. Gynecology : . if pessariesdo more than encourage the development of a tissue already predisposed tocancer. The growth has at first a circular circumscribed appearance with somewhatraised indurated periphery. The original area gradually spreads, infiltratingthe paravaginal connective tissue, until it involves the entire vaginal and bleeding take place early, and the symptoms are the same asthose of cancer of the cervix. The diagnosis of primary cancer of the vagina is usually not difficult unless 298 GYNECOLOGY the disease has so involved the cervix that the original seat of
. Gynecology : . if pessariesdo more than encourage the development of a tissue already predisposed tocancer. The growth has at first a circular circumscribed appearance with somewhatraised indurated periphery. The original area gradually spreads, infiltratingthe paravaginal connective tissue, until it involves the entire vaginal and bleeding take place early, and the symptoms are the same asthose of cancer of the cervix. The diagnosis of primary cancer of the vagina is usually not difficult unless 298 GYNECOLOGY the disease has so involved the cervix that the original seat of the disease cannotbe distinguished. The prognosis of vaginal cancer is very bad, but extirpation is possible if anearly diagnosis can be made. The method of operation depends on the originalseat of the disease. If it is located high in the vagina the best operation isabdominal extirpation of the uterus and vagina by the Wertheim extendedmethod. If the cancer is situated near the introitus the operation should be. Fig. 76.—Squamous Carcinoma of the Vaginal power. The growth is seen invading the stroma of the vaginal wall. At its upper end it haslost the typical layer of basal cells and the basement-membrane. The cells are large, the nuclei varygreatly in size. The stroma above the growth is infiltrated with leukocytes, an inflammatory reactionoften found with carcinoma. from below, and be completed either from below or be combined with abdominalextirpation. In inoperable cases radium sometimes proves to be valuable as a palliativemeasure. When the disease has extended into the rectum the only hope of a cure is atotal extirpation of the uterus, vagina, and rectum. This necessitates the estab-lishment of an artificial anus. NEW GROWTHS 299 Secondary cancer of the vagina is very common, especially as a manifesta-tion of advanced cancer of the cervix. Both everting and inverting carcinomaof the cervix tend in time to involve the paravaginal connective tissue, especi-ally
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