HUMAN ANATOMY. 



surface of the axillary fascia, forming one 



r - seen 



,odes at the summit of the axilla may be involved through lymph vessels 

 , SrActoralis minor and through Mohrenheim's fossa without entering 



rfor Biediarinal glands may be invaded-especially if the inner 



seement of the breast is affected-by way of the lymph vessels following the per- 



ne arteries and emptying into the nodes along the internal mammary artery. 



t s k m n . uU as by direct extension through the inframammary tissue, the 



, r:l L -ia and muscles^ and the chest wall, the pleura and lung may become 



,,lu r symptoms due to mediastinal growth have been described in rela- 



in the subareolar plexus between the glandular 



: '"'' >uperficial, (paramammary) and the subcutaneous and thoracic 



ti IHT uith the connection established between the penglandular 



kin above by the ligaments of Cooper (suspensory ligaments), 

 tin- fre<,ucncv with which mammary carcinoma extends to the overlying 

 skin \s a i. Milt of its infiltration the latter becomes dense, inelastic, brawny, 

 du.kv ami adherent. It cannot be picked up between the thumb and finger in a 

 (,,!,.; ten quite rally and before it has become adherent, and as a result of con- 



tii.n of tin- growth pulling on the fibrous bands uniting it to the deeper parts, it 

 i-, drawn into a numlH-r of little depressions or dimples like those on the skin of an 

 When such infiltration is diffuse and spreads largely through the subcu- 

 t.,,,, uork of lymph vessels, the condition known as cancer en cuirasseis pro- 



duced. In the later stages ulceration, infection, hemorrhage, and foul discharge are 

 ireqiu Mit results of the cutaneous involvement. 



6. If the growth is central it may extend to the lactiferous ducts or to the peri- 

 ,<>us ti^ne (ontinnous with that surrounding the ducts, and through its own or 



tlu-ir .-ii-atrifial contraction it may depress or retract the nipple or pull it so that it 



deviates from its normal din-ction. This is not so valuable a symptom as the dim- 



pling ot tin- skin above described, as it may be caused by injury or by chronic disease, 



ess, tuU-rcle, or mastitis. Moreover, it may not be present if the growth 



ripheraL 



7. The carcinoma may extend through the lymph communications between the 

 ylaml and the underlying connective tissue and pectoral fascia and muscle, so as to 

 become fixed to or incorporated with those structures, the breast losing much of its 

 inol'ilit'. illy in a direction parallel with the pectoralis major fibres. It may 

 thru. < continue through the thoracic wall and invade the pleuralor mediastinal cavity 



8. Through the intercommunication of the lymph system of the two breasts 

 through the siilxrutancons thoracic lymphatics, cancer of one breast may extend to the 

 ot! r to the glands of the opposite axilla (Volkmann, Stiles), or to the 

 glat -h axilla- Sc.ii pa. C<>pri ; quoted by Williams). 



9. Gen- nination of the cancerous disease may also take place through 

 detached crlls or particles (emboli) from the primary growth entering the blood 



thr organ most frequently affected by metastasis in cases of 

 rin- boiu-s. thr lungs, and the pleurae come next, but almost no 

 the !>odv is r\rmpt. 



: he following anatomical points should be borne in mind : 

 n l. twc.-n the skin and the gland itself by means of lymph- 



"" ' "' Is - ! 'v the sii^H-nsm-v ligament, and by glandular processes accom- 



f'' contained within these ligament> , Stiles),' shows the necessity for free 



sacn n overlying the li 



;lar shape ,,i tlie 1,,-east, which has two extensions that frequently 

 E axilla, an.l one that reaches to ,, r overlaps the border of the sternum, 

 nmonly ,.mi!a. pn-eessrs that spring from other parts' of the surface of 



