A Text-book of Diseases of Women

by Charles B. Penrose

III. When the cancer begins in the distal ends of the cervical glands (adeno-carcinoma), it may appear as a nodule in the body of the cervix. It will be remembered that sometimes these glands become so distended peripherally that they appear beneath the mucous membrane of the vaginal aspect of the cervix as Nabothian cysts. In a similar way, when the glands become seats of cancerous infection, hard nodules of various size may appear or be felt beneath the vaginal mucous membrane. In other cases the nodule is situated beneath the mucous membrane of the cervical canal. These nodules disintegrate and perforate the overlying mucous membrane, and in this way form a malignant ulcer which may appear either in the cervical canal or on the vaginal aspect of the cervix.

Fig. 116.—Nodular cancer of the neck of the uterus (a) (Ruge and Veit).

As has been said, when ulceration and destruction take place, in the last stages of the disease, all the varieties of cancer present a similar appearance and are accompanied by similar symptoms.

Cancer of the cervix uteri may extend to the vagina, to the body of the uterus, to the broad ligaments, the bladder, rectum, ureters, and the peritoneum, and it may be carried by the lymphatic vessels to the pelvic and inguinal lymphatic glands.

In nearly all cases of long standing the upper part of the vagina is involved. Sometimes the whole of the vaginal canal, from the cervix to the vulva, is infiltrated with cancerous growths.

The body of the uterus always becomes involved sooner or later. This is most apt to occur in those cases in which the disease begins in the cervical canal. The endometrium is affected by direct extension, the malignant disease being often preceded by some benign form of endometritis.

Sometimes the cervix becomes hypertrophied by general infiltration to three or four times its usual size.

The broad ligaments are very usually involved by direct extension of the disease. They become thick, hard, and very rigid, holding the uterus fixed in the pelvis. When only one ligament is affected, the uterus is drawn to that side. The ureters become involved by extension of the infiltration to their walls or by pressure upon them by the thickened broad ligaments.

The bladder, on account of its close relationship to the cervix, is always involved in the last stages. The disease may extend to the vesical mucous membrane, and symptoms of cystitis will appear. Sometimes the vesico-vaginal septum is destroyed and a urinary fistula results. Extension to the rectum is not so common. As the disease extends upward the peritoneum may be perforated, though this is an unusual accident. In most cases peritoneal involvement is preceded by local inflammation and by adhesions which prevent direct penetration of the peritoneal cavity.