Sarcomata may appear on any portion of the integument and exhibit little preference for any particular location, and after they have existed for some time are liable to develop on the mucous membranes, and also invade the viscera.
The general healthy and vigor may be apparently unimpaired during the early periods of the existence of sarcoma; but as the disease advances, these gradually fail, but without however the development of a cachexia, as marked as in the latter stages of cancer.
The prognosis of sarcoma varies. In single small tumors of recent appearance it is good, as they can be easily removed and when the operation is properly performed they do not as a rule return. When sarcoma becomes generalized the prognosis is unfavorable, and this is specially the case when complicated with melanosis. Large sarcomatous tumors are usually fatal.
Treatment.- Beyond attention to the general health, there need be little expected from internal treatment although there are undoubted cases of sarcoma on record in which the homeopathic remedy exerted a favorable influence and apparently effected a cure.
In small and young single sarcomata mechanical removal should be effected just as soon as a diagnosis is established care being taken to remove a considerable portion of the apparently healthy skin, and the location of the tumor will permit. Special provision should be made against hemorrhage, which, from the large number and size of vessels entering the tumor may be excessive. In every large sarcomata, in which an ultimate fatal termination is to be anticipated removal is hardly to be recommended, except as a palliative measure, looking only to temporary relief. In these cases removal by means of a loop of platinum wire heated by electricity is to be preferred to the knife, on the score of safety from hemorrhage.
Carcinoma
The carcinomatous family of malignant tumor contain the tumors which the term cancer, as understood and the present day, is properly applied. A carcinoma is a tumor made up of a typical epithelial new formation-cells, of epithelial origin but imperfect embryonic cells. Structurally it consists of cavernous, fibrous stroma, in the interspaces or alveoli of which are found the epithelial cells suspended in a serous fluid. The cells are not separated by any visible intercellular substance. Even the blood vessels run in the fibrous stroma and not between the cells.
The development of cancer from epithelium has been clearly shown in certain localities where morbid processes are taking place. Some years ago, paget called attention to the point that a certain eczema of the nipple is often the precursor of cancer. In cases of this kind, it has been shown that the proliferation of cells which is active over the denuded portions is continued down into the mild ducts until these ducts have become filled and expanded by the over-accumulation of imperfectly formed cells. At the same time, the connective tissue surrounding the duct takes on an increased vascularity from the irritation and is infiltrated with small cells resembling leucocytes. There is no direct connection between the cells of the duct and those found in the connective tissues outside. The latter are not migrating epithelial cells, but appear as the product of inflammation. As the ducts become filled and their walls distended, they give way, and the epithelial cells infiltrate into the surrounding tissues where they proliferate and become centres of disease.
It is believed by some pathologists that the entire growth is not due to the proliferation of epithelium, although originating in this way. Endothelial cells, connective tissue cells, and indifferent corpuscles in the presence of, or by contact with a growing carcinoma, it is claimed, become infected and transformed into cells similar to those of the tumor itself. While this may be true, the progress of carcinoma in its extension to the lymphatic glands does not support this theory for instead of infecting and transforming the gland as a whole the mode of invasion is between and around the lymph corpuscles, they being affected only by the pressure of the rapidly growing masses. As the cells increase and distend the connective-tissue spaces the fibrous tissues are pressed back and welded together and the stroma of the cancer makes its appearance. The stroma is not real cancerous tissue its appearance. The stroma is not real cancerous tissue, but the natural tissue of the part is sometimes increased by unnatural activity of the surrounding tissue. The blood-vessels of the stroma like the fibrous tissue in crease in size, so that the stroma becomes much more vascular than the original fibrous tissue.
Scheurlen claims to have obtained by cultivation from the juice of cancer of the breast in sterilized plural fluid, colonies of bacilli and spores the bacilli being from 1.3m. to 2.5 m. in length. By inoculating six dogs, in the posterior mammary glands, with an emulsion of these cultures he has demonstrated the appearance of cancerous tumors. Finally he has found the spores, if not the bacilli in question, in all the preparations of cancer stained by Gram’s method. His conclusions areas follows: I There exist constantly in cancerous tumors bacilli which may be isolated. 2. The spores of these bacilli are found in all microscopic preparations of cancerous tissue.
3. Inoculation of animals with pure cultures of these bacilli determines the development of cancerous tumors.
4. There is a relation of cause and effect between these bacilli and cancer.
The female sex, on the whole is much more exposed to cancer than the male on account of the greater liability of the female organs of generation. The breast alone probably furnishes as many cases of carcinoma as all other portions of the body.
Carcinoma is essentially a disease of old age. It is so rare before thirty years that the age is often the most important consideration in the early diagnosis between benign and malignant growths. After thirty years of age it becomes more frequent, but it is not until the acme of life is reached and the organs begin their natural retrogression, that cancer becomes common. At and after the climacteric in women and at and after the climacteric in women, and at a somewhat later period in men the cancer is most active. So well recognized is this fact that a tumor appearing at this of life is always regarded regarded with suspicion. Certain localities are attacks are attacked much earlier than others. In early adult life it is found most frequently in the testicle and labia; from thirty-five to fifty, in the breast uterus, the tongue and the penis; from fifty to sixty-five years, on the lip and oesophagus. It is a noticeable fact that the organs in which natural degeneracy of function takes place are the organs most frequently attacked.
The carcinoma is a tumor of rapid growth. It never remains idle and with the the exception to be noted, never decreases in size. In the manner of its extension locally, it resembles sarcoma.
The carcinoma is liable to many changes, but one of the most common features is the tendency to ulceration shown by the growth.
The reproduction of cancer in an associated lymphatic gland is of such frequent occurrence that it is looked upon as one of the most certain signs of carcinoma. The glands affected are usually those having a direct anatomical connection with the affected part. Thus the axillary glands follow infection of the breast; the lymphatics in the groin, carcinoma of the testicle and the submaxillary or sublingual glands, infection of the tongue or lip. There seems to be limit to the number of glands involved. From one fifty have been found enlarged, varying all the way from the size of a pea to that of a walnut.
The lungs, liver, etc., may become infected through metastatic deposits carried thence by the blood.
The chief forms of carcinoma are the schirrus, encephaloma, colloma, and melanoma.
The schirrus is characterized by its firm hard, dense feel, having a similarity in this respect, to normal cartilage. It is most frequent of all the forms and has been observed and recognized from the earliest times.
The encephaloma is a soft tumor, and is the most malignant of all tumors. It occurs at an earlier age than the other forms of cancer being almost the only one which is found before the age of puberty. To the touch the tumor presents a peculiar soft feel, giving way under pressure and returning to its shape again, as if filled with fluid. It varies in volume from the smallest kernel to a tumor of the size of an adult’s head.
The colloma is so called because it consists, in large part, of a clear viscid, gelatine-like substance.
The melanotic cancer is apparently an encephaloid cancer which has been changed in appearance by the deposition of a black pigment in the elements composing the growth. A noted peculiarity of melanosis of the integument is its pronounced tendency to form in or under a pigmentary mole.
The diagnosis of the different forms of carcinoma, when located in some external part, is usually a matter of no great difficulty.
