| Benign Growths. | Malignant Growths. |
|---|---|
| Common at all ages. | Rare in early life. |
| Usually slow in growth. | Usually rapid in growth. |
| No evidences of infiltration or dissemination. | Infiltration in all cases, dissemination in many. |
| Are often encapsulated, nearly always circumscribed. | Never encapsulated, seldom circumscribed. |
| Rarely adherent unless inflamed. | Always adherent. |
| Rarely ulcerate. | Often ulcerate—nearly always when surface is involved. |
| Overlying tissue not retracted. | Overlying tissue nearly always retracted. |
| No lymphatic involvement when not inflamed. | Lymphatic involvement an almost constant feature. |
| No leukocytosis. | Leukocytosis often marked. |
| Elimination of urea unaffected. | Deficient elimination of urea (?). |
Table II.—Diagnosis between Sarcoma and Carcinoma.
| Sarcoma. | Carcinoma. |
|---|---|
| Occurs at any age. | Rare before thirtieth year of life. |
| Disseminates by the bloodvessels (veins). | Disseminations by the lymphatics. |
| Arises from mesoblastic structures. | Arises from glandular (epithelial) tissues. |
| Distant metastases are more common. | Less so. |
| Contains blood channels rather than complete bloodvessels. | Contains vessels of normal type. |
| Less prone to ulceration. | More so. |
| Involvement of adjacent lymphatics not common. | Almost invariably adjacent lymphatics are involved. |
| Secondary changes and degenerations are more common. | Degenerations not common; other secondary changes rare. |
| (Sugar present in the blood?) | (Peptone present in the blood?) |
Differential diagnosis between epithelioma and ulcerating gumma will be found in [Chapter X].
Table III.—Diagnosis between Epithelioma and Tuberculosis (Lupus).
| Epithelioma. | Tuberculosis (Lupus). |
|---|---|
| Preceded usually by continued irritation or warty growths. | Irritation plays no figure. Preceded usually by nodules. |
| Diathesis plays no known part. | Diathesis evident. Coincident evidences of tuberculous disease elsewhere. |
| Rarely multiple. | Often multiple. |
| Area of thickening ahead of ulceration. | Extension of ulceration not preceded by thickening. |
| Ulceration advancing from a central focus. | Various foci, which may coalesce. |
| Border usually raised and everted, regular in outline. | Border abrupt, eaten, irregular, thickened, firm, often inverted, irregular in outline. |
| Often assumes fungoid type. | Never fungoid. |
| Base may be deeply excavated. | Base nearly level with surface. |
| Usually painful. | Seldom painful. |
| Bleeds easily. | Seldom bleeds. |
| Never tends to cicatrize. | As marginal ulceration proceeds there is often cicatrization at centre. |
| Most rare in the young. | Common in the young. |
| Discharge is very offensive. | Discharge rarely offensive. |
| Lymphatic involvement nearly always. | Rarely. |
GENERAL CONSIDERATIONS CONCERNING CANCER.
Cancer is one of the most fatal of diseases, yet has no symptomatology of its own. It produces no symptoms which may not be produced by other affections, and this lack of pathognomonic features constitutes one of the great difficulties in diagnosis. It may disturb every function of the part involved. Experimenters have sought in vain for a distinctive feature by which the disease can be recognized; neither in the blood nor in the various organic tissues have such changes been found that can be explained only on the hypothesis of cancer. The pain which it is supposed to cause is often lacking, and is extremely variable and uncertain. The cachexia of its terminal stages is not characteristic, no matter how pronounced, and may be explained by a variety of conditions, all of which may accompany the disease. The search for the suspected parasites cannot be made with such certainty as to lead to any definite conclusions. It is known by a complex of clinical conditions or by microscopic sections of tissues already removed.
When the disease is superficial it is easily recognized, but when deep-seated, recognition comes later.[15]
[15] Since the discovery of Spirochæta pallida in syphilis, Mulzer and Loewenthal have found spiral organisms on the surface of ulcerating tumors. Borrel also found spirochætæ in conjunction with helminthia in two enclosed mouse tumors, and also in a large tumor sent from Ehrlich’s laboratory. None of these authors attributed any significance to the presence of these organisms, but recently, through the publication of Gaylord, in the Journal of Infectious Diseases, who has found a characteristic small spiral organism in nine out of ten primary mouse tumors, and in all of the transplanted mouse tumors of three distinct strains in the New York State Cancer Laboratory, the subject has attracted new interest.