UTERUS (ABNORMAL ANATOMY). 



699 



first, in the cervix, and especially in the va- 

 ginal portion, is so preponderating, that this 

 may be regarded as mainly the seat of origin 

 of uterine cancer. 



The comparative rarity of opportunities for 

 examining uterine cancer in the incipient stage, 

 has limited to a certain extent our knowledge 

 of this part of the subject. 



The cervix in the incipient stage, smooth, 

 tense and hard, or exhibiting upon its surface 

 here and there knotty projections, is found 

 upon section to have its tissues infiltrated in 

 parts by the cancerous structure, which differs 

 in the character and relative proportions of its 

 elements, according to the form which the 

 cancer assumes. In the medullary variety a 

 white cream-like or lardaceous semi-fluid mat- 

 ter, composed of the usual cancer constituents, 

 is found interspersed among the meshes of a 

 loose reticuhnn, in the softer portions of which 

 few if any of the normal uterine fibres can be 

 traced. The larger preponderance of the en- 

 cephaloid matter, compared with the fibrous 

 stroma, occasions that semi-elastic feel which 

 the part early acquires, and at the same time 

 constitutes the main difference between en- 

 cephaloid and scirrhous cancer. 



In the scirrhous or fibrous variety the 

 greater hardness of the structures is depend- 

 ent upon the presence of a large proportion of 

 a coarser fibrous stroma, composed of dense 

 white fibres, the minute interspaces of which 

 are occupied by a greyish or reddish softer and 

 often pulpy substance, which may be obtained 

 by scraping, or may be squeezed from the part. 

 In the harder forms of scirrhous but little fluid 

 is so obtainable ; but in some specimens here 

 and there, softer portions are found from 

 which a fluid cream-like matter exudes, dif- 

 fering in no respect from the pulp of ence- 

 phaloid cancer. These and the softer portions 

 obtained by scraping are composed of cancer 

 cells with molecules, granules, and disinte- 

 grated fibrous tissue. 



The irregular nodulated projections oc- 

 casioned by the unequal development of the 

 cancer structure rapidly increase in the en- 

 cephaloid variety, and the cervix becomes 

 much enlarged. The surface of the more 

 projecting portions becomes florid and vas- 

 cular, and these portions pass first into ul- 

 ceration by thinning and absorption of their 

 mucous covering. The creamy or cheese- 

 like contents of these tuberculuted portions 

 then escape, and being sometimes of a yel- 

 low colour may be mistaken for tuberculous 

 matter. 



This stage is followed by the formation of 

 one or more corresponding ulcers upon the 

 outer cervix, which coalescing destroy the 

 remaining portions of the mucous membrane, 

 and spreading up the cervical canal, convert 

 it into an irregular funnel-shaped cavity, 

 bounded below by hard rugged margins. Or 

 fungous vascular growths, friable and easily 

 bleeding, sprout from the part and entirely 

 destroy its natural configuration. A yellow 

 or greenish-brown sanious discharge, of a 

 highly fetid odour, mixed occasionally with 



florid blood and ultimately with fragments of 

 putrid tissue, dates from the commencement 

 of ulceration, and increases in proportion to 

 the extent of surface denuded. The frag- 

 ments of putrefied tissue which hang from the 

 ulcerated surfaces, and occasionally pass away 

 in the discharges, consist mainly of connec- 

 tive tissue fibres, which are more slowly dis- 

 integrated, stained of a dirty brown colour by 

 infiltration with decomposed blood. 



By these disintegrating processes both lips, 

 and finally the cervix itself, are destroyed and 

 removed ; the cancer structures being con- 

 tinually deposited in advance of the ulcera- 

 tion, while the fund us and even the body of 

 the uterus may still remain sound. In like 

 manner cancerous deposits take place in the 

 fibrous tissue surrounding the uterine neck, 

 and attaching it to adjacent parts. Thus the 

 uterus becomes fixed in the pelvis, and at the 

 same time a way is paved for the further ex- 

 tension of destructive ulceration, by which 

 first the bladder ami then the rectum are 

 penetrated, and the disease further extending 

 down the vagina, the whole is laid open into 

 one ulcerous cloaca (J%. 479.). If life is 



Fig. 479. 



it 



r 



Cancer of the neck of the uterus (?/), extending 

 to the bladder (/*), rectum (/), and upper part of the 

 vagina (v~). (Ad Nut.) 



maintained beyond this point the pelvis be- 

 comes lined with cancerous matter, and, the 

 peritoneum inflaming, all the adjacent parts 

 become agglutinated together, until finally the 

 ulceration may extend into and lay open the 

 peritoneal cavity itself. 



The penetration of the bladder earlier than 

 the rectum, which almost uniformly obtains, is 

 explained by the different modes of connexion 

 of the cervix with these two parts. Since 

 nothing but fibrous tissue intervenes between 

 the bladder and the anterior cervical wall 

 (fig. 426. b b and 4.3.'J F), the cancer elements 

 are readily deposited, and extended in this 

 direction, while the posterior wall being se- 

 parated from the rectum by a double fold of 



