The centrifugal spread of mammary carcinoma in the parietes, and its bearings on operative treatment / by W. Sampson Handley.

  • Handley, W. Sampson (William Sampson), 1872-1962.
Date:
1904
Catalogue details

Licence: In copyright

Credit: The centrifugal spread of mammary carcinoma in the parietes, and its bearings on operative treatment / by W. Sampson Handley. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    17/38 (page 15)
    (2) The Bones distal to the Knee and Elhoiv escape Cancerous invasion, except in the rarest instances. Among the seventy-three cases of hone deposit or fracture there are one real and one apparent exception to this rule. These two cases will he dealt with in detail later on. If hone deposits take their origin from particles lodging in the peripheral hlood-vessels they can hest he studied in the limhs, the regions which appear most liable to emholism. If, on the contrary, the view he accepted that hone deposits are incidents in the centrifugal spread of the cancer hy continuity, it is equally in the limhs that clear evidence on the point is likely to he obtained. For this reason metastases in the hones of the trunk may he ignored, and attention will he concentrated on the long hones of the limhs. (a) Secondary Deposits in the Femur. Out of 329 cases there are recorded nine in which one or both femora were the seat of definite deposits, with or without fracture, and five others in which spontaneous fracture alone is said to have occurred. In twelve of the fourteen cases there was fracture of one or both femora; in four cases the fracture was bilateral. In every case where the deposit was local or the fracture single the pathological condition was present in the upper third of the hone, most often a little (about two inches) below the base of the great trochanter. This statement is based on eleven of the fourteen cases (see Table III., p. 32), and the apparently exclusive preference of early cancerous growth for this particular part of the hone is a striking fact. The point of election for spontaneous fracture in breast cancer does not coincide with the usual positions of senile fracture of the femur, which is across the neck, nor with the point of entry of the nutrient artery. There are indications that the base of the great trochanter is the usual point of invasion of the femur, hut that, owing to the thickness of the bone at this level, actual fracture generally occurs rather lower down. Thus in Case XII (Table III., p. 34) there was fracture of the right femur through its upper