Carcinoma

The carcinomatous family of malignant tumors contains the tumors which the term cancer, as understood at the present day, is properly applied. A carcinoma is a tumor made up of a typical epithelial new formation-cells, of epithelial origin, but imperfect embryonic cells. Structurally it consists of cavernous, fibrous stroma, in the interspaces or alveoli of which are found the epithelial cells suspended in serous fluid. The cells are not separated by any visible intercellular substance. Even the blood-vessels run in the fibrous stroma and not between the cells.

The development of cancer from epithelium has been clearly shown in certain localities where morbid processes are taking place. Some years ago, Paget called attention to the point that a certain eczema of the nipple is often the precursor of cancer. In cases of this kind, it has been shown that the proliferation of cells which is active over the denuded portions is continued down into the milk ducts until these ducts have become filled and expanded by the over-accumulation of imperfectly formed cells. At the same time, the connective tissue surrounding the duct takes on an increased vascularity from the irritation, and is infiltrated with small cells resembling leucocytes. There is no direct connection between the cells of the duct and those found in the connective tissues outside. The latter are not migrating epithelial cells, but appear as the product of inflammation. As the ducts become filled and their walls distended, they give way, and the epithelial cells infiltrate into the surrounding tissues where they proliferate and become centres of disease.

It is believed by some pathologists that the entire growth is not due to the proliferation of epithelium, although originating in this way. Endothelial cells, connective tissue cells, and indifferent corpuscles in the presence of, or by contact with, a growing carcinoma, it is claimed, become infected and transformed into cells similar to those of the tumor itself. While this may be true, the progress of carcinoma in its extension to the lymphatic glands does not support this theory, for instead of infecting and transforming the gland as a whole, the mode of invasion is between and around the lymph corpuscles, they being affected only by the pressure of the rapidly growing masses. As the cells increase and distend the connective-tissue spaces the fibrous tissues are pressed back and welded together, and the stroma of the cancer makes its appearance. The stroma is not real cancerous tissue, but the natural tissue of the part is sometimes increased by unnatural activity of the surrounding tissue. The blood-vessels of the stroma, like the fibrous tissue, increase in size, so that the stroma becomes much more vascular than the original fibrous tissue.


Scheurlen claims to have obtained by cultivation from the juice of cancer of the breast in sterilized plural fluid, colonies of bacilli and spores, the bacilli being from 1.3 µ to 2.5 µ in length. By inoculating six dogs, in the posterior mammary glands, with an emulsion of these cultures he has demonstrated the appearance of cancerous tumors. Finally, he has found the spores, if not the bacilli in question, in all the preparations of cancer stained by Gram's method. His conclusions are as follows: 1. There exist constantly in cancerous tumors bacilli which may be isolated. 2. The spores of these bacilli are found in all microscopic preparations of cancerous tissue. 3. Inoculation of animals with pure cultures of these bacilli determines the development of cancerous tumors. 4. There is a relation of cause and effect between these bacilli and cancer.

The female sex, on the whole, is much more exposed to cancer than the male, on account of the greater liability of the female organs of generation. The breast alone probably furnishes as many cases of carcinoma as all other portions of the body.

Carcinoma is essentially a disease of old age. It is so rare before thirty years that the age is often the most important consideration in the early diagnosis between benign and malignant growths. After thirty years of age it becomes more frequent, but it is not until the acme of life is reached and the organs begin their natural retrogression, that cancer becomes common. At, and after the climacteric in women, and at a somewhat later period in men, the cancer is most active. So well recognized is this fact that a tumor appearing at this time of life is always regarded with suspicion. Certain localities are attacked much earlier than others. In early adult life it is found most frequently in the testicle and labia; from thirty-five or fifty, in the breast, uterus, the tongue, and the penis; from fifty to sixty-five years, on the lip and oesophagus. It is a noticeable fact that the organs in which natural degeneracy of function takes place are the organs most frequently attacked.

The carcinoma is a tumor of rapid growth. It never remains idle, and, with the exception to be noted, never decreases in size. In the manner of its extension, locally, it resembles sarcoma.

The carcinoma is liable to many changes, but one of the most common features is the tendency to ulceration shown by the growth.

The reproduction of cancer in an associated lymphatic gland is of such frequent occurrence that it is looked upon as one of the most certain signs of carcinoma. The glands affected are usually those having a direct anatomical connection with the affected part. Thus the axillary glands follow infection of the breast; the lympthatics in the groin, carcinoma of the testicle; and the submaxillary or sub-lingual glands, infection of the tongue or lip. There seems to be no limit to the number of glands involved. From one to fifty have been found enlarged, varying all the way from the size of a pea to that of a walnut.

The lungs, liver, etc., may become infected through metastatic deposits, carried thence by the blood.

The chief forms of carcinoma are the schirrus, encephaloma, colloma, and melanoma.

The scirrhus is characterized by its firm, hard, dense feel, having a similarity, in this respect, to normal cartilage, It is most frequent of all the forms, and has been observed and recognized from the earliest times.


The encephaloma is a soft tumor, and is the most malignant of all tumors. It occurs at an earlier age than the other forms of cancer, being almost the only one which is found before the age of puberty. To the touch, the tumor presents a peculiar soft feel, giving way under pressure, and returning to its shape again, as if filled with fluid. It varies in volume from the smallest kernel to a tumor of the size of an adult's head.

The colloma is so called because it consists, in large part, of a clear, viscid, gelatine-like substance.

The melanomatic cancer is apparently an encephaloid cancer which has been changed in appearance by the deposition of a black pigment in the elements composing the growth. A noted peculiarity of melanosis of the integument is its pronounced tendency to form in or under a pigmentary mole.