410 



Tumors. 



to glands. Those cancers which exhibit a distinct tubular or acinous 

 structure (from which, however, the deviations just indicated are 

 evident) are adciiocarciiwinafa. All of the types of cancer here 

 under discussion may be said, at least in their early period, to be 

 adenocarcinomata. Those in which the proliferative and infiltra- 

 tive processes have so advanced as to destroy the original gland 

 resemblance, so that definite tubes or acini are not well or numer- 

 ously recognizable, may well be called carcinoiiia simplex. These 

 merely represent more advanced stages of the first, and. are more 

 common as actively growing and extending cancers. 



The stroma of true cancer, as the author remarks, is exceedingly 

 variable and is often the basis for special sub-divisions of the 

 growths. Thus it may be relatively small in amount, the epithelial 

 elements predominating ; this condition underlies the group of soft 

 cancers (medullary cancers). Or it may be greatly in excess, 

 markedly predominating over the epithelium of the growth, dense 

 and fibrous ; such growths are the well known hard cancers or 

 scirrhous cancers (substantive scirrhns). The connective tissue 

 stroma may exceptionally be found largely or totally of a gela- 

 tinous type {carcinoma myxomatodes) ; or highly cellular and evi- 

 dently of a sarcomatous type {carcinoma sarcomatodes). Other 

 types of connective tissue may also be encountered in varying 

 amounts in the more highly mixed cancers.] 



TJic cvternal shape and other macroscopic characters of cancer 

 vary with the location of the original growth, the structural con- 

 stituents of the tumor and the age of the neoplasm. Cancers de- 

 veloping on the free surfaces of the skin and mucous membranes 

 [squamous epitheliomata, surface adenocarcinomata^ often appear 

 as cancerous ulcers. The infiltrative growth causes a thickening 

 of the membrane, with the [ulcerated] exposed surface uneven 

 with nodular prominences, suppurating, red or dirty dark brown, 

 and perhaps covered with crusts, with the base and wall shown 

 in cross sections as a more or less defined growth and as a light 

 gray bacony zone often penetrating by root-like extensions into the 

 deeper tissue. The normal epiderm is usually sharply defined along 

 the border of the ulcerating exposed tumor surface. In mucous 

 membranes, as the urinary bladder, cancer often forms merely super- 

 ficial, undulating, slightly elevated thickenings [flat tabular swell- 

 ings], recognizable from simple inflammatory changes by the 

 accompanying enlargement of the lymph glands, the infiltration of 

 the growth into the muscular layers and by the definition of the 



