J. Veit' describes a polypoid excrescence, growing from the mucous membrane of the body of the uterus, which was expelled spontaneously after dilatation of the os. The growth was found to contain gland tubules, plugged up with epithelial elements.
According to Ruge-Veit (I. c.) cancer of the body of the uterus inva riably arises in the mucous membrane. They distinguish a diffuse in filtration from a polypoid form, the latter occurring in the shape of broadly-attached excrescences. Both varieties are characterized by their tendency to disintegration, so that we rarely encounter large growths. But the adjoining organs often suffer early from extension of the disease.
The papillary form of cancer, i.e., epithelioma, does not occur on the mucous membrane of the uterus.
It would be superfluous to repeat in this situation all the factors which enter into the causation of cancer in general, and which have been fully discussed in the chapter on Carcinoma of the Cervix. The disposition to carcinoma of the corpus uteri seems to develop at a more advanced age than is the case with carcinoma of the inferior segment of the uterus. In seventy-four cases, thirty-four of which are borrowed from Pichot, and the remainder from the sources mentioned at the head of this chapter, the distribution as to age was as follows: This table shows a marked predisposition to the disease between the ages of fifty and sixty years, while in cancer of the cervix the greatest number of cases occur between the fortieth and the fiftieth year.
Schroder' calls attention to the fact that cancer of the body of the uterus occurs with remarkable frequency in nulliparous women. Hof found six nulliparm in twenty-eight cases of this kind, i.e., 21 per cent., whereas of all other cases of cancer observed at the clinic of Schrtider, only 2.5 per cent. had not given birth to children. Ohiari's three patients, on the contrary, were confined within six months of the fatal termination, the disease making its appearance immediately after childbed and seeming to originate at the placental site.
The symptoms occasioned by malignant tumors of the body of the uterus resemble those of fibromata, especially in the incipient stages of the affection, and before purulent liquefaction basset in. Even after the development of the latter condition, they are often very similar to those of a sloughing myoma. This is particularly true of that form of carci
noma which occurs in the shape of knots and knobs. In all cases very intense, agonizing pain at an early stage is the most prominent symptom. Being caused by the rapid growth of the tumor it is much more violent and more constant than in cases of fibromata, where a sense of pressure predominates. When the tumors are spheroidal the pains often resemble labor pains, just as in cases of sub-mucous fibromata. In that variety of carcinoma which begins in the superficial layers of the mucous membrane, suffering is complained of only after the disease has penetrated to the deeper layers, and attacks the nerve ends in the uterine substance, just as when cancerous destruction of the cervix spreads upwards and into the substance of the organ.
At all events much more intense pain is felt, for above-mentioned reasons, in the early stages of carcinoma of the body of the uterus, than in the corresponding stage of ordinary epithelioma or carcinoma of the vaginal portion. But while the latter affections soon give rise to severe perimetritic and parametric symptoms by extension to the cellular tissue of the pelvis, this happens much more infrequently in cancer of the corpus uteri. Symptoms of pressure on the bladder and rectum are also very rarely observed, for the same reasons, and only de velop in exceptional instances when these viscera are in contact with large cancerous growths, or when they participate in the disease.
The second prominent symptom, hemorrhage, is even more constant, and thus again helps to simulate certain forms of myoma. While in cancer of the cervix, hemorrhages usually occur only after the tumor has begun to break down, in cancer of the corpus uteri they appear at first in the guise of profuse menstruation, and at a very early period, because the uterine mucous membrane is either actually diseased, or has, at least, undergone changes similar to those which take place in cases of intersti tial fibromata. Very soon, however, an abundant, watery, serous dis charge sets in, followed by profuse hemorrhages, as soon as the diseased tissues have commenced to ulcerate.