. The breast: its anomalies, its diseases, and their treatment . atic systems not indirect communication with the breast is a late manifestation of the disease and isthe result of permeation (Handley) or retrograde embolism (Nagle and others). Theupper brachial, the sub-scapular and the inguinal nodes are the principal members of CARCINOMA 507 the accessory parietal systems which may become involved in cancer of the in the course of the disease they should never be overlooked in the routineexamination of an apparently operable case. Other Parietal Metastases.—Cancer of the breast b
. The breast: its anomalies, its diseases, and their treatment . atic systems not indirect communication with the breast is a late manifestation of the disease and isthe result of permeation (Handley) or retrograde embolism (Nagle and others). Theupper brachial, the sub-scapular and the inguinal nodes are the principal members of CARCINOMA 507 the accessory parietal systems which may become involved in cancer of the in the course of the disease they should never be overlooked in the routineexamination of an apparently operable case. Other Parietal Metastases.—Cancer of the breast becomes rapidly disseminativein the tissues adjacent to the primary growth owing to the rich lymphatic supply ofthese parts. The breast itself becomes diffusely infiltrated at an early stage of the dis-ease, and every particle of the organ must be removed if our operations are to be radicalin the true sense of the word. According to Handley, the parietal tissues are susceptibleto metastasis in direct proportion to their proximity to the primary tumor. Stiles,. -Huge inoperable carcinoma of the breast with a large metastatic mass in thesupraclavicular region. on the other hand, states that metastasis to the skin results from embolic invasion ofthe small arterioles of the breast. This is a rational explanation for the occurrence ofisolated nodules which appear at a considerable distance from the primary focus, anoccurrence which Handley maintains is due to permeation with destruction of thelymphatics intervening between the nodule and the primary growth. The muscles are rarely involved in cancer of the breast notwithstanding the proximityof the cancer-laden lymphatics of the deep fascia. Murphy preserves the pectoralmuscles in his operation believing in his abihty to separate the overlying pectoral fasciatogether with its intra-muscular extensions from the substance of the musclesthemselves. 5o8 THE BREAST In advanced cases the intercostal muscles often become diseased and in so
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectbreast, bookyear1917
