. Modern surgery, general and operative. to be enlarged when the patient first comes for treat-ment. Because the surgeon cannot feel enlarged glands is no proof that they donot exist. As a matter of fact, the glands are usually involved within twomonths of the beginning of the disease, but the involvement can rarely bedetected externally until months later. Enlargement of the axillary glands isfollowed by enlargement of the glands in the posterior cervical triangle and inthe mediastinum. Herbert Snow has shown that the blocking of the axillaryglands often leads to regurgitation of lymph contai
. Modern surgery, general and operative. to be enlarged when the patient first comes for treat-ment. Because the surgeon cannot feel enlarged glands is no proof that they donot exist. As a matter of fact, the glands are usually involved within twomonths of the beginning of the disease, but the involvement can rarely bedetected externally until months later. Enlargement of the axillary glands isfollowed by enlargement of the glands in the posterior cervical triangle and inthe mediastinum. Herbert Snow has shown that the blocking of the axillaryglands often leads to regurgitation of lymph containing cancer-cells, the cellsbeing thus deposited in the head of the humerus and in the thymus gland. Cancer Acinous Cancer 1585 in the thymus and in the mediastinal lymph-glands, after a time, causes a projec-tion of the sternum (the sternal symptom). When the axillary lymphatics areextensively involved the arm swells from obstruction to the lymph-How (lymphe-dema) or pressure upon the vein. If there be lymphatic obstruction the skin of. Fig. loSg.—Cancer en cuirasse. the breast becomes pitted and resembles pig skin. The skin is actually can-cerous or soon becomes so by infiltration. Each pit is the opening of a sweat-gland. The sweat-duct is helddown by contracting fibrous tis-sue. This condition is termedpeau dorange, or pigskin saddleappearance. The tumor usuallygrows rather slowly unless lacta-tion is established, when it growswith frightful rapidity. As itgrows it infiltrates adjacent struc-tures (the pectoral fascia, pectoralmuscles, subcutaneous cellular tis-sue, and skin). When a tumor be-comes adherent to the skin theskin becomes congested and of adark purple hue. When the skinis destroyed, an ulcer forms, andaround this ulcer the skin becomesred and filled with cancerous nod-ules, which feel like shot in theskin. Metastases are apt to occur in the bones, liver, brain, pleura, lung, spine, thymus gland and rarely theeye. The pleura and lung may be attacked by direct
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