A Text-book of Diseases of Women

by Charles B. Penrose

There is no one symptom of cancer of the cervix present in all cases, and all the common symptoms may be absent in exceptional cases until the last stages of the disease—until the disease has extended so far that cure is impossible. It is of great importance to remember this fact, so that the absence of one or more of the classical symptoms of cancer shall not engender a feeling of security that may cause the postponement of a thorough physical examination.

The usual symptoms of cancer of the cervix are hemorrhage, pain, and discharge.

Hemorrhage.—The first symptom that should direct our attention to this disease is bleeding from the vagina. Such hemorrhage often first appears as a menorrhagia—as an increase in the amount of blood lost at the normal menstrual periods. The loss of blood may be greater, and the duration of the period longer. Sometimes, if the woman keeps quiet during the period, the loss of blood and the duration are about as usual; but if she is upon her feet the loss is increased, and if she begins an active life immediately after the usual duration of the menstrual period has elapsed, bleeding may reappear for one or more days.

In other cases slight bleeding appears in the menstrual interval. A spot of blood may be discovered upon the clothing. The accustomed leucorrheal discharge may occasionally be streaked with blood. Such appearances are most frequent after long walking or standing or physical work, or after straining at stool, or very often after coitus.

If the woman has passed the menopause, the hemorrhage of cancer may appear as a re-establishment of menstruation—often to the satisfaction of the woman. This post-climacteric bleeding may occur with more or less regularity—every month or every three or four months—or it may appear as an occasional loss of blood after unwonted effort.

All hemorrhage of this kind, in women over thirty years of age, demands immediate and careful physical examination. Any bleeding from the vagina in a woman who has passed the menopause should arouse the gravest suspicion. From the slight hemorrhages just described the bleeding increases in intensity and duration, until there is a continuous loss of blood that saps the strength of the woman and produces the profound anemia characteristic of the last stages of cancer of the cervix, Sudden fatal hemorrhage in this disease is rare.

Pain is not a constant accompaniment of cancer of the cervix in the early stages, nor is it in any way characteristic. The intensity and character of the pain may depend upon the direction of the growth of the disease. In some cases pain is absent throughout. The pain may be dull and gnawing in character, or it may be sharp and lancinating. The pain may resemble that of uterine colic. It may be referred to the back in the region of the sacrum, or to one or both ovarian regions, or to some part of the pelvis remote from the uterus, as the crest or the anterior superior spine of the ilium. It may extend down the posterior or anterior aspects of the thighs or into the rectum. In most cases of cancer of the cervix pain is not a prominent symptom until the later stages.

Discharge from the vagina may be present in cancer of the cervix before there are any symptoms of hemorrhage or pain. The discharge depends upon the position and character of the growth and the stage of the disease. It may first appear as an ordinary cervical leucorrhea in a woman previously free from such discharge; or the discharge of cancer may first appear as an increase of an accustomed leucorrhea. In such cases it is due to hypersecretion from the irritated cervical glands.

Later in the disease, when ulceration takes place or when the friable vascular vegetations appear, the leucorrhea becomes puriform in character and streaked with blood. It then becomes thinner, less mucous in consistency, and of a constant brownish color from the admixture of blood. The pus and débris from the breaking-down cancerous mass increase, and a horrible odor characteristic of the later stages of cancer of the cervix appears. This odor is not peculiar to cancer. It is caused by the sloughing tissue, and is observed when such a process occurs in other conditions, as in sloughing fibroid polyp. The discharge is irritating in character, and the ostium vaginæ, the vulva, and the inner aspects of the thighs become excoriated in those who do not observe strict cleanliness.

Systemic absorption of the cancerous discharges produces a general septic condition, which, with the anemia from hemorrhage and the uremia from obstruction of the ureters, results in the so-called cancerous cachexia.