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Tumours of the Womb

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Three forms of tumour of the womb are of comparatively frequent occurrence, namely polypus, fibroid or fibrous tumour, and cancer. There is one broad distinction between the two former of these and the latter, and that is, that the two former are simple tumours, formed of overgrowth of some part of the sub stance of the womb, not destroying the sub stance and not necessarily dangerous to life ; while the latter is a growth foreign to the true substance of the part, invading and destroying it, and tending inevitably to death within a comparatively limited period.

The Polypus varies in size from that of a small pea upwards, and may be an overgrowth of the lining mucous membrane, or an over growth of the wall beneath the lining mem brane. It projects into the cavity of the womb, being connected to its walls by a longer or shorter stalk. By its presence a polypus causes a greater determination of blood than is proper to the womb, and thus gives rise to bleeding, especially to excessive loss at the monthly periods. It also excites contractions of the womb, and so occasions painful spasms and pains in the back and loins. It may block the opening of the womb, and by causing difficulty of escape of the monthly discharge cause the illness to be attended by severe pain.

The treatment is surgical, and consists in the removal of the polypus.

The Fibroid Tumour, Fibrous Tumour, or Fibromyoma, as it is also called, may occur in various situations, and may be of a great variety of size. It is a simple overgrowth of part of the wall of the womb. It may project into the cavity of the womb like a polypus, or it may project in the direction of the outer wall towards the cavity of the belly, or it may remain embedded in the substance of the wall, difficult to distinguish from simple enlarge ment of the womb. In size such tumours vary from that of a pea to that of a human head. They are extremely common, but may exist without giving any indication of their presence. They rarely appear before the period when the monthly illness begins. Their growth is en couraged by the regularly recurring increase in blood supply to the womb by the monthly illness, and also by the stimulus of sexual ex citement. Marriage will thus tend to stimu

late the growth of one already present, while the presence of one may be a cause of sterility : the fact of sterility will also encourage the growth. As a rule they cease to grow when the child-bearing period has passed, and thus if this age is reached a woman troubled with such a tumour may look for a gradual relief from its symptoms.

The symptoms are of two kinds:. (1) those due to the mere pressure of the growth on sur rounding parts, the chief of which is pain ; and (2) those due to the increased blood supply to the womb which the tumour occasions, of which the chief is excessive loss of blood during the monthly illness, or a more or less continuous loss of blood.

The pain may be of a spasmodic character due to the tumour stimulating contractions of the womb, or it may be of a neuralgic form due to pressure on nerves, or it may be a dragging pain in the back and loins, a constant wearied feeling, easily increased by walking, and also by carriage exercise when the tumour is of any size. Other pressure symptoms may exist, such as confirmed constipation from pressure on the bowel, frequent desire to make water, or inability to make water, or pain in making it, swelling of the legs, &c., and such symptoms are all liable to be aggravated at the monthly period owing to the increased size of the womb at that period. Then the monthly illness may be attended with great pain owing to the tumour blocking the escape of the discharge, and the presence of the tumour also occasions not unfrequently great pain during sexual in tercourse.

Excessive flow of blood may not be marked in cases where the tumour is embedded in the walls of the womb or bulging towards the cavity of the belly, but is likely to be the main symp tom when it bulges towards the cavity of the womb itself. Usually it is a prominent symp tom, and, as has been said, the loss of blood may not be limited to the period of the monthly illness, but may go on almost without ceasing.

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