INTESTINAL CAECINOMA. 367 



the point of junction of the descending and iliac portions of the 

 colon. 



Carcinoma at the splenic flexure cannot as a rule be palpated, 

 since this part of the colon is deeply situated under cover of the 

 ribs. Any tendency to prolapse of the growth is counteracted 

 by the phrenico-colic ligament. The growth is in close relation 

 with the spleen and the front of the left kidney. 



Similar considerations apply to growth at the hepatic flexure. 

 The growth lies deeply, and the hepato-colic ligament which is 

 occasionally present may keep it up. It is in relation with the 

 right lobe of the liver, the gall bladder, and the duodenum. 



Carcinoma of the transverse colon is usually associated with 

 prolapse of this part. The average length of this segment of 

 the large bowel is twenty inches, and the length of the mesocolon 

 is five inches from origin to attachment. The prolapsed growth 

 tends to become adherent to the pelvic colon, the urinary bladder, 

 or the uterus. Occasionally it becomes adherent to the stomach, 

 to the lower border of which the transverse colon is closely 

 applied. 



Carcinoma of the caecum is rare, and commences in the neigh- 

 bourhood of the ileo-caecal valve. It may become adherent to 

 the external iliac vein or the right ureter. Carcinomata of the 

 ascending or descending colon or caecum occasionally ulcerate 

 into the retroperitoneal tissue, since these parts of the bowel 

 may be devoid of a complete peritoneal investment. Carcinoma 

 at the junction of the iliac and pelvic segments of the colon 

 may do the same. 



Secondary deposits may be expected in the lymphatic glands 

 and also, since this part of the bowel belongs to the portal 

 area, in the liver. In some cases the general circulation is 

 invaded, and metastatic deposits occur in the lungs, bones, and 

 other parts. Involvement of the glands is slow. The lym- 

 phatics of the ilio-pelvic colon terminate in glands around 

 the inferior mesenteric artery. The lymphatics of the trans- 

 verse colon and its two terminal flexures are numerous, and 

 pass alongside the middle colic artery to the glands of the 



