. The diagnosis and treatment of diseases of women. nant tumor fibromyoma as it grows, pushes aside the adjacent tissues, but a malignanttumor as it grows penetrates the adjacent tissues and destroys them. It is this insidious involvement of contiguous tissues that makes many cervicalcarcinomata inoperable when first seen. It is this same gradual extension outward 664 MALIGNANT DISEASE OF THE UTERUS by continuity of tissue that later causes the patient most of her suffering andthat in most cases causes her death, by involving the uterus or bladder or rectum. In extension through the
. The diagnosis and treatment of diseases of women. nant tumor fibromyoma as it grows, pushes aside the adjacent tissues, but a malignanttumor as it grows penetrates the adjacent tissues and destroys them. It is this insidious involvement of contiguous tissues that makes many cervicalcarcinomata inoperable when first seen. It is this same gradual extension outward 664 MALIGNANT DISEASE OF THE UTERUS by continuity of tissue that later causes the patient most of her suffering andthat in most cases causes her death, by involving the uterus or bladder or rectum. In extension through the lymphatics, some carcinoma cells are caught inthe lymph current and carried to lymphatic glands, where they lodge and growand destroy tissue the same as the parent growth. This invasion of the lymphaticglands by carcinoma cells does not occur usually until rather late in the disease—until it has extended by continuity of tissue through the cervix into theparametrium. Winter found cancerous glands in only 2 cases in 44 autopsies on patients where. Fig. 619. An Epithelioma of the Cervix Uteri, still farther growth has invaded the bladder and rectum, causing fistute into theseorgans. (CuUen—Cancer of the Uterus.) the disease was confined to the uterus. Wertheim, in 60 operated cases, foundinvolvement of removed glands in 15 percent of early cases and in per centof all cases. Schauta made a most thorough autopsy-study of 60 cases, in 40 ofwhich the patients died from the natural effects of the cancer and in 9 from inter-current affections. In per cent of the whole series, the glands were entirelyfree of carcinomatous metastases. The lower (removable) glands alone were PATHOLOGY OF CARCINOMA OF CERVIX 665 involved in per cent, the upper (not removable) glands alone in per centand both lower and upper glands in 35 per cent. Kundradt, in a study of 76 cases operated on by Wertheim, in which the para-metrium was involved on one or both sides, found t
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