New growths in the intestinal tract are much more common in the large than in the small division. Of the large intes tine the rectum is most frequently at tacked; then in the order of frequency the sigmoid flexure, the cmcum, and the remainder of the colon. Of the small in testine the ileum seems to suffer most commonly, the duodenum next in fre quency, and the jejunum least. The growth is usually primary; less com monly it arises by extension from con tiguous disease. Metastasis to other or gans is frequent, and rather the more so from the small than from the large bowel. The involvement of adjacent structures and organs also is common.
The most usual variety of neoplasm is carcinoma and especially of the cylin der-cell type; epitheliomata are less com mon. Sarcomata are rare. The disease occurs a little more commonly in males than in females and rather earlier in life than malignant disease elsewhere, a larger number of cases occurring before the age of 30 than when the disease is situated in other parts of the body. The duration of malignant disease of the bowel averages from six to twenty-four months.
Symptoms.—Among the most con spicuous symptoms of malignant disease of the intestine are anaemia, cachexia, wasting, pain, indications of intestinal obstruction, fever, and the presence usually of a tumor yielding dullness on percussion. When ulceration occurs the stools will contain blood, pus, and per haps fragments of the new growth. The associating symptoms will necessarily vary somewhat with the situation of the growth.
Methods to be followed in examining intra-abdominal tumors:— Tumors through which gases may be detected by gurgling indicate either an involvement of the bowel in the tumor or pressure of the growth on the bowel, with adhesions to the same. If this symptom is coupled with a history of a pyloric cancer or a meal growth, it is confirmatory in its indications. Some growths have a disposition to change position, but all growths have one or more attachments, and it is safe to infer that this attachment is to the site at which the neoplasm had its beginning, its movements being only around an are of a circle. Adhesions may prevent a growth from moving, or anchor a tumor in a locality far from its original point of starting, and here the history of the inflammatory attacks and pain aid in the diagnosis. The character of the pain and the amount and area of tenderness are of great assistance. The withdrawal of free fluid from the peritoneum often shows the presence of a tumor before undetected. A. H. Cordier (N. Y. Med. Jour., Oct. 26, '95).
Carcinoma of the duodenum is rare.
Among the records of about 18,000 autopsies at Guy's there are reports of 10 cases of primary malignant growth of the duodenum: 4 carcinomata and (1 sarcomata. Together with collected
cases, a total of 22 primary malignant growths are described: 13 carcinomata and 9 sarcomata. Secondary deposits of malignant growths are very rarely observed in the duodenum. Perry and Shaw (Guy's Hosp. Reports, vol. 1, p. 171).
The symptoms of carcinoma of the ciecum have their importance because, by reason of the small number of cases that have been aiagnosticated as such during life and have been reported, little attention has been given them in the classical works on general or special surgery. The commencement of the dis ease is usually remarkable by its latency, but always comes to an end as soon as the growth has developed suffi ciently to be made out by palpation, and at this time the period of full develop went has been reached. The symptoms which first draw the physician's atten tion to the cmcum do not always follow in the same order, but in the order of frequency of their apparition they may be classed as follows: (1) pain; (2) alternating diarrhoea and constipation; (3) loss of flesh; (4) dyspeptic disturb ances; (5) intestinal hmmorrhage. Oc casionally the functional symptoms are absent, and only those are met with which occur when it has arrived at its full development, and tuns one finds re ported eases in which the tumor in the right iliac region was detected before it had given rise to any other symptom, while in one case the affection made its presence first known by the formation of a fecal fistula.
The physical symptoms are observed when the carcinoma of the cmcum has attained its full development, and they characterize the disease. By far the most important is the appearance of a tumor in the right iliac fossa. In the early stages it is movable under the ab dominal wall and also over the deeper structures. The neoplasm, which in the beginning is limited to the intestine, will finally invade the pericmcal cellular tis sue and throw out narrow adhesions be tween the diseased structures and the iliac fossa, or the neoplasm may become adherent to the abdominal wall. Later on the lymphatic glands become in volved, and their number and size vary very greatly in different cases. After the lymphatics have become greatly in volved a large tumor may be felt which may project at a point quite distant from the primary neoplasm, as, for ex ample, at the umbilicus or in the epi gastric region. The tumor will now be found to be very adherent, and it may happen that from its size it compresses the iliac vessels so that an oedema of the right lower limb will arise. C. G. Cum ston (Med. News, Feb. 16, 1901).