CANCEROUS ULCER. — The ulcer at tending cancer, besides the features al ready noted, is ragged and everted, progresses irregularly in various direc tions, and presents an angry-looking ap pearance. It soon becomes fungous and granular, is covered with an ichorous, foetid liquid, and bleeds upon the least contact: a condition witnessed in no other variety of ulcer. Again, the neighboring glands soon become en larged: the only condition in which this occurs in lupus, which seldom if ever attacks the tongue primarily. The age of the patient, beyond forty years, at which cancer occurs is seldom, if ever, that after which lupus is observed.
Tumors of the Tongue.
The relative frequency of tumors of the tongue was well illustrated by statis tics based upon 13,824 neoplasms treated in two London hospitals during a pro longed period. An analysis of these cases by Roger Williams showed that out of this number 880, or 6.3 per cent., originated in the tongue. As regards the varieties observed in this organ, 804 out of the total number were epitheli ontata (91.3 per cent.), while the remain ing forms consisted of sarcomata, papil lomata, cystomata, fibromata, adenomata, angiomata, and one rnyxoma.
Cancer of the Tongue.
As just stated, the variety invariably met with in the tongue is epithelioma.
Symptoms. — The symptoms depend upon the location of the initial lesion. When it begins far back in the month, the submaxillary or posterior sublingual regions become sensitive, and darting pains reaching the ear are complained of. If the region be palpated, lobular, movable, hard swellings may perhaps be felt: glands which are infiltrated. Deg lutition soon becomes somewhat im paired, and the tongue is moved with difficulty during articulation. The sub maxillary glands have, by this time, probably become fixed and enlarged in size and the disease progresses rapidly. Profuse ptyalism is soon followed by the expectoration of foul pus, often tinged with blood, all evidences that the stage of ulceration has begun. This involves the danger of death from haemorrhage, owing to the proximity of the growth to large vessels.
When the growth starts anteriorly, the process may be followed with more pre cision. A small slit or crease, a minute hypertrophied papilla, or a small warty projection may prove to be the primary focus. The crown of this soon becomes ulcerated and covered with thin scabs, which the patient removes as fast as formed, leaving a bleeding surface. Then gradually develops the typical epi theliomatous ulcer with ragged edges, and a hard, broad, infiltrated base and fungous outgrowths filled with foetid pus, which gives the breath a repulsive odor. As the neoplasm spreads, the suf fering of the patient gradually becomes more acute, the tongue is immovable, the submaxillary markedly enlarged, and he gradually sinks as a result of starva tion and exhaustion, if 112morrhage does not bring on sudden death. When the growth begins anteriorly, the lymphatics are not involved as early, and the chances for a successful operation are conse quently greater.
[The lymphatics from the anterior por tion of the tongue, from the lips, and adjoining parts of the mouth pass to the lymph-glands under the lower jaw, in contact with the submaxillary; thence the current traverses the superficial cer vical lying beside the sterna-mastoid; from these, to the deep cervical in con tact with the large blood-vessels. Hence, in epithelioma primarily attacking the parts here indicated, we always find these three sets of lymph-glands enlarge successively.
On the other hand, the lymph-eurrent from the root of the tongue and from the pharynx passes mainly to the deep cervical glands; a portion from the sur face tissue also to the superficial cervi cal. Epithelioma, commencing here, ac cordingly implicates secondarily these two sets, sometimes only the deep. The submaxillary lymph-glands now always escape infection,—that is, until a very late stage,—and those at the edge of the sterno-mastoid may do so. RUDOLPH MATAS, Assoc. Ed., Annual, '93.] Etiology.—Cancer of the tongue is comparatively rare among women, being about 16 per cent. of reported cases.