CANCER OF THE LIVER CARCINOMA HEPATIS. $93 



flattened, or have a shallow excavation, a so-called " cancer navel." 

 The size and number of the tumors vary ; they are found from the 

 Bize of a pea to that of a child's head; sometimes they are solitary 

 again innumerable. The nearer they lie to the periphery of the liver, 

 the more readily do knobbed protuberances appear. Their consistence 

 varies from that of firm brawn to that of soft brain-matter. A large 

 amount of " cancer-juice " may be pressed out of the softer cancers, 

 while only a small amount can be expressed from the harder ones. 

 Lastly, the color of the tumor is milk-white or reddish, according as it 

 has few or many vessels ; it may also be dark red, from effusions of 

 blood, or black from deposits of pigment. In the unaffected parts of 

 the liver there is usually great hyperaemia, which has something to do 

 with the enlargement of the organ, which is often very great. Not 

 unfrequently the liver is rendered intensely yellow by compression of 

 the gall-ducts and retention of the bile. In the immediate vicinity of 

 the cancerous tumors, the liver-cells have usually undergone fatty de- 

 generation. Chronic partial peritonitis almost always occurs quite 

 early in the covering just over the tumors, causing thickening and ad- 

 hesion with the neighboring parts ; in other cases cancerous masses 

 develop in this part, and spread over the entire peritonaeum. The for- 

 mationof the " cancer navel " in carcinoma of the liver, as in carcino- 

 ma elsewhere, depends on atrophy of the oldest parts, of the neoplasia, 

 in which the cellular elements undergo fatty degeneration and atrophy ; 

 but occasionally we meet cases of cancer of the liver where this retro- 

 gression extends to the entire tumor, which is finally reduced to a 

 yellow crumbly mass, enclosed in a cicatricial connective tissue (the 

 remains of the cancerous framework). If young cancer be found with 

 these cicatricial masses in the liver, there can be no doubt about the 

 nature of the latter ; but if this be not the case, it will be difficult to 

 decide whether it be indeed cancer that has recovered or the remains 

 of some other process. In rare cases medullary cancer softens, and, by 

 disintegrating, leads to acute peritonitis, or to dangerous haemorrhage. 



In the second form, which HoJcitansJcy calls infiltrated cancer, we 

 find large portions of the li ver converted into a white cancerous mass. 

 The obliterated vessels and gall-ducts, which are surrounded by rudi- 

 mentary liver-cells atrophied, fattily degenerated and colored by bile, 

 often traverse this white mass as a coarse yellow framework. Toward 

 the periphery the infiltrated cancer gradually passes into the normal 

 parenchyma, as there are places where cancerous masses, and others 

 where the liver-cells, are in excess. 



The alveolar or gelatinous cancer, which almost exclusively attacks 

 the stomach, intestines, and peritonaeum, in some few cases extends 

 from the latter to the parenchyma of the liver. In one case, observed 



