The schirrus is generally found in the breast. It is a solitary tumor and rarely appears before the forty-fifth year of age. In feel it is firm hard, dense, resembling cartilage. It grows slowly and never attains large size. From its start it is accompanied by sharp, shooting lancinating pains, which are distinctly localized. It early contracts adhesions to the integument and deeper tissues. If in the breast, the nipple is retracted. The superficial veins are but slightly enlarged. Ulceration occurs early and the ulcers has an abrupt steep edge, and a firm hard base. The lymphatics are invaded at, or soon, the beginning of ulceration. The diagnostic symptoms of schirrus are clear-cut and cannot be mistaken.
The encephaloma may occur at any age and in almost any portion of the body. It is soft lobulated, usually solitary. It grows rapidly, and often acquires a very large size pain is absent or slight until the advent of ulceration, when it becomes severe but does not assume the lancinating character of the enlarged. Ulceration is early and the ulcer is foul, with thin edges, and is often covered with a fungous, friable mass. The lymphatics. are early involved.
The colloid cancer is rare and its characteristics are not pronounced. It is tardy in its growth, of uniform consistency, free from pain, and often attains an immense bulk,. It is usually found in the peritoneal cavity; when superficial, it may be confounded with superficial it may be confounded with a fibrous or cartilaginous tumor or sarcoma. It is distinguished from fibroma by its more rapid growth, its large size and its constitutional tendency; from chondroma by its elasticity and less firm feel as well as by its more rapid progress; from sarcoma by its more rapid progress; from sarcoma by its more uniform growth and comparatively slow progress.
The melanotic cancer can only be distinguished by the peculiarity of its color and its frequent origin from pigmentary moles. From the facts given in the diagnosis this may be deduced; a tumor appearing late in life, which grows rapidly is attended with pain infiltration of the surrounding tissues, and adhesions to the integument and tissues beneath shows a marked tendency to ulceration and to infection of the lymphatic glands, and decay of the vital forces is a cancer or malignant tumor.
The prognosis in carcinoma is exceedingly unfavorable, the natural progress in every case being towards the destruction of life. The prognosis, as to course and duration of the disease, varies much in the different forms and in the different parts of the system affected. Scirrhous cancer is one of the most regular in its course its average duration when uninterrupted by operation, being about three years.
The encephaloma is more rapid in its course the average duration of life being less than two years even in parts whose formations are not essential to life. Carcinoma of the tongue, the interior of the mouth, the oesophagus, and the penis are very rapid in progress, being usually fatal in from twelve to eighteen months. Carcinoma of the lip, the face, and the rectum are slower and more amenable to treatment.
Treatment.-The treatment of cancer has always been extremely unsatisfactory. Various remedies have from time to time been heralded as cures, but after thorough trial have in every instance been discarded. Among these are: Chian turpentine; Resorcin; Inter-parenchymatous injections of ozone-water; Chromic acid; Cundurango bark, etc. Galvanism has been highly recommended, as has also the inoculation of the cancer with erysipelas.
Occasionally, cures of cancer by the administration of homoeopathic remedies have been recorded, but the cases are so few, and the possibilities of error in diagnosis so many, that the value of these remedies in the treatment of this disease cannot but be called into question. There are many tumors, the result of acute or chronic inflammatory action, which resemble very closely some of the forms of cancer. Many of these are amenable to the properly selected remedy, and it is cases of this character that have been cured by the remedy recorded. That no remedy has been discovered which is absolutely specific to the disease there can be no reason to doubt, but that remedies are of no value in the treatment of the disease cannot be so positively asserted. Whatever doubts may arise as to the value of remedies in overcoming the disease when once aroused, there can be none as to service rendered by remedies in retarding the development of the disease and in relieving many of the accompanying symptoms. At the close of this article will be found the remedies employed in the treatment of cancer.
While remedies are of value in relieving many of the attendant symptoms of cancer, and are often curative in ulcerations and indurations resembling cancer, at the present day surgery offers the only possibility of a radical cure. In certain forms of cancer in which involvement of the lymphatics does not occur until late in the progress of the disease, the possibility of cure following an operation is always greater than in those in which lymphatic involvement is early noticed.
Epitheliomas of the lower lip are quite amenable to treatment, the thorough removal of the tumor before the submaxillary gland becomes involved being, in many instances, followed by cure. Even in the more rapid and malignant scirrhous and encephaloid tumor, thorough removal gives a percentage of cures sufficiently large to encourage the belief that early and radical measures will succeed in materially reducing the mortality of the disease.
The removal of the disease, if it does not succeed in effecting a cure, is still a great benefit to the patient. A careful study of the statistics shows that the average duration of life is increased twelve months in cases operated upon over those in which the disease proceeds unmolested by surgical measures. The increase in life in some cases is several years. Even if this hope cannot be entertained, an operation is often justifiable on the ground that it will avert the suffering attendant upon the regular progress of the disease. The relief which follows an operation is sometimes remarkable. Freed of the local pain and offensive discharge, the patient will become cheerful, sleep, eat, and even gain in flesh.
In those cases in which an operation is not advisable, much relief from pain and offensive odor may be obtained by the use of certain applications. The best of these is hydrochlorate of Cocaine. Painting the ulcerated surface with a two-to-four per cent. solution affords instant relief. When the discharge is profuse and offensive, the ulcer should be washed frequently with a strong solution of carbolic acid. Hyposulphite of soda may be used when other disinfectants fail. The surface of the ulcer is washed with a saturated solution added to an equal quantity of water, and lint steeped in the solution is laid upon it. The distressing night-sweats of the later stages of the disease may be controlled or improved by the use of aromatic sulphuric acid or aromatic vinegar. At this time also the use of morphine to allay pain and to secure sleep is permissible. It is best given by hypodermic injection.
Therapeutical indications:
Acetic acid.-Cancer of stomach, ulcerative gnawing pain at one spot in stomach with agony and depression, preventing sleep; severe burning pain in stomach and abdomen, vomiting of yellow, yeastlike matter, of blood; eyes sunken and surrounded by a dark circle; face pale and waxen; tongue pale and flabby.
Apis mel.-Is indicated in cancer of the breast, in which the induration has followed an old case of mastitis, and in which the pain is of a burning, stinging character. The characteristic urinary symptoms of the drug are the best indications for its use.
Arsen.alb.-Foul, destructive, easily bleeding, and cancerous ulcers, with burning and corrosive pains in the interior of the affected parts; terrible darting and lancinating pains through them; burning discharge, which may be thick or thin, brown or black, extremely offensive; worse after midnight.
Aurum.-The womb is prolapsed and indurated; pain like that of a bruise, with shooting and drawing, and the mind constantly dwells on suicide. Cancer of the palate and nasal bones, or of the nose; pus greenish, ichorous, and putrid; cancer of stomach in last stage, when there are only few subjective symptoms.
Bellad.-Scirrhous indurations; cancerous ulcers burning when touched; black crust of blood in the bottom of the ulcer; pus scanty. Pains come and go suddenly.
Carbo animalis-Cachexia fully developed. Scirrhous cancer on the forehead; sudden and short aching from colloid cancer in the pit of the stomach, on taking a deep inspiration, clawing and griping in stomach, violent pressing in loins, small of back and thighs during menses, with chilliness and yawning; weak empty feeling in the pit of the stomach; it checks the putrid taste, the waterbrash, and contracting, spasmodic burning; scirrhous mammae with dirty bluish loose, skin or red spots on skin, burning, and drawing towards axilla; axillary glands indurated.
