CARCINOMA OF THE INTESTINES. 



by the cancer spreading from the intestine to neighboring organs. 

 The development of the tumor may contract the calibre of the intes- 

 tine to the size of a quill ; the stricture is not usually over a few inches 

 in length. Above the stricture the intestine is often enormously dilated 

 and filled with faeces and gas, its walls are hypertrophied, and the mu- 

 cous membrane is inflamed in various degrees ; below the stricture the 

 intestine is empty and collapsed. As we have stated, when speaking 

 of cancer of the oesophagus and pylorus, the stricture may be enlarged 

 by the breaking down of the cancer. Occasionally the destruction of 

 the cancer extends to the peritonaeum ; when this has been destroyed, 

 the contents of the intestine enter the abdomen, or, if there have been 

 previous adhesions, the destruction attacks neighboring organs. In 

 the latter case, there may be abnormal communications between differ- 

 ent portions of intestine, or, if the affected portion of intestine have be- 

 come adherent to the abdominal wall, there may be a fecal fistula ; 

 perforation of the vagina or bladder may be caused by the breaking 

 down of cancer of the rectum. Ulceration of the inflamed part of in- 

 testine above the stricture may also cause perforation, and permit the 

 escape of the contents into the abdomen, or lead to abnormal commu- 

 nications. 



SYMPTOMS AND COURSE. -In many cases it is impossible to recog- 

 nize cancer of the intestines with certainty. Patients in whom it de- 

 velops complain of dull pain, sometimes continuous, sometimes occur- 

 ring at intervals at a circumscribed part of the abdomen. Besides this, 

 there is habitual constipation, which usually begins before the stricture 

 exists, and is then due to the degeneration of the muscular coat and 

 the interruption of the movements of the intestines at that part. From 

 tune to time the constipation becomes peculiarly obstinate ; the pain 

 increases, the belly is puffed up, and nausea, vomiting, and other symp- 

 toms of obstruction of the intestines occur. If constipation be relieved, 

 the patient feels pretty well again. These attacks recur at shorter in- 

 tervals, increase in severity, and threaten life more and more. Finally, 

 the constipation cannot be relieved, and the patient dies with the 

 symptoms of ileus. If, up to that time, the appearance and nutrition 

 of the patient had not suffered, if there were no tumor to be felt in the 

 abdomen, and the form of the faeces gave no clew for diagnosis, the 

 disease would be very obscure. It might be known that there was a 

 gradually increasing obstacle, to the progress of the contents of the 

 intestines, but the nature of this obstruction would not be certainly 

 known till revealed by autopsy. 



In other cases the patients do not die so soon from an acute attack 

 of obstruction of the bowels, but, besides the gradually increasing con- 

 stipation and the dull pain in the abdomen, the signs of a severe en- 



