A Text-book of Diseases of Women

by Charles B. Penrose

In some other cases, instead of a protruding mass we discover an immense crater in the vaginal vault—a crater with indurated edges and sides, surmounted by the body of the uterus. The size of the crater shows that the destruction of tissue has extended far beyond the normal limits of the vaginal and supra-vaginal cervices. The interior of the crater presents an ulcerated, sloughing surface.

There is no condition which should be mistaken for cancer of the cervix in the last stages. A sloughing uterine polyp presents superficially a similar appearance, but the gangrenous mass will be found surrounded by a ring or collar, often very attenuated, of healthy cervical tissue, and the presenting tumor is usually elastic to the touch, not unyielding and friable like the cancerous mass.

In the early stages of cancer the appearance resembles closely the erosion of a bilateral laceration of the cervix. In the simple laceration, however, the erosion is soft, not indurated; there are no palpable edges; the cervix is not brawny; and it will be found that the simple erosion yields to local treatment, while the cancerous erosion does not.

Syphilitic ulceration and the ulceration of lupus are very rare upon the cervix. Syphilitic ulceration sometimes presents all the gross appearances of cancer. The history, the microscopical examination, and the therapeutic test will enable one to make a differential diagnosis.

Cystic degeneration of the cervix should not be mistaken for the nodular form of cancer, for the cysts may be seen and punctured and their character determined.

Benign fibroid tumors of the cervix are very rare, are usually single, and are larger than the nodules of cancer.

In every case of doubt, in every case in which the physician has the least cause to suspect malignancy, microscopic examination of an excised portion of tissue should be made. Examination of tissue scraped off should not be relied upon. The most suspicious portion of tissue should be seized with a tenaculum and freely cut out. Pieces of tissue may be thus excised from two or more situations. In the nodular form of cancer a nodule should be seized and excised. It is perfectly justifiable, in cases which cannot thus be elucidated, to amputate the cervix and examine the whole structure.

The excision of small pieces of tissue may be done without an anesthetic, as little or no pain is caused by the operation. Bleeding is very slight, and may always be controlled by a light vaginal compress of gauze or cotton. If the case is not malignant, healing is rapid. The specimen removed should be placed in absolute alcohol and submitted to microscopical examination by an experienced pathologist.

Symptoms of Cancer of the Cervix.—A study of the early symptoms of cancer of the cervix is of the greatest importance. In the early stages the disease may be eradicated with every probability of permanent cure. Cancer of the uterus is more favorable for surgical attack than cancer in most other parts of the body. Excision of the disease is not done in the continuity of an organ or a structure, but the whole organ attached by distinct structures may be removed.

The great majority of women with cancer of the cervix come to the operator when the disease has extended too far to permit any radical treatment. Hopeless palliation is the only course to be followed. This unfortunate condition of things is due to the ignorance of the woman in regard to the significance of the early symptoms of the disease, and to the failure of the physician first consulted to insist upon a thorough examination as soon as any suspicious symptoms appear.