Outlines of the diseases of women / by John Phillips.

  • Phillips, John.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of the diseases of women / by John Phillips. Source: Wellcome Collection.

    194/332 (page 174)
    cancer owing to the late stages of the disease at which patients seek for relief; but from examinations made during the earlier stages it seems it may appear: 1. On the vaginal portion of the cervix either as a cauli- flower excrescence or an ulcerating surface ; 2. As hard nodules in the substance of the cervix and beneath the mucous membrane: these nodules as they grow, approach the surface and break down. (3) Mode of Extension,—Usually there is a tendency for the disease to creep along the vaginal roof on to the walls of the vagina—i.e., downwards. It may pass upwards into the cervical canal and thence infect the endometrium of the body. Lastly, it may pass outwards into the connective tissue about the cervix, and the cellular tissue between the layers of the broad liga- ments (Fig. 98). These facts are of extreme importance as they influence the prognosis and the operative measures possible : it is obviously doubt- ful treatment to remove the whole uterus for cancer of the vaginal portion of the cervix which is tending to spread on to the vaginal walls; and it is just as useless to remove the cervix alone when the cancer has already invaded the endometrium of the body. On the other hand, there seems to be a growing opinion among pathologists that if cancer has attacked any organ, the more of it that can be removed, the less chance is there of recurrence; the treatment of very early cancer of the cervix will be discussed later. By the cancer spreading, the various viscera in the neighbour- hood of the cervix become gradually invaded as the disease progresses. 1. The bladder is most usually involved; this is caused by infil- tration of the connective tissue between the cervix and the bladder, and just above the anterior fornix: the bladder mucous membrane becomes affected, ulcerates, and a vesico-vaginal fistula results. This occurs in about 40 per cent, of all cases. 2. The ureters ivam their close anatomical relations to the cervix (Fig. 15) are sometimes pressed upon or occluded, producing all the usual train of symptoms dependent upon hydronephrosis and dilated ureters. 3. Implication of the rectum with formation of a recto-vaginal fistula is more rare. 4. The peritoneum may be attacked, but the cavity is never opened into; this is due to the formation of adhesions between the inflamed and irritated membrane and the advancing growth, which quite shuts it off. Beside this extension by actual contact, the disease may become