316 
EPITHELIAL CANCER OF TIIE BLADDER. 
mass in various directions. On subjecting a portion of this 
matter to microscopic examination, it was found to be com- 
posed of cells mostly nucleated, and of various sizes. Some of 
these were but little altered from the form of tesselated 
epithelium, while others had a more irregular shape, and 
very many had become elongated into “ caudate cells.” These 
several forms will be easily recognized in the annexed en- 
graving, which will also serve to identify this disease. 
Professor Paget, in his lectures on f Surgical Pathology/ 
when describing epithelial cancer, says:* 
“The essential anatomical character of epithelial cancer is, that it is 
chiefly composed of cells which bear a general resemblance to those of such 
tesselated or scaly epithelium as lines the interior of the lips and mouth, 
and that part of these cells are inserted or infiltrated in the interstices of 
the proper structures of the skin or other affected tissue. 
“ The epithelial cancers of the skin or mucous membrane from which, as 
types, the general characters of the disease must be drawn, present many 
varieties of external shape and relations, which are dependent, chiefly, on 
the situation in which the cancerous structures are placed. They may be 
either almost uniformly diffused among all the tissues of the skin or mucous 
membrane, predominating in only a small degree in the papillae ; or the 
papillae may be their chief seat ; or they may occupy only the sub-integu- 
mental tissues. As a general rule, in the first of these cases, the cancer is 
but little elevated above or imbedded below the normal level of the integu- 
ment, and its depth or thickness is much less than its other dimensions ; in 
the second, it forms a prominent warty or exuberant outgrowth ; in the 
third, a deeper-seated flat or rounded mass. These varieties are commonly 
well marked in the first notice of the cancers, or during the earlier stages of 
their growth; later, they are less marked, because (especially after 
ulceration has commenced) an epithelial cancer, which has been superficial 
or exuberant, is prone to extend into deep-seated parts ; or one which was 
at first deeply seated may grow out exuberantly. Moreover, when ulcera- 
* Yol. ii, pp. 413 et seq. 
