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

by Lucius Duncan Bulkley

Metastases form a very considerable and important element in inoperable and recurrent cancer, and we will briefly consider these. They occur mainly through three channels: 1. The lymphatic system; 2. The venous system; and 3. The arterial system. The permeation theory of Handley relates to direct extension laterally through lymphatic spaces, and belongs to the first mentioned means of extension. It is also believed that metastases may be formed in the peritoneal cavity, and likewise in the pleural cavity, by direct contact of cancer cells or pieces of malignant tissue which have gained access to those cavities and have been carried down by gravity and movement of viscera. They then become engrafted on healthy tissue and form metastases there.

While holding firmly to the belief that the original cancerous growth and other foci of disease are developed from a vicious state of the blood current, there seems to be no reason for doubting that the disease may also be extended in the manner above indicated. Although cancer material cannot be inoculated from one person to another, or from a human being to animals, nor from one species of animal to another, experience and observation show that the malignant process can be transferred from one organ or structure of the same individual to another part or structure, whether there has been a surgical operation or not.

The lymphatic system is apparently the first means for the spread of the malignant process, and all are familiar with the lymph nodes seen in the neighborhood of cancerous masses. It is supposed that these are caused by the lodgment of detached cells which have taken on the abnormal reproductive action which characterizes cancer. As with other foreign bodies, pus cocci, etc., the minute lymphatic glands seek to arrest their passage into the circulation, and it is probable that some of them are destroyed there, for the single enlarged gland will often remain for a long time as the only manifestation of metastasis. In many cases, where the original cancer has disappeared under dietary and medicinal treatment, the enlarged glands also disappear, as I have seen many times.

When the disease is unchecked, however, the glands fail in their endeavor to protect the system and continue to enlarge one after another along the line of the lymphatics, and the lymph stream then carries certain cancer elements through the thoracic duct into the venous circulation; thence they reach distant parts of the body, through the arterial system, and, being lodged in capillaries, a more or less general carcinosis results. Cancer elements can also proliferate along lymphatic tracts, and, furthermore, they may enter the venous and arterial systems directly by the invasion of a malignant growth.

All these and other points regarding the metastasis of cancer form a very interesting study, but time does not permit of further elaboration. All know that while primary carcinoma of the liver is very rare, its secondary or metastatic involvement is very common. The bones, lungs, spleen, kidney, and viscera generally are all often found to be the seat of metastases, and in general carcinosis, which has lasted some time, metastases will be found abundantly both in the lymphatics of many parts of the body and in many organs and tissues. Metastases in the lungs are not uncommon in breast cancer, as also metastasis in the bones of the thorax. In the last lecture reference was made to the frequency of metastases in the skeletal structures of the body, which probably have much to do with the pernicious anemia which carries off the patient.

An interesting study relates to the extension of the carcinomatous process in the skin; this occurs at first near, and then around, and even at a distance from the site of an operation, especially after removal of the breast. These nodules are at first small, and felt deep in or below the skin, and are not colored. They steadily increase in size, and when about that of a small pea, they become red and elevated a line or so. Later they may appear more numerous and even involve a large area, forming the so-called cancer en cuirasse, and may ulcerate. Sometimes single lesions of some size may appear here and there, even some distance from the site of the original tumor, and may not be colored. While these may represent lymphatic infarctions, it is often impossible to trace any direct connection with lymph ducts, and they more probably arise from capillary deposits of cancerous elements. I have frequently had these scattered cutaneous lesions excised, in cases under medical treatment, with a view of removing mechanically some of the foci from which the disease could be spread. The wounds have invariably healed promptly and perfectly, and no carcinomatous process has resulted.

The BLOOD IN CANCER has been studied mainly in reference to its solid constituents, and very little in regard to its plasma; whereas it is from the plasma that the blood corpuscles are formed, and this is the principal agent in the development and nutrition of tissues, normal and malignant. For it is to be remembered that the chyle is discharged directly into the venous blood current, and the venous radicles absorb much of the nutritive material directly from the abdominal organs. The plasma, therefore, carries with it constantly a varying quantity of partially assimilated material to be oxidized in the lungs, and slowly purified by the agency of the kidneys; the serum albumen and serum globulin are also active agents in the formation of tissue, malignant or other. There is great need of laboratory studies along these lines, and also on the alkalescence of the blood, which we found to have a marked diminution in cancer.

We know also comparatively little in regard to the origin and destruction of the cellular elements of the blood, and can only depend on the microscopic examination of their forms and appearances in health and in many conditions of disease. These have been abundantly studied morphologically, but mainly in the more severe forms and later stages of cancer, as detailed somewhat in my former lectures. Enough was there quoted to show the continued degeneracy of the blood after a cancerous growth had acquired some progress; there has also been observed some improvement for a while after the removal of a tumor, evidencing the deleterious effect of the hormone secreted by a cancerous mass.

The laboratory study of the blood from 22 of the cancer patients in the New York Skin and Cancer Hospital under my care, has been instructive as well as valuable along certain lines. In most of them it was made weekly, and often over long periods of time, and the results tabulated for easy comparison, in order to study closely the condition of the patient and the effect of remedies. No very startling revelations were made by these blood studies, they confirmed in the main the observations of others, though some interesting facts were learned from an analysis of the data. They referred to ten cases of cancer of the breast, four of the stomach, two of the uterus, one of the rectum, one of general abdominal carcinosis, and the rest in scattered locations.

The lowest hemoglobin index was 35, with 2,800,000 red blood cells, in a woman aged 59 with cancer of the stomach. The next lowest hemoglobin index was 45, with which the patient, aged 53, died, with inoperable cancer of the right breast; the blood count showed 3,700,000 erythrocytes, and 10,400 white blood cells, 76 per cent of which were polynuclear. During the course of observation, covering several months, the red blood cells were once 2,100,000, but under careful treatment rose to 4,110,000 not long before death. The next lowest red cell count observed was 2,200,000, with 12,000 white blood cells, and 65 hemoglobin index, in a man aged 52, with a terrible inoperative cancer of the cheek and neck, of which he died.