Tumulus

“ It is probable that many of the cancer cells which are carried away in the blood or lymph stream undergo necrosis and fail to give rise to secondary growths. Secondary growths present a faithful reproduction of the structure of the primary tumour. Apart from the lymph glands, the chief seats of secondary growths are the liver, lungs, serous membranes, and bone marrow. ”

“ If the cells undergo degeneration and absorption and the stroma contracts, the tumour becomes still harder, and tends to shrink and to draw in the surrounding parts, leading, in the breast, to retraction of the nipple and overlying skin, and in the stomach and colon to narrowing of the lumen. When the cells of the tumour undergo colloid degeneration, a _colloid cancer_ results; if the degeneration is complete, as may occur in the breast, the malignancy is thereby greatly diminished; if only partial, as is more common in rectal cancer, the malignancy is not appreciably affected. ”

“ 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. ”

“ 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. ”

“ The integuments over the inflamed bone are swollen, and the tumour is œdematous; whilst a hard and solid tumefaction exists in the more deeply-seated parts, caused partly by enlargement of the osseous tissue and partly by effusion of lymph into the cellular substance. The bone is imbedded in a gelatinous or lymphatic effusion, situated mostly beneath the periosteum. This membrane is more vascular than in its natural condition, thickened, and at the same time opened out in texture. The bloodvessels of the affected bone are much increased, both in activity and in size ”

“ It is generally believed that the secondary growths in cancer that develop at a distance from the primary tumour, those, for example, in the medullary canal of the femur or in the diploe of the skull occurring in advanced cases of cancer of the breast, are the result of dissemination of cancer cells by way of the blood-stream and are to be regarded as emboli. ”

“ Osseous tumors may arise from the periosteum or from the marrow. If they arise from the periosteum they may extend early to the adjacent soft tissues and involve and destroy them. If the tumor arises in the marrow, it is for a long while cut off from the adjacent soft tissues by the thick cortex, and about the extending medullary tumor may also come a reactive proliferation by the periosteum, so that as the tumor extends it still may, for a long time, be surrounded by a shell of bone which prevents infection of the soft parts. ”

“ This density often obscures the diagnosis of tumours on the cranium. A tumour growing upon the head may be either above or below the aponeurosis of the scalp. If below, it will have a firm resisting feel, being bound down by the aponeurosis. Nevertheless its firmness and resistance may depend not simply on its confinement beneath the aponeurosis, but on its having its origin within the skull. Look with suspicion, then, on every tumour on the head that will not readily permit you to move it about, so as to be sure of its connections prior to an attempt at extirpation. ”

“ 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. ”

“ 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.) ”

“ In the great majority of cases careful examination will show that the tumour occupies a depression in the bone, saucer-like in nature, in which the tumour rests. They are seldom freely movable, and are often markedly fixed, being either attached to the pericranium or to deeper structures. ”

“ The patient is seated facing a good light and the body of the prominent tumour is laid hold of by the vulsellum; the forceps are then introduced, with the blades expanded, and carried backwards so as to reach its neck, which is then to be firmly grasped by the instrument, and gently twisted, so as to separate its connexions with the membrane. No force, no jerking or pulling, is allowable. It may happen, even with the gentlest and most careful management, that a small fragment of bone comes away along with the tumour ”

“ 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. ”

“ 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. ”

“ Inasmuch as many of the tumours are destitute of a limiting wall, a considerable mass of brain-tissue has to be traversed in order to remove the growth, and the ultimate result, so far as the impairment of functions is concerned, is a serious disappointment. If, however, the tumour is found to be encapsuled, its removal is sometimes quite easily effected, and perfect recovery is then likely to be the result. ”

“ 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 ”

“ 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 ”

“ 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 ”

“ On section these tumours present a brownish-red or chocolate colour, and, being highly vascular, are liable to haemorrhages, and therefore also to pigmentation, and to the formation of blood cysts. Sometimes the arterial vessels are so dilated as to impart to the tumour an aneurysmal pulsation and bruit. The enlargement or "expansion" of the bone results in the cortex being represented by a thin shell of bone, which may crackle on pressure--parchment or egg-shell crackling. ”

“ 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. ”

“ Encysted tumours; cysts of the lids; tarsal tumour.—Under these and similar names are recognised a very frequent form of disease, chiefly in the upper lid: small tumours which rarely exceed half a pea in size, convex towards the skin, which is freely moveable over them; they give no pain, and are annoying only from their bulk and deformity.
Operation.—Evert the lid, incise the conjunctiva freely over the tumour, insert the blunt end of a probe and roughly stir up the contents of the cyst, thus evacuating it. ”

“ Many tumours have around them a kind of diseased atmosphere, an atmosphere which extends more or less remotely, which always exists in the cellular texture, and which constantly partakes of the nature of the tumour. If it is acute, as in phlegmon, it is a simple swelling which disappears almost entirely at death; as I have often seen in dead bodies an inflamed part that was very large during life, resume by the loss of the vital forces, nearly its ordinary size. ”

“ Innocent: Papilloma, Adenoma, Cystic Adenoma; (2) Malignant: Epithelioma, Glandular Cancer, Rodent Cancer, Melanotic Cancer —III. Dermoids —IV. Teratoma. Cysts: Retention, Exudation, Implantation, Parasitic, Lymphatic or Serous. Ganglion. [2] For the histology of tumours the reader is referred to a text-book of pathology.
A tumour or neoplasm is a localised swelling composed of newly formed tissue which fulfils no physiological function. Tumours increase in size quite independently of the growth of the body, and there is no natural termination to their growth. ”

“ 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. ”

“ Special mention should be made of the _myeloma_ which is met with at the wrist or ankle as an elongated swelling of slow development, or over the phalanx of a finger as a small rounded swelling. The tumour tissue, when exposed by dissection, is of a chocolate or chamois-yellow colour, and consists almost entirely of giant cells. The treatment consists in dissecting the tumour tissue off the tendons, and this is usually successful in bringing about a permanent cure. ”

“ 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 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. ”

“ In some cases no source of infection is discoverable. The individual glands attain a considerable size, and they fuse together to form a large tumour which fills up the axillary space. The disease progresses more rapidly than it does in the cervical glands, and almost always goes on to suppuration with the formation of sinuses. Conservative measures need not be considered, as the only satisfactory treatment is excision, and that without delay. ”