Cancer: Its Cause and Treatment, Volume 1 (of 2)

by Lucius Duncan Bulkley

Much labor has been expended, by very many observers, upon the analysis of the urine in connection with cancer, as that might be expected to reveal the metabolic changes connected with this disease. While many departures from the normal have been reported, and while under complete volumetric analysis the urine of a subject of cancer is rarely if ever that of health, it cannot be said that any definite and specific changes have been established which may not be found in those without cancer; although there have been several who have so claimed even diagnostic signs from the urine. But minute, volumetric analysis is often of great service in guiding the nutrition and medication of these patients, and gross errors are continually met with, which have the greatest bearing on the case in hand, as indicating very great metabolic disturbance: and constantly the urinary excretion will be found to be extremely deficient, both as to its quantity and its total solid elimination. In one very interesting case of cancer of the breast, in a stout, flabby lady, near 55, in private practice, the total daily quantity of the urine, measured for weeks, is always very far below the normal amount; and in spite of active medication it seems almost impossible to raise the total daily solids excreted in the urine, to more than one-half of that called for by the weight of the patient. We may now briefly consider some salient points reported in connection with the urine in cancer.

As remarked in regard to other elements in the study of the disease, it would be very desirable to have a knowledge of the urine in pre-cancerous stages of health, or ill health, and also in very early cancer, likewise after surgical operations, that we might better understand the metabolic changes which lead up to malignant disease; but unfortunately these are exceedingly few and unsatisfactory, and almost all the studies have been made in advanced cancer, and often when the disease has affected vital organs, or when by its own poison it has disturbed the workings of the economy.

Many observers agree that there is a disturbance of proteid metabolism in cancer, and dependent upon this many deviations from normal are found in the urine, some of which in turn are related to the inanition which occurs. The urea is almost invariably diminished, often very greatly, as I have verified time and again in many cases.

A number of studies have been made upon the nitrogen partition in cancer by Einhorn, Kahn, and Rosenblum, also by De Bloeme, Swart, and Terwen, and others, showing an increase in colloid nitrogen, to more than double the normal amount, increased elimination of xanthin, oxyproteic acid, and urinary ammonia, together with many other changes which show that disintegration of the protein elements is very imperfect and often excessive. An interesting statement is made by Blumenthal that the oxyproteic acids are increased even in very early cancer, and independently of the size of the tumor and degree of cachexia, seemingly showing them to have some specificity for cancer, because they have not been found in other forms of malignancy. He also states that urobilin is increased in a large proportion of cases of cancer, especially when cachexia is setting in, and is a grave symptom.

Reid, who has confirmed many of these matters reported by others, says: “I have found an increase of amino-acid nitrogen in practically every case of cancer I have examined”; ... “Hence we can only infer that in cancer, the liver, while not involved in the disease, is still unable, for some reason, to perform its functions in synthetizing urea. The organ is functionally injured, no lesions having been found to explain its insufficiency”; or possibly ... “cancerous subjects form proteids which the liver is unable to deal with, so that they are excreted unchanged, or nearly so.” Degrez has made confirmatory studies along these lines, and found the nitrogen disintegration very imperfect, with increase of the ammonia fraction of nitrogen, and increased elimination of xanthin bases. He states that “the toxicity of the urine is increased apparently as the result of the presence of substances which have not been fully oxidized.”

Notable changes have also been recorded concerning the sulphur elements in the urine, with a great increase in neutral (unoxidized) sulphur and a considerable excess of sulpho-cyanic acid, together with an increase in sulphates and indican showing the results of intestinal fermentation of protein elements, which also I have constantly observed.

The chlorides, on the other hand, are, as a rule, diminished in cancer, especially in its late stages, when there is inanition or kidney insufficiency; and probably any change in them has only a relation to the nutrition of the patients, for the chlorides come from the food and are commonly an index of the amount of nutriment absorbed. Robin finds some relation between the excretion of chlorine and nitrogen, according to the stage or degree in which the system is affected by cancer.

The phosphates are known to be increased in the urine of cancer subjects, although irregularly and in an inverse ratio to the chlorides; as inanition increases there is greater autolysis of cellular structure, and the nuclei yield an excess of phosphates, which are excreted in the urine. A more or less general demineralization of the system through the urine has been observed by several, and has been recognized as a significant matter, and is of special importance when we consider what an important part minerals take in the nourishment of cell life.

While the changes which have been observed in the urine in connection with cancer are not wholly pathognomonic, but occur in connection with other diseased states of the system, so that none of them can be accepted as diagnostic of malignant disease, they all have a certain significance as indicating the metabolic changes which accompany and, as we believe, have much to do with the etiology of cancer; and, as stated before, a careful, systematic, and frequently repeated volumetrical analysis of the urine certainly assists greatly in the proper management of these cases, that is when the departures from normal are carefully studied and correctly interpreted.

The saliva, and its action, constitutes a very important part in the process of digestion, and consequently of metabolism and the genesis of cancer; far too little attention, however, has been paid to it practically, in ordinary life or disease, although there have been many laboratory studies and writings on the physiological action of this secretion; but I have not been able to find in literature any investigations relating to its condition in cancer. And yet the experience and writings of Mr. Fletcher and others have demonstrated wonderful results from perfect mastication and thorough insalivation, and a careful consideration of digestion must convince every one of the importance of this secretion in connection with nutrition, both in health and disease.