154 DISEASES OF THE UTERUS. 



[CHAPTER VIII. 



CANCER OF THE WOMB. 



ETIOLOGY AND ANATOMICAL APPEARANCES. Primary cancer 

 appears more frequently in the womb than in any other organ of 

 woman, not excepting the breast. Secondary cancer of the womb, 

 on the other hand, is rare. Nothing certain is known as to the 

 cause of this miserable disease, and its assumed hereditary trans- 

 missibility is not proved. It is met with chiefly among married 

 persons, especially among multipara, and with increasing frequency 

 from the thirtieth year up to the climacteric period, which age fur- 

 nishes the most victims. Beyond it cancer is common enough still, 

 and does not become a rarity until the seventieth year. 



The point of origin of primary cancer is almost always in the 

 neck of the womb, very rarely in its body. According to 'Waldeyer, 

 all forms of cancer spring from the true primordial epithelium of 

 the organism, and hence are to be regarded generally as epithelial 

 growths ; and even the smooth and papillated cancroids formerly 

 distinguished as carcinomata are to be included in this category. 

 The development of cancer of the cervix is as follows : The super- 

 ficial epithelium of the mucous membrane proliferates, throwing 

 offshoots into the connective and muscular tissue beneath it. These 

 sprouts, ramifying in all directions, everywhere form new nests of 

 cancer-cells, and encroach more and more upon the normal tissues, 

 which finally break down and ulcerate through pressure and arrest 

 of circulation. The cancerous infiltration meanwhile continues to 

 invade new tissues around it, which in their turn ulcerate. This is 

 often accompanied by considerable development of the papilla3 of the 

 mucous membrane, and this is in the beginning liable to be confound- 

 ed with the non-malignant papillary outgrowth due to catarrh. In- 

 deed, it has been assumed that papillomata, originally simple, might 

 change into cancer by consecutive ingrowth of their epithelium into 

 their basement-tissue. At a later period the malignant papilloma 

 is distinguishable from the simple form by the rapidity and luxuri- 

 ance of its growth, and by its early ulceration. At other times, in- 

 stead of papillae, there develops a smooth, knotty group of swellings 

 in one or other lip, or perhaps throughout the whole circumference, 

 of the os. These nodules, unless they prematurely break down by 

 ulceration, may form a tumor which fills the upper part of the va- 

 gina. But there are cancers which do not begin at the surface, but 

 originate deep in the interior of the neck, and develop as circum- 



