450 CLINICAL APPLIED ANATOMY. 



Carcinoma. There are four varieties of epithelium from which 

 carcinoma may arise the stratified epithelium of the vaginal 

 portion of the cervix, the columnar epithelium of the cervical 

 canal, the epithelium of the cervical glands, and the epithelium 

 of the glands imbedded in the body of the uterus. 



Whilst it is true that an epithelioma commencing in the cervix 

 may involve the vagina below and the uterus above, the im- 

 portant fact concerning the spread of the disease is that the 

 carcinoma extends in a lateral direction into the parametrium, 

 or the tissue at the base of the broad ligament. It is this 

 extension which renders futile any operation unless it is under- 

 taken in quite the early stages of the disease. The close relation 

 of the ureter to the supravaginal portion of the cervix, as it 

 passes forwards and inwards, explains why the tube is liable to 

 be injured during operations in this region. 



It is in this situation that the growth tends to rapidly involve 

 the ureters, and produce obstruction of these tubes. 



As it progresses anteriorly it will invade the bladder, which 

 may eventually be ulcerated into, a vesico-uterine or vesico- 

 vaginal fistula being thereby caused. 



By the growth of the neoplasm into the uterine veins, particles 

 may become detached and carried by the blood stream to the 

 heart and lungs, inducing rapid dissemination and growth of 

 secondary deposits. The lymphatics may also convey the cells, 

 carrying them so as to infect the iliac group of glands, and later 

 those placed along the aorta, distal to the origin of the renal 

 arteries. 



THE VAGINA AND VULVA. 



Yulvitis and Yulvo-Yaginitis. Invasion of the vulva, and 

 subsequently of the vagina, by micro-organisms, particularly 

 the staphylococcus and gonococcus, is very frequent, and on 

 account of certain anatomical peculiarities it is difficult to 

 entirely eradicate them. 



Bacteria may lie latent in the various folds and depressions of 

 the labia, remnants of the hymen, and rugae of the vagina, as 



