A Text-book of Diseases of Women

by Charles B. Penrose

The pelvic and retroperitoneal lymphatic glands become affected in the later stages of cancer of the cervix.

The inguinal glands are rarely involved in the last stages of the disease. Metastasis to remote parts of the body is unusual. Cancer of the cervix usually remains localized and does not become metastatic.

From this description it will be observed that in the early stages of cancer of the cervix the disease presents a variety of appearances. As cure of the disease depends upon its early recognition, it is of the utmost importance that the physician should be familiar with these early phenomena.

When cancer begins in an erosion of a laceration, we find that the eroded surface bleeds more easily than in the non-malignant condition, and is somewhat more elevated than the surrounding surface of the cervix. We may by palpation detect around the erosion a more or less indurated edge which is not felt around a benign erosion. The submucous structures of the cervix may feel brawny and indurated. If the erosion has become an ulcer, the indurated edges and the involvement of the deeper structures of the cervix are more marked. It must always be remembered that an ulcer of the cervix is very rare as a benign condition.

In the vegetating form of cancer of the cervix we may find small warty growths, or large cauliflower-like masses, or rounded or irregular protuberances growing from the surface of the cervix. There is here also felt an induration around the base of the growth and throughout the cervix.

A very striking characteristic of cancerous growths of the cervix uteri is their friability. The warty growths or cauliflower-like masses break off readily upon even gentle palpation, and profuse bleeding often results. There is no other disease of the cervix in which the outgrowths are of such a friable and vascular character. Even in the ulcerated form of cancer the edges of the ulcer are of this same friable nature.

When the disease begins immediately within the external os, this opening becomes enlarged, the cervical canal is destroyed, and there is presented the appearance of a deep conical excavation, with ulcerated, unhealthy edges, in the center of the vaginal cervix. When the disease begins still higher up, the cervical canal may be the seat of extensive destruction of tissue before any lesion is visible below the external os. Usually, however, the os is sufficiently open to permit the condition of the canal above to be seen.

When the disease begins in the racemose glands of the cervix, the nodules may be felt beneath the mucous membrane of the vaginal aspect of the cervix. The whole cervix is usually indurated and somewhat enlarged. The mucous membrane overlying the nodule may appear congested, and upon palpation it is found that the overlying mucous membrane does not glide readily over the nodule, but seems to be more than normally adherent to the underlying structures.

In all the forms of cancer of the cervix there is present to a greater or less extent a general induration of the cervix. The elasticity or resiliency of the cervix is diminished or lost; this is shown not only by the sensation upon palpation, but by the fact that the cervix is not capable of dilatation, by sponge tent or otherwise, as in the normal condition.

In the last stages of the disease the gross appearance is the same in all forms of cancer of the cervix. The cervix may fill the whole vaginal vault, sometimes hypertrophied to the size of the adult fist. The presenting mass is ulcerated, gangrenous, and covered with friable vegetations bathed in thin fetid pus and blood. The vaginal vault itself is usually involved by extension of the disease. The body of the uterus is found to be enlarged, and the mass of the cervix is held rigidly in the pelvis by the thickened cancerous broad ligaments.