DiagnosisThe diagnosis of the different forms of carcinoma, when located in some external part, is usually a matter of no great difficulty.The scirrhus is generally found in the breast. It is a solitary tumor, and rarely appears before the forty-fifth year of age. In feel it is firm, hard, dense, resembling cartilage. It grows slowly, and never attains large size. From its start it is accompanied by sharp, shooting, lancinating pains, which are distinctly localized in early lancinating adhesions to the integument and deeper tissues. If in the breast, the nipple is retracted. The superficial veins are but slightly enlarged. Ulceration occurs early, and the ulcer has an abrupt, steep edge, and a firm hard base. The lymphatics are invaded at, or soon after, the beginning of ulceration. The diagnostic symptoms of scirrhus are clear-cut and cannot be mistaken. The encephaloma may occur at any age and in almost any portion of the body. It is soft, tabulated, usually solitary. It grows rapidly, and often acquires a very large size. Pain is absent or slight until the advent of ulceration, when it becomes severe, but does not assume the lancinating character of the scirrhus. The subcutaneous veins are always enlarged. Ulceration is early and the ulcer is foul, with thin edges, and is often covered with a fungous, friable mass. The lymphatics are early involved. The colloid cancer is rare, and its characteristics are not pronounced. It is tardy in its growth, of uniform consistency, free from pain, and often attains an immense bulk. It is usually found in the peritoneal cavity; when superficial, it may be confounded with a fibrous or cartilaginous tumor or sarcoma. It is distinguished from fibroma by its more rapid growth, its large size, and its constitutional tendency;' from chondroma by its elasticity and less firm feel, as well as by its more rapid progress; from sarcoma by its more uniform growth and comparatively slow progress. The melanomatic cancer can only be distinguished by the peculiarity of its color and its frequent origin from pigmentary moles. From the facts given in the diagnosis this may be deduced; a tumor appearing late in Me, which grows rapidly, is attended with pain, infiltration of the surrounding tissues, and adhesions to the integument and tissues beneath, shows a marked tendency to ulceration and to infection of the lymphatic glands, and decay of the vital forces, is a cancer or malignant tumor. |
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