384 SURGERY 



a case in which elastic fibers were present in the stroma, the connection of which 

 with the elastic tissue of the duct wall could be demonstrated. 



This shows that the stroma is throughout an accessory unimportant, unessen- 

 tial component of cancer; although in certain cases the stroma is of importance 

 in determining the character of the cancer; but that a scirrhus is not different in 

 its nature from a soft medullary cancer is shown most clearly by the fact that the 

 edges and the metastases of scirrhus may be entirely of a soft, medullary char- 

 acter. 



If, as we have said, the essential character of cancer is the uninterrupted origin 

 from preformed epithelium, from the scientific standpoint all cancers must bear, 

 according to the customary nomenclature, the name of epithelioma. To distin- 

 guish it from other epithelial tumors it may be designated malignant, destructive, 

 or heterotopic epithelioma; for the distinguishing characteristic is, that in cancer, 

 epithelial cells occur in places where epithelium does not belong. Where there is 

 a sharp line between the epithelial and non-epithelial parts of an organ, as in the 

 gastro-intestinal tract (muscularis mucosae), the heterotopia of the cancer cells is 

 easily shown. In other places it is the occurrence of connective tissue inclusions, 

 especially of elastic and colloid fibers in masses of cancer cells, which proves that 

 cancer cells are present where they do not belong; that they have forced their 

 destructive way into other tissues. 



Another result of the epithelial nature of cancer is, that the forms of cancer 

 must be determined by the behavior of epithelial cancer cells, and it is of especial 

 importance that however cancer cells may differ from normal epithelium (ana- 

 plasia of Hansemann) still, on the whole, the cells of the primary tumor, as well 

 as those of the metastases, retain a definite character in their arrangement as well 

 as in their morphologic and in their biologic behavior. 



Thus, we may distinguish two groups of heterotopic epitheliomata : 



(1) Those with a typical arrangement of the cancer cells; 



(2) Those with an atypical arrangement. 



To the first group belong (a) cancers (usually formed of cylinder cells) arranged 

 after the gland type (Adenomata) which possess gland canals and complicated 

 glandular structure, and which, especially in the gastro-intestinal tract, not 

 infrequently produce a mucoid secretion. (&) Cancers which resemble epidermis 

 in the form, character, and stratification of their cells, and which have borne for a 

 long time the name of cancroids. It is specially important, for the doctrine that 

 all cancer cells of metastatic growths arise from cells of the primary cancer, that 

 in this first group of cancers, in adenoma as well as cancroids, the cells in the 

 metastases show the same form and the same arrangement or stratification as 

 those of the corresponding primary tumor. 



The second group is composed of cancers whose cells are grouped irregularly 

 in heaps and cords which show no typical arrangement. The cells also show less 

 marked peculiarities, although we may say that they differ according to the 

 individual organs from which the original tumor may have developed. I might 

 designate these cancer forms with the word which forms the root of cancroid, 

 namely, Cancer. 



There are, however, mixed forms and transition forms between these particular 

 types. 



II 



These facts give us important bases for the second principal question, that 

 regarding the parasitic nature of cancer; for, if the primary cancer with all its 

 metastases is nothing more, histologically and histogenetically, than a great 

 family of epithelial cells, which all have a common origin from preformed epithe- 



