, may go on increasing to huge bulk while the body is steadily emaciating. Again, the tissues of the aged gradually undergo atrophy, yet cancers arise at this time and grow rapidly.
Tumors are unrestrained in growth and structure. In the development of an animal we know at what period of its existence the mass of tissue called liver will develop—what its site, structure, and size will be. ”

“ 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 ”

“ The growth of ovarian cystomata at and after puberty, and of these and mammary tumors during pregnancy, are also explained on the ground of a more abundant supply of blood at such periods. He and others find in physiological conditions a source for the abundant blood-supply—that is, the efficient nutrition for the growth of a tumor. The necessity of sufficient nutrition in the development of tumors is universally admitted, and its source may be looked for in pathological as well as physiological conditions. ”

“ When they originate from the glands of the skin or of a mucous membrane, they tend to project from the surface, and form pedunculated tumours or polypi.
Adenomas may be single or multiple, and they vary greatly in size. The tumour is seldom composed entirely of gland tissue ”

“ As the growth of the tumour proceeds, the surrounding parts yield, are condensed, and form an envelope for the new formation; the neighbouring bloodvessels are excited to a greater degree of action, and more blood is poured into the vessels of the tumour; the action of these in turn is very vigorous, and the increase of the new growth is more and more rapid. They become, it would appear, dilated and tortuous. Morbid enlargement, or rather new productions, often attain an enormous size ”

“ It is sometimes introduced by a tumid upper lip, and chop in the middle of it; at other times the first appearance is oval moveable tumours in the lymphatic glands of the neck, under the chin, or below the ears. These tumours often continue inert one, two, or more years, and without pain, until they tend towards suppuration; and are various in size, from a walnut to an egg, or larger. At length there is some fluctuation, ulceration, and exudation of viscid serum, but no concocted pus; the ulcers spread unequally; their edges are not callous; yet they are very tardy in cicatrizing. ”

“ 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. ”

“ DEFINITION.—Cancer of the stomach is characterized anatomically by the formation in this organ of a new growth, composed of a connective-tissue stroma so arranged as to enclose alveoli or spaces containing cells resembling epithelial cells. The growth extends by invading the tissues surrounding it, and frequently gives rise to secondary cancerous deposits in other organs of the body. ”