DEVELOPMENT AND TREATMENT OF CERTAIN TUMORS. Carcinoma, or scirrhons c•anc•er, is the form most frequently seen in the breast, where it is invariably primary. It follows a blow or other injury, in many cases; often no cause can he assigned. It most commonly commences as a small. circumscribed tumor, round. hard, slowly growing. and with little o• no pain. As it in creases in size it becomes irregular. granular, and adherent to the adjacent parts. Infiltration of the surrounding structures follows, the pectoral muscles may become involved, and the skin may become attached. The skin also becomes stretched and sliming, stiff and brawny. CEdema of the arm follows, with enlargement of the axillary glands. The pain now beeomos intense and fair ly constant, extending not only to the shoulder. but down the arm to the hand. The nipple, as in some non-malignant tumors, becomes retracted and deeply attached. As the process goes on the cellular tissue, intercostal muscles, and ribs may become attacked, the pleura may be in vaded, and hydrothorax as well as visceral de posits may follow.
The duration of life after the occurrence of seirrlins of the breast is about three years. In old people the progress is slow, and in a few recorded cases life was prolonged for ten years. Most cases occur between the ages of thirty and forty-five years. The treatment consists of removal of the growth as early as found. In most cases the whole breast should he removed. and the axilla he laid open, that all enlarged lymphatic glands may be excised. Caustics are rarely successful. Quacks are prone to diagnose simple fibromata as cancers, and then cure them with caustics. The use of light has proved of increasing efficacy in the removal of malignant growths, and it is confidently expected that Fin sen's light or the X-ray will become a substitute for the knife. See l'IIOTOTIIERARY; X-IfAv.
Epithelionia, or 'epithelial cancer,' is often diagnosed from other tumors with much diffi culty. The following points are of assistance: (1) It occurs almost invariably on muco-cutane ous surfaces. (2) it ulcerates very early. (3i Ul ceration follows upon the new growth so rapidly that it seems to spread by ulceration. (4) It arises after local irritation. (5) There is no metastasis to intm•nal organs in the vast ma jority of cases of epithelioma. It is common in middle-aged or elderly people. Epithelioma of the lip, an ordinary form, follows smoking (and hence is called 'smokers' cancer'). or irri tation from a broken tooth, intermittent pressure of some article held in the mouth. as a painter's dust-brush, etc. It commences generally as a small wart or flat tubercle with hard edges and a suppurating surface. Ulceration spreads, the edges of the ulcer being hard and thickened. .1t scabs over and the scab scales MT again. Glands in the neck become enlarged, and the muscles of the face become involved. Earl• excision of a lib eral V-shaped section of the lip, the larger part being removed from the vermilion border, and the cut edges. being stitched together afterward, is the proper treatment. Frequently from three to seven years pass before recurrence in the scar follows, or recurrence may never take place. ln some instances the ligature, or the 6craseur, or caustic is preferable. The X-ray or Finsen's light may also succeed.
Consult: Delafield and Prudden, Handbook of Pat/m/ogicai Anatomy and Histology (New York, 1901) ; Virchow, Die krankhaften Geschwiilste (Berlin, 1900) ; Park, Surgery by American Au thors (Philadelphia, 1901).