Secondary Tumours.—Next to tuberculosis, secondary cancer is the most common disease of lymph glands. In the neck it is met with in association with epithelioma of the lip, tongue, or fauces. The glands form tumours of variable size, and are often larger than the primary growth, the characters of which they reproduce. The glands are at first movable, but soon become fixed both to each other and to their surroundings; when fixed to the mandible they form a swelling of bone-like hardness; in time they soften, liquefy, and burst through the skin, forming foul, fungating ulcers. A similar condition is met with in the groin from epithelioma of the penis, scrotum, or vulva. In cancer of the breast, the infection of the axillary glands is an important complication.

In pigmented or melanotic cancers of the skin, the glands are early infected and increase rapidly, so that, when the primary growth is still of small size—as, for example, on the sole of the foot—the femoral glands may already constitute large pigmented tumours.

Fig. 83.—Cancerous Glands in Neck secondary to Epithelioma of Lip.

(Mr. G. L. Chiene's case.)

The implication of the glands in other forms of cancer will be considered with regional surgery.

Secondary sarcoma is seldom met with in the lymph glands except when the primary growth is a lympho-sarcoma and is situated in the tonsil, thyreoid, or testicle.

CHAPTER XVI
THE NERVES