Cancer of the Breast.—The breast is one of the most frequent sites of cancer in women. The most common time of life is about the "change of life." Any of the three varieties named above may occur. ' The variety called Epithelioma very often shows itself first as a hack, crack, or fissure about the nipple, which fails to heal, and from which a thin discharge leaks, forming a crust. The crack tends to form an ulcer. Now there is almost nothing about this hack or fissure to mark its malignani; character, except its refusal to heal; but if a little bit of it be cut out and examined under the microscope its essentially cancerous nature will he revealed. In any case of doubt, therefore, this test should he applied. No woman should ever wait till the true nature of the fissure is shown by other symptoms, such as enlargement of glands in the armpit, for then the chances of success of an operation are dimin ished. If, before other symptoms appear, a microscopic test indicates a malignant growth, removal of the whole breast should be immediately performed.
Cancer may also begin in the breast as a lump or swelling within the substance of the breast. Hard cancer (scirrhus) and soft cancer (medullary cancer) both begin in this way. It is often purely accidentally that a woman dis covers that such a swelling exists. She should not delay a moment in such circumstances to get capable advice. Sometimes it is the occur rence of sharp stabbing pain that causes s woman to feel the breast, and thus to discover that there is a lump in it.
Now in the case of scirrlina this lump is of stony hardness. If manipulated it is found to be of gloliular outline, and to be firmly con nected with the rest of the breast. It cannot, that is to say, be moved apart from the structure of the breast. Its edge is not well-defined, but it thins off there into the substance of the breast. As it grows, its grip, so to speak, causes the nipple to be drawn in or retracted. This is
a most significant sign, and fine offshoots, be coming connected with the deep layer of the skin, hinder the skin moving freely under the finger. As it grows, the disease spreads to the lymphatic glands of the breast, side of the chest, and armpit, which can be felt as hard nodules under the akin in these situations. Pain is frequent—sharp, stabbing pain,—though it may be entirely absent.
Soft cancer similar characters, except that of stony hardness. A further sign, sometimes present, is a thin discharge from the nipple, mixed or tinged with blood.
In the course of its growth the tumour ap proaches the surface, and more and more tends to involve the skin, which becomes purplish in colour, and finally breaks down into a ragged ulcer from which an offensive discharge leaks. If the growth be not removed, it rapidly in creases on the surface as well as in the sub stance of the breast, forming a raw, foul, funga ting mass, and the patient dies of exhaustion or of the implication of some vital organ.
The growth ought never to be permitted to reach such a stage. At the earliest possible moment the whole breast and all the infected glands up in the armpit should be swept away in the most thorough manner.
But every tumour in the breast is not malig nant, and there is quite a variety of growths, cysts, fatty and fibrous and glandular tumours, of an entirely innocent kind.
The important point, therefore, is to deter mine as early as possible whether a growth is innocent or malignant. Frequently the only way to do this is for a surgeon to cut down upon it to see it, or to remove a piece and to examine it microscopically. This is a course to which no woman should refuse her consent. because if she waits till the true character is apparent, her best chance of recovery has gone past.