The irregular nodulated projections oc casioned by the unequal development of the cancer structure rapidly increase in the en cephaloid variety, and the cervix becomes much enlarged. The surface of the more projecting portions becomes florid and vas cular, and these portions pass first into ul ceration by thinning and absorption of their mucous covering. The creamy or cheese like contents of these tuberculated portions then escape, and being sometimes of a yel low colour may be ntistaken for tuberculous matter.
This stage is followed by the formation of one or more corresponding ulcers upon the outer cervix, which coalescing destroy the remaining portions of the mucous membrane, and spreading up the cervical canal, convert it into an irregular funnel-shaped cavity, bounded below by hard rugged margins. Or fungous vascular growths, friable and easily bleeding, sprout from the part and entirely destroy its natural configuration. A yellow or greenish-brown sanious discharge, of a highly fetid odour, mixed occasionally with florid blood and ultimately with fragments. of putrid tissue, dates from the commencement of ulceration, and increases in proportion to the extent of surface denuded. The frag ments of putrefied tissue which hang from the ulcerated surfaces, and occasionally pass away in the discharges, consist mainly of connec tive tissue fibres, which are more slowly dis integrated, stained of a dirty brown colour by infiltration with decomposed blood.
By these disintegrating processes both lips, and finally the cervix itself, are destroyed and removed ; the cancer structures being con tinually deposited in advance of the ulcera tion, while the fundus and even the body of the uterus may still remain sound. In like manner cancerous deposits take place in the fibrous tissue surrounding the uterine neck, and attaching it to adjacent parts. Thus the uterus becomes fixed in the pelvis, and at the same time a way is paved for the further ex tension of destructive ulceration, by which first the bladder and then the rectum are penetrated, and the disease further extending down the vagina, the whole is laid open into one ulcerous cloaca (fig,. 479.). If life is maintained beyond this point the pelvis be comes lined with cancerous matter, and, the peritoneum inflaming, all the adjacent parts become agglutinated together, until finally the ulceration may extend into and lay open the peritoneal cavity itself.
The penetration of the bladder earlier than the rectum, which almost uniformly obtains, is explained by the different modes of connexion of the cervix with these two parts. Since nothing but fibrous tissue intervenes between the bladder and the anterior cervical wall (flg.426. b b and 433 F), the cancer elements are readily deposited, and extended in this direction, while the posterior wall being se parated from the rectum by a double fold of peritoneum (fig. 426. 433. G), the cancer mat ter does not so easily penetrate through this, not at least until adhesions have formed.* But cancer may commence in the fundus or body, instead of in the cervix, although this is rare ; or it may, extend to the uterus from the ovary. In this way extensive dis
organisation of' the adjacent parts may occur, the cervix remaining intact.t Cancer, when thus developed, especially in the encephaloid variety, assumes often the form of distinct masses or tumours, rather than of an infiltration of the tissues.
These tumours tnay be imbedded in the uterine walls, or form numerous irregular rounded and sometimes pedunculated masses, variously attached to, or projecting from their surface. On the other hand such a distinct mass formed in the substance of the uterine walls, or beneath the mucous membrane, may in the course of growth push the latter before it, and, subsequently acquiring a stem, may fill the uterine cavity or protrude into the vagina, and constitute a malignant polypus.
In most cases of uterine cancer the uterus is the primary, and except in those instances where the disease has spread by direct ex tension to adjacent parts, it may remain throughout the sole organ attacked. Or uterine cancer may be associated with like formations in the stomach, mamma, ovary, Scc., and be developed concurrently with or consecutively to these.
Cancmid. Epithelial cancer. Cauliflower excrescence.—Cancroid of the uterus is li mited in its commencement to the vaginal portion of the cervix, and presents the follow ing principal varieties. It may appear under the form of papillary growths, resembling con dylomata, which spring from the mucous sur face, and form little compact masses that gradually, by the growth and elongation of the papillw, become soft, pulpy, and brittle, and easily bleed on being touched. After a time a basis of cancroid is developed in the cervical tissues, or the papillary growth appears upon a larger scale, forming a hard, knotty, and brittle mass, which grows with tolerable ra pidity, and ultimately more or less fills the vagina or protrudes from the vulva. In form the growth often resembles a cauliflower, to which it was likened by Dr. John Clarke. The surface is of a bright flesh colour, and is covered with small projections or granules. These again are united into larger masses or lobes, set upon short and broad stems, that ultimately, coalesce into a common basis formed by one or both lips of the cervix. The whole tumour has a certain firmness and solidity ; but the superficial granules are so brittle that slight handling causes some to break away, a free hremorrhage resulting. Or the cancroid, after being developed in and beneath the mucous membrane of the cervix in the form of little granular masses, gradually breaks through the surface ; while in the course of time ulcerations form upon the most prominent portions, and these coalescing, while increased deposits of cancroid take place in the sublying tissues, which in turn are also destroyed, a sore, more or less ex tensive, is formed that in its further aspect and progress very nearly resembles encepha loid cancer.