CYLINDRICAL-CELL carcinoma starts as a small nodule in the mucous membrane that may spread superficially, producing extensive ulceration. It extends quite early into the uterus, but does not cross to the pavement-epithelium of the vag inal portion until late.
In other cases the cervical walls are infiltrated before the ulceration becomes extensive, and the cervix is enlarged and hardened, and exhibits the ordinary his tological characteristics of carcinoma. Later the process of necrosis excavates the cervix until nothing but a shell is left.
In all forms ulceration follows sooner or later; the extension and excavation may in time reach the bladder, rectum, or ureters, and finally open these organs, and may convert the pelvic interior into a large ulcerating cavity. Obstruction of the ureters is sometimes caused by the infiltration.
Symptoms and Diagnosis.—Occasional slight hemorrhages, becoming more fre quent and later more abundant and of fensive, constitute one of the first symp toms. A gray watery discharge, resem bling dish-water and becoming more and more foul-smelling from the admixture of necrotic tissue, is observed between times. lain is usually a late symptom, and is a result of extension to the sur rounding tissues. A severe pain extend ing into the iliac region or hip is more often the earliest pain. Later pains due to the surrounding cystitis, rectitis, or peritonitis may become prominent.
Anaemia, general debility, faulty di gestion, septicaemia, and ummia develop as the result of the local inflammation and sepsis.
Squamous-cell carcinomas give to the examining finger the notion of an in duration or tumor of the cervix; in early eases a mere projection of one lip, later a large mushroom-shaped growth. The surface, at first smooth and hard, soon becomes fissured and friable, and bleeds freely whenever firm pressure is made upon it. The os is seldom in the centre, as is the case when a similar mushroom shape is produced by laceration and ever sion, for the changes commence on one part of the circumference, and affect that part first and to the greatest degree.
The surface, before ulceration, has a purplish color, with grayish patches cor responding to the accumulations of epi thelial cells. The ulcerated surface is irregularly fissured, and has a vascular border. It presents a mottled appear ance, produced by yellowish-gray necrotic areas surrounded by vascular spots in • which small blood-vessels may be seen. A cheesy substance can be pressed out. All manipulations produce a persistent, bloody oozing. If the odor is not per ceptible upon introducing the speculum, it will be detected when the discharges are seen, or by smelling of the examining finger.
Cylindrical-cell carcinoma without in filtration does not alter the shape or ap pearance of the cervix until far advanced, unless there is eversion. An introduc tion of the sound or dilator will usually bring out a thin, foul-smelling discharge or some granular matter and blood. If there is eversion an irregular-fissured, ex cavated, yellowish-red ulcer, with abrupt vascular edges, will be seen. The sur face is hard, but bleeds easily.
When the cervix is infiltrated the cervix feels hard and inelastic and globu larly enlarged, the largest portion being above the vaginal junction. The vaginal portion may be normal in color, hut a tenaculum hooked into it will tear out easily and cause free bleeding, while in a hyperplastic cervix, or one enlarged by a myoma, the tenaculum will hold firmly. Just before ulceration the cervix may present a yellowish-pink, granulated, glistening surface that in connection with the above is quite characteristic. The tenaculum readily tears out of a cervix that has undergone cystic eration, but the laceration-tissue does not bleed profusely, like carcinoma.
If the surrounding parts are infiltrated, glands will be felt beside or behind the cervix, or indurated tissue extending from the cervix under the broad or sacro uterine ligaments, often reaching to the walls of the pelvis and immobilizing the uterus. When the ulceration reaches the vaginal junction, the parametrium is always infected.