Vickipedia

CA’NCER, a disease characterized by slow alterations of structure, or tumors in various parts of the body, occurring either simultaneously or in a certain order of succession. In many cases, an isolated tumor in an external part is the earliest symptom; it is then viewed as the starting-point of the disease, and is termed a malignant tumor (tumor mali moris), from its presumed tendency to infect the system, and to cause the reproduction of growths similar to itself. It is right, however, to remark, that upon the pathology of C. authorities are by no means agreed, some holding that a constitutional taint or diathesis must always precede any local development of C., and that the first growth in point of time (or primary C.) is therefore only the first of a series determined by a pre-existing cause in the blood or general system; while others hold that C. is originally a truly local disease, or even that a growth at first simple (non -malignant or benign), may, in consequence of local causes, degenerate—i.e., become cancerous, and infect the whole system with the morbid tendency thus secondarily acquired. The discussion of this disputed question involves statements of a too complicated kind to be in place here; but it is a question of considerable importance, as bearing on the probability or improbability of curing the disease by extirpating the primary tumor at an early stage of its development. All authorities are agreed that, when any trace of secondary C. exists, the removal of the parts affected gives scarcely any hope of a favorable result, and, accordingly, operations under these circumstances, unless merely for the relief of local suffering, are discountenanced by all respectable surgeons.

The disease, however, is one of which the ignorant as well as the learned have a well-founded dread, and hence it presents a large field for the practice of imposture, and for that less deliberate, but often not less hurtful kind of quackery which is the result of pure ignorance, grafted on a meddlesome desire to do good. We propose to give such a sketch of the characters and progress of cancerous disease as may serve, in some degree, as a protection against ignorance on the one hand, and deception on the other. The leading character of C. being a tumor or morbid growth in apart, it is important, in the first place, to observe that not all, nor even the majority, of morbid growths are cancerous. A very large proportion of growths, involving swelling or change of structure in a part, are either determined by a previous process of inflammation—leading to chronic abscess and induration—or belong to what is called the non-malignant order of tumors—e.g., cysts, fatty and fibrous tumors, simple hypertrophy of glandular structures, cartilaginous, bony, calcareous, and vascular growths. See tumors. Further, among the tumors admitted by general consent into the order of cancerous, there are widely different degrees of malignancy or cancerousness, so to speak; some having the tendency to spread rapidly, and infect the system at an early period, while others remain local for a considerable time and may be removed while yet local, with good hope of a permanent recovery.

Now, the practical distinction, or diagnosis, to use the technical phrase, of these different tumors, is founded upon a very careful and delicate appreciation of the characters of the malignant and non-malignant tumors, considered as morbid products, and also upon a thorough knowledge of the anatomy and relations of the textures in which they arise. One of the leading characters of malignant tumors is the tendency to involve, by a kind of specific destruction or degeneration, the ultimate elements of the textures in which they arise, and in which they spread. The attempt, therefore, to distinguish these from other growths, must always call for the highest qualities of the surgeon—large experience, guided at every step by consummate science, and, in particular, by minute and thorough knowledge of natural structure. And the difficulties of the inquiry are such, that even in the dead body, or in a tumor excised from the living body, all the resources of the anatomist, aided by the microscope, will occasionally fail in distinctly and surely discovering the true character of the morbid structure.

The most common seats of C. are, among external parts, the female breast, the eye, the tongue, the lip, the male genital organs, and the bones; among internal organs, the liver, stomach, uterus, rectum, gullet, peritoneum, and lymphatic glands. Some of these parts are more liable to primary, others to secondary cancer. Thus, the female breast, the neck of the uterus, the lower lip, the scrotum, the extremity of the penis, are very often the seats of a single cancerous tumor, which in its early stage at least seems to be unconnected with any constitutional taint; while the liver, the bones, and the lymphatic glands are more frequently the seats of secondary or multiple cancerous tumors. There are also differences in the character of the C. itself, apart from its anatomical seat, which are to be taken into account in estimating the probability of its being solitary. Some of these differences are regarded by pathologists as amounting almost to specific distinctions; thus, scirrhus, or hard C., observed most frequently in the breast, uterus, and stomach, is more frequently solitary than encephaloid (brain-like), otherwise called medullary, or soft C.; again, melanosis, or melanic C., a variety charged with a brown or black pigment, is almost always multiple in its occurrence; while epithelial C., or epithelioma, as it has been recently termed, of which examples are frequently found in the lip, scrotum, penis, or tongue, is so generally solitary as to have led some pathologists to place it in a class altogether apart from the truly cancerous growths, with which, however, it presents too many points of affinity in its fatal tendency to recur after operation, and to infect the lymphatic glands and other structures adjoining the part primarily affected. Again, there are certain varieties of fibrous and of cartilaginous tumor, as well us certain tumors of bone, and bone-like tumors developed in soft parts (osteoid), which must be regarded in the meantime, as occupying a doubtful position between the malignant and non-malignant growths. Paget, (Lectures on Surgical Pathology, vol. ii.). Generally speaking, a tumor may be said to fall under the suspicion of being C. when it more or less completely infiltrates the texture in which it arises, and passes from it into the surrounding textures; when it invades the lymphatic glands adjoining the part first affected; when it is attended by stinging or darting pains, or by obstinate and slowly extending ulceration, not due to pressure; when it occurs in a person having impaired health, or past the middle period of life, and is not traceable to any known cause of inflammatory disease or local irritation, nor to any other known constitutional disease, such as syphilis or scrofula. The probabilities are of course increased if the tumor be in one of the habitual seats of C., or if it be attended by evidence of disease in some internal organ known to be frequently thus affected.

