Tumor

“ Tumors form one of the most common causes of death (after the age of thirty-five one in every ten individuals dies of tumor) ; medical and surgical resources are, in many cases, powerless to afford relief and the tumor stands as a bar to the attainment of the utopia represented by a happy and comfortable old age, and a quiet passing. Every possible resource should be placed at the disposal of the scientific investigation of the subject, for with knowledge will come power to relieve. ”

“ 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 ”

“ We know that the tumor represents essentially an abnormal growth, and that this growth is due to new formation of cells. In certain cases the tumor repeats the structure of the organ or tissue in which it originates, in others it departs widely from this; always, however, its structure resembles structures found in the body at some period of life. The tumor cells, like all other cells of the body, grow by means of the nutriment which the body supplies; they have no intrinsic sources of energy. ”

“ Cancerous cells are always surrounded by alveoli. Sarcoma in many instances resembles very closely the fibrous tumor. In malignancy it is very much like the cancerous tumor.
CLINICAL HISTORY.—The early symptoms of sarcoma are leucorrhoea, hemorrhage, and tumefaction. The discharge from the genital organs resembles that of fibrous tumors. This does not generally possess an offensive odor, but as the disease advances necrosis of the tumor occurs to a greater or less extent, and then the smell of the discharge comes to [p. 272] resemble that of cancer. ”

“ No one ever attempted to remove a tumor except by external applications. Those with which the natives are chiefly troubled are fatty and fibrous tumors; and as they all have the 'vis medicatrix naturae' in remarkable activity, I safely removed an immense number. In illustration of their want of surgical knowledge may be mentioned the case of a man who had a tumor as large as a child's head. This was situated on the nape of his neck, and prevented his walking straight. He applied to his chief, and he got some famous strange doctor from the East Coast to cure him. ”

“ 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 possess no physiological function. They are absolutely useless. Fibrous tumors bind no parts of the organism together; bony tumors add nothing to the supporting framework of the body; the tissue of fatty tumors never serves as a storehouse of feed and energy; the cells of an adenoma, or gland tumor, furnish no secretion; a tumor composed of muscle tissue produces no increase to the strength of the individual—its muscle cells are not contractile. ”

“ The concentric variety of growth includes those tumors which have commonly been described as encapsulated, and which are capable of ready enucleation from their surroundings in virtue of a thin layer of loose connective tissue lying between the tumor and the contiguous tissue. Such a capsule represents the matrix, the pia mater, in which lie the blood-vessels going to and coming from the tumor, and is often nothing else than the distended and hyperplastic fibrous tissue remaining after the absorption of the muscular fibres or gland-cells from the tissues surrounding the morbid growth. ”

“ Often, however, the whole muscular coat beneath the tumor is replaced by the cancerous growth, and can no longer be recognized. The serous and subserous connective tissue, like the submucous coat, offers a favorable soil for the growth of the tumor, which here appears usually in the form of large and small nodules projecting from the peritoneum. Adhesions now form between the stomach and surrounding parts, and opportunity is offered for the continuous growth of the cancer into these parts. ”

“ 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. ”

“ A weak solution forms little globules in a tumor, and we can imagine one so small as to be carried into the circulation.”
To effect a radical cure, it is desirable to get rid of the tumor bodily, not by shrinking or contraction into a hard knot, or by inflammatory destruction, but by a separation of the spongy and vascular growth from the normal tissue of the body, the same as if dissected off root and branch. ”

“ 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. ”

“ 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. ”

“ The coincidence of injury and tumor is apt to be overestimated because of the strong tendency to connect succeeding events. Tumors are not most common on those parts of the body which are most exposed to injury. They are rare, for instance, on the hands and feet, and very rarely do they appear at the site of wounds caused by surgical operations. For those tumors which develop in intra-uterine life it is difficult to assign injury as a cause. ”

“ 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. ”

“ Cancer of the Breast.—Of all the tumors which affect the breast, cancer is the most frequent. Any tumor in the breast of a woman forty years of age or more is quite likely to be a cancer. A tumor (or lump) which has remained small for years and then begins to grow rapidly has changed its type and become cancerous. ”

“ 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 ”

“ These are the appearances which present themselves at first sight; but those under the great tumor are no less extraordinary; for, upon lifting up the great tumor, and looking up [351] under it, his right eye comes in sight, with which he sees very well, and the eye is clear and sound; but the under lid is pulled down, and stretched to six or seven inches long, to which a tumor hung also, as large as that anterior one at the chin, the lowest of the three ”

“ A tumor may be of any size: so small as to be invisible to the naked eye, or its weight may exceed that of the individual who bears it. The limitations to its growth are extrinsic and not intrinsic. There is no distinct color. Certain tumors have color which depends upon the presence of a dark brown or black pigment within the cells. Hæmorrhages within them are not infrequent, and they may be colored by the blood or by pigments formed from it. Usually they have a gray color modified by their varying vascularity, or the cut surface may be mottled due to areas of cell degeneration. ”

“ These often become separated from the main mass and are carried by the blood into other parts of the body, where they grow and form tumors similar in character to the parent tumor. In the extraordinary capacity for growth possessed by tumor cells, they resemble vegetable rather than animal cells. ”

“ The tumor gradually increases in front and laterally, until it produces great deformity, and often interferes with respiration and the act of swallowing. From its pressure on the great blood-vessels running to and from the head, there is a constant liability to engorgement of blood in the brain, and to apoplexy, epilepsy, etc. When the enlargement once makes its appearance, it continues to increase in size as long as the person lives, unless appropriate treatment be resorted to. It never disappears spontaneously. ”

“ 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. ”

“ On examining the affected parts after death or amputation, the tumor itself is found to consist of a soft substance, somewhat like the brain, of a greyish colour, and greasy appearance, with thin membranous-looking divisions running thro’ it, and cells, or abscesses, in different places, containing a thin bloody matter, occasionally in very considerable quantity. ”

“ 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. ”

“ Woods. We [Pg 346] found that the tumor did extend from the antrum, into which I could bore my finger easily. Dr. O'Sullivan, Professor of Pathology in Trinity College, declared the growth to be a round-celled sarcoma. Of that there is no doubt. The tumor returned in a couple of months, and the patient then saw Dr. Semon, in London, who advised immediate removal. He returned home, and after a further delay he asked to have the operation performed. I did this in May last by the usual method. I found the tumor occupying the whole of the antrum. The base of the skull was everywhere infiltrated. ”

“ 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. ”

“ Besides the sarcomata we find in young children frequently so-called mixed tumors, consisting of several kinds of tissue; in the kidney tumors for instance we may find side by side proliferating epithelial gland tissue, round cells resembling sarcoma, muscle and even bonelike tissue. In other organs also we find not rarely such mixed tumors to prevail among the cancers in children. Cancer of the female generative organs occurs in children not mainly in the uterus, as is the case in adults, but in the ovaries and in the vagina. ”

“ 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) . ”