Many forms of encysted dropsy of the ovaries are attended with cancerous affections; here we find colloid cancer, medullary cancer, and what for more exact definition are termed cystosarcomata. Some description of the mode of formation of these will be given in connection with our account of Dropsy of the Ovaries. And for a more thorough and complete view of all the various structural disorders of these organs, the reader is referred to the work of Scanzoni, on the Diseases of Females.
Symptoms. – Ovarian cancers are less painful than the uterine; but the pain is of the same lancinating character; menstruation may continue so long as the disease is confined to one ovary; but it will necessarily fail when both organs become involved. Conception has been known to take place in persons laboring under malignant disease of one ovary. From their situation in connection with the rectum and bladder, the enlarged ovaries must of course occasion more or less irritation and disturbance of both these organs. And in fact the most painful symptoms which arise in connection with ovarian cancer are those which occur either from its thus involving other and more sensitive organs, or form its escape into the abdomen and subsequent softening, involving all the surrounding peritoneal membranes in this distressing inflammation. “These disease frequently lead to a rapidly fatal termination, and are accompanied by that extreme sense of debility and bloodless appearance of the body so characteristic of malignant disease. “The malignant form of disease may be recognized, during life, by the want of nutrition, the broken health of the patient, the unceasing and rapid growth of the tumor, the simultaneous enlargement of glands in other parts of the body, and the occasional recurrence of lancinating pains in the parts. The latter symptom is not constant. The pulse is quick and feeble, and as the disease proceeds, there is hectic fever, and often aphthae in the mouth, with an inexpressible sense of debility. – Boivin and Duges.
Diagnosis. – “From ovarian dropsy, both scirrhus and encephaloid may be distinguished by their greater hardness and compactness; by the absence of fluctuation generally, and by their lobulated, tuberose surface.
“From Pregnancy, by the hard lobulated surface, and by the absence of the audible signs of pregnancy.
“From fibrous tumors of the uterus, by their greater size; by their not being pediculated, but more movable, at least during the early stages; and in an advanced stage, by the lancinating pain and constitutional distress.
“Scirrhus is of slow growth, gives rise to mechanical symptoms; and to disturbance or irregularity of the catamenia; but to no pain or constitutional suffering. Encephaloid disease, or fungus haematodes, on the contrary, gives rise to fever, emaciation and other constitutional symptoms. – Churchill.
For other constitutional symptoms and affections, see cancer of the uterus; since this malignant disease either in the uterus or in the ovary must affect the system in a very similar manner. For the treatment of cancer of the ovary study the remedies mentioned under Ovarian Tumors and Cancer of the Uterus.
CANCER OF THE BREAST.
In the female the cancerous diathesis usually develops itself in the uterus, in the ovaries or in the breasts. And since the mammae are intimately connected with the ovaries, constituting important parts of the sexual system, we have thought it best to include in this section all that needs to be said of cancer as affecting the former organs.
There are many forms of tumors occurring in the female breast, – some of which are mild or innocuous; some malignant, apparently from their outset; and some, after remaining stationary and harmless for a long course of years, are capable of suddenly assuming a malignant form and character. This latter circumstance is owing no doubt to the fact that in such cases the tumor becomes the representative of a more depraved, or of a cachectic condition of the system. And as in a former chapter we have seen the reciprocal relation of the tuberculous to the cancerous diathesis, in different members of the same life the constitutional miasm may assume a more malignant form.
Of the actual cancerous affections of the female system, the breast becomes the seat of development of by far the larger number. And the cancers of the breast, – either those originally so appearing, or those subsequently so becoming, – are almost all of the scirrhous variety; and they all occur after the accession of the period of puberty. But before proceeding to the description of mammary cancers, it will be proper to mention to or three forms of tumors which resemble such cancers, especially in their initial stages.
These are glandular engorgements, “which have received the name of adenoid tumors, or adenocele. Commencing as a small almond- shaped tumor, very loosely attached to the surrounding tissue and gliding with great freedom under the skin when pressed by the fingers, it may grow to the size of a duck’s egg or even larger. It is seldom solitary, never attaches itself to the skin, and within my experience never suppurates, so long as it remains simply an adenocele. This tumor is observed more generally in the mammae of unmarried females. – Cooke. These tumors, or glandular enlargements and indurations, are supposed to be of a scrofulous (tuberculous) nature; an external development of what might have become pulmonary tuberculosis. Some cases of tumors of this form are believed to depend upon uterine irritation or sexual excitement; and to be only capable of being removed by the removal of the exciting cause. Other cases of adenoid tumors of the mammae are those which may remain for many years painless and innocent and finally assume a cancerous form. “It need not be denied that cancerous growths may occur in tumors that were previously of an innocent kind.-Paget. This is to be accounted for from the fact that phthisical parents beget cancerous offspring, and cancerous parents have phthisical children; – hence tumors of long standing, having none of the characteristics pertaining to cancer, may suddenly assume an active, cancerous condition. These statements are made particularly to show the importance of being guided in all our prescriptions for such tumors, – not by our diagnosis as to their being cancerous or otherwise,-but by the symptoms present.
Still another class of tumors of the female breast is to be found in those which arise from external injury. “A blow upon the soft tissues of the female breast may result in a diffused hypertrophy of the gland and neighboring structures; or in a circumscribed tumor which obtains considerable hardness, and is attended with great pain; or in the development of cancer. The result in either case being determined by the internal condition of the various systems, which obtains considerable hardness, and is attended with great pain; or in the development of cancer. The result in either case being determined by the internal condition of the various system, which are all alike externally affected by the same exciting cause. Thus unless one has in her constitution either the cancerous dyscrasia itself, or its complement, the tuberculous diathesis, no cancer can result from an external injury, however severe.
The various forms of non-malignant tumors of the mammae hitherto mentioned, are indurated, solid. But there are others, which may become cancerous or not, which are properly termed cysts in the mammae. These arise from the distension of one of the lactiferous tubes of which the gland is composed. “When fully developed this cystic tumor is so tense as to give rise to some doubt whether it be a solid or fluid body. They may occur singly, or in numerous clusters. In the former case, they are declared by Cooke, – a high allopathic authority, from whom in this section we have borrowed freely, – to be innocent and curable; in the latter they may be either innocent or malignant.
The cancers of the female breast have already been stated to be almost entirely of the scirrhous variety. The medullary form of mammary cancer is so rare, that it is sufficient to state that it sometimes does occur. Scirrhus of the breast has been divided into three general classes.
I. Scirrhus proper: a hard tumor which is felt beneath the skin, generally movable, but in an advanced stage attached to the pectoral muscle as well as to the skin, very heavy and incompressible, and attended with severe stabbing pain. These tumors may be reabsorbed; or become open ulcerated cancers.
II. Scirrhus with cysts, cysto-scirrhus: a cancerous tumor having an indurated base, in which cysts have been developed. This variety in some instances appears to be but a further development of the former.
III. Cuirass-form scirrhus: tegumentary scirrhus, which involves both the skin and the gland, binding the whole down by a hard, brawny, almost iron clasp to the ribs themselves. This peculiar induration of the skin frequently extends over the thorax, creeping gradually round to the back, and anteriorly across the sternum to the other breast. It is the least manageable of all the forms of scirrhus and never at any time admits of operation with the slightest prospect of delaying its progress. It is in this form of scirrhus principally that we have those nodules or tubercles which are sometimes seen upon the surface of the breast, and indicate generally the hopeless nature of the case; but these tubercles do also appear in the advanced stages of the other forms of scirrhus, and especially when the disease returns after an operation. – Cooke.