But it is hardly necessary to point out that the very complex elements of diagnosis here referred to ought to be always submitted to the scrutiny and judgment of a well-educated medical adviser, whose skill and personal character place him above suspicion, before the disease has assumed such a form as to be beyond the reach of remedial procedure. The patient who broods in secret over a suspicion of C., or who declines to apply for advice from a fear of encountering the truth, is in all probability only cherishing the seeds of future suffering; while if, as often happens, the suspicion is unfounded, a few minutes’ careful examination would suffice to remove a source of misery which otherwise would poison the mind for years.

These remarks apply still more emphatically to the misguided persons who trust to the non-professional cancer curer, or to the quasi-professional specialist. The charlatan, who pretends to hold in his hands a secret remedy for this most terrible disease, will invariably be found to pronounce almost every tumor C., and every C. curable. By this indiscriminating procedure, and by the fallacious promise of a cure without an operation, many persons who have never been affected with C. at all, have been persuaded to submit to the slow torture of successive cauterizations by powerful caustics, at the expense of needless mutilation and no small risk of life. In other cases, truly cancerous tumors have been removed slowly and imperfectly, at the cost of frightful and protracted sufferings, only to return at the end of a few weeks; and Mr. Spencer Wells has lately shown that in some notorious instances persons were reported as cured, when they had actually died of the disease at no long period after the supposed cure was stated to have taken place. (Cancer and Cancer-curers, London,1860).

What is really known as to the cure of C., may be stated in few words. Modern pathological researches render it probable that a complete suspension of the progress of C. sometimes, though rarely, takes place; and individual tumors are found not unfrequently to undergo partial healing, or even to become entirely metamorphosed into inert cicatrices, while others, associated with them, continue to advance. The degree of rapidity of the advance of C. is also, as we have already stated, exceedingly variable. But these observations modify only to a very slight degree the general doctrine, that C. is a disease tending to fatal issue, and hardly, if at all, under the control of remedies, as to its ultimate result. The removal of a cancerous tumor, indeed, is still resorted to by surgeons; and there appears to be no reasonable doubt that when performed early, and in well-selected cases, it has been followed by long-continued exemption.

But the occasional spontaneous arrest of such growths on the one hand, and the doubtful results of operation in a large proportion of cases on the other, have combined to render surgeons of late years more chary of the use of the knife. In aged persons, in particular, the question often resolves itself into a calculation of the chances of life, founded on a great number of conflicting data, and only to be solved by a careful attention to the state of the general health, as well as to the rate of progress of the local disease. Operations are now very rarely performed after the lymphatic glands are involved, or when there is evidence of a deteriorated constitution, or of internal disease; but sometimes great pain, or profuse and exhausting discharge from an external tumor, may justify its removal, as a palliative measure, even under these unfavorable circumstances. For the mode of removal of cancerous and other tumors, see tumors.

Among the lower animals, this disease is more rare; nevertheless, cases are not unfrequent, presenting the same malignant characters as those observed in the human subject. Usually manifesting itself in the form of a specific tumor of some organ or tissue, there is a tendency to the invasion of other parts of the system, and the development of a constitutional state called the cancerous cachexia. M. U. Leblanc of Paris, the best veterinary authority on this subject, has shown that the dog and cat are most frequently affected with C.; and next in frequency comes the pig, ox, horse, and mule. It has not been observed in birds, reptiles, or fishes. Females are more liable to C. than males. It is hereditary, but not transmissible from animals to man. or from one animal to another. It does not disappear under the influence of remedies, but, if possible, the tumors should be excised when first seen, and if the knife fail to extirpate the malady, cauterization should be had recourse to. A relapse is almost certain; but Leblanc says there is greater chance for the patient, when a carnivorous animal, if it is kept on a strictly vegetable diet.