GROWTHS, are said to occur in the rectum, but they must be extremely rare.
ANGIOMA.—These mevoid tumors are likewise of rare occurrence in the rectum, and when they exist may occasion con siderable hwmorrhage.
CYSTOMA.—Various cystic tumors may occur about or within the rectum, but dermoid cyst is the most authenticated variety found in this locality.
Symptoms. — There are no marked symptoms to be defined as peculiar to benign growths. A sensation of weight in the rectum may be experienced; shoot ing pains, distress in the loins or back, more or less tenesmus, and diarrhoea, with more or less discharge of mucus and of blood, are often noted. The character and intensity of the symptoms are in fluenced by the size and position of the growth. If situated high in the rectum,. but little, if any, inconvenience may be experienced. When, however, it is at tached low in the bowel, the local dis comfort is complained of.
The differential diagnosis of the vari eties of rectal tumors has already been sufficiently dwelt upon. Piles are not pedunculated, and a prolapse should oc casion no difficulty in diagnosis. In cases of polypoid growth an enema should be administered and the entire rectum examined by first passing the examining finger as high as possible into it, then sweeping the palmar surface around the mucous membrane from above down ward. In this manner the polypus may be caught between the finger and the rectal wall if present. Otherwise the growth would escape detection by being pushed ahead of the examiner's finger.
Tumors of the rectum, especially when situated some distance up, may occasion intussusception and even prolapse of the bowel. Partial and even complete ob struction of the gut may likewise be caused. Ulceration and extensive bleed ing may also be produced.
Treatment.—The treatment of these tumors is essentially surgical. Prompt removal is the only safe advice to give, the actual cautery or the ligature being employed. Anesthesia may be required in some forms of this trouble before op erative interference may be carried out. Small polypi may, with comparative safety, be twisted off with a pair of h ostati c forceps.
Malignant Growths of the Rectum.
The rectum is one of the favorite sites for malignant growths. In this region, as elsewhere, cancer is viewed as an in curable affection, and is asserted to run its course in about two years. It usually occurs after middle life, though cases are recorded in which it attacked the very young, and, though believed to be more frequent among females, Messrs. Ailing ham state that in their experience many more men are victims to this disease, to which statement the limited number of cases seen by me would lend emphasis.
Varieties.—The forms of malignant disease met with in this locality are: (a) epithelioma, (b) scirrhus, (c) various forms of sarcoma, ((l) encephaloid, (e) colloid, and (f) melanotic. In those
tumors in which much fibrous tissue is mixed with the newly formed glandu lar structures, the growth is hard and resistant; when the neoplastic tubules are in excess, and the fibrous tissue delicate and scanty, the tumor is soft and fungous, and corresponds with the description of medullary cancer. A gelatinous condition due to mucoid or colloid change affecting the cells has given rise to the term "colloid" as ap plied to such growths.
The three terms scirrhus, medullary, and colloid, signify varying conditions of a growth or parts of a growth com posed essentially of glandular tubules and epithelial cells.
Cooper and Edwards (op. cit., pp. 190 93) subdivide the adenocarcinoma into three forms, which may be severally dis tinguished as (a) the laminar, (b) the tuberous, and (c) the annular. Their description of these varieties is as fol lows:— "In the laminar form, which is the most common, a portion of the intestinal wall is infiltrated or thickened, the af fected area varying in size according to the stage of the disease. The thickening appears to exist between the muscular and mucous coats, and it tends to spread laterally rather than either upward or downward. Its centre is slightly raised, while the edges are beveled off. The growth is connected with and binds to gether all the tissues of the bowel, but at first is freely movable as a whole. After awhile the surface of the neoplasm gives way, leaving a ragged ulcer with characteristically infiltrated borders. The destruction generally begins near the centre and extends toward the circumfer ence; but sometimes ulcers form at sev eral points on the surface. As the process advances, the infiltration is gradually eaten away; its remains may be recog nized as nodules or papillary excrescences rising from the base or border of the ulcer. In later stages the base may he smooth, hard, and clean, being formed by cicatricial tissue and the remains of the muscular coat, while the edges are hard and raised, and either tolerably uni form or beset with nodular or papillary growths. Much connective tissue is de veloped beneath the base of the ulcer, and becomes constricted and puckered, as these changes are in progress. The course of the groWth is sometimes dif ferent, inasmuch as the deposit is only partially destroyed by the ulceration, and its remains sprout up and form tu mors projecting into the cavity of the bowel. The ulceration sometimes has another result, viz.: destruction of the coats of the bowel and perforation of adjoining viscera.