CARCINOMA OF THE KIDNEY. 45 



CHAPTEE IX. 



CARCINOMA OF THE KIDNEY. 



OF the malignant neoplastic growths, carcinoma is the- one. most 

 frequently seen in the kidney. Renal cancer is sometimes primary ; 

 sometimes it accompanies carcinoma of other organs, as a secondary 

 formation. Young persons, and even children, are quite frequently at- 

 tacked, although it is somewhat more common in advanced age. 



Cancer of the kidney generally assumes the medullary form. 

 Scirrhus and colloid are far more rare. The former sometimes de- 

 velops in the form of circumscribed nodules of varying size, which 

 gradually replace the parenchyma of the kidney. Sometimes the can- 

 cerous degeneration spreads farther and farther into the surrounding 

 tissues from its original point of development, so that the kidney 

 gradually becomes transformed into cancer (Rokitansky, infiltrated 

 cancer). A carcinomatous kidney may attain an enormous bulk some- 

 times, forming a' nodular tumor of the size of a child's head. The de- 

 generation often involves the lymphatic glands in the hilus of the kid- 

 ney, whence it spreads to the retroperitoneal and mesenteric lym- 

 phatics, and to the ligaments and periosteum of the spinal column ; or 

 else it may grow inward into the cavity of the organ, and thence into 

 that of the adjoining veins. The frequency with which cancer of the 

 kidney is complicated with cancer of the testis is a matter of impor- 

 tance, which calls to mind the still more common coincidence of tuber- 

 culosis of these organs. Haemorrhages both within the tumor and on 

 its periphery are very apt to occur. In the latter case, the blood is 

 effused either into the peritonaeum or else into the urinary passages. 



The disease often remains latent for a long time. It is usually by 

 the gradual advance of a marasmus, for which no other cause can be 

 assigned, that suspicion is awakened of the existence of a malignant 

 tumor in a region inaccessible to palpation. There may be no pain at 

 all in the lumbar region, and, when it does exist, it is not character- 

 istic. The renal secretion may go on undisturbed, and the urine may 

 be quite free of blood and albumen. As the disease advances, the tumor 

 formed by the cancerous kidney, which is often of enormous size, can 

 generally be felt through the abdominal walls, especially when the 

 latter have become wasted and relaxed. The form of the tumor, and 

 especially its immobility, will prevent our mistaking the enlarged kidney 

 for an enlargement of the liver or spleen. It cannot be moved from 

 side to side, nor does it follow the motions of the diaphragm. Very 

 large cancers of the right kidney sometimes produce a remarkable and 

 peculiar displacement of the liver inward, causing it to turn upon its 



