Sarcomas frequently arise from the periosteum. Commencing in the interior of a bone, they develop for the most part very slowly, and expand the bone more or less symmetrically, in distinction to those growths of external origin which are in evidence on one or another aspect of the bone involved ([Figs. 247] and [248]).
Sarcoma not infrequently has its origin from the callus of a delayed bone union, and I have had repeatedly to amputate for this sequel of fracture. (See [Fig. 252].)
As the disease advances there is increase of pain, usually with increasing cachexia, while augmentation in size of such a tumor may make a limb not only useless, but the source of greatest annoyance and difficulty in management of the case.
Treatment.
—There is but one treatment in cases which will permit it—amputation of limbs, extirpation of tumors from certain bones, or excision of entire bones. Thus for sarcoma of the scapula we extirpate the entire bone; for sarcoma of the skull we make extensive resections of the same, removing the underlying dura when involved; for sarcoma of the lower or upper jaw we remove it in whole or in part. Sarcoma of the spine is inoperable, that of the pelvis almost equally so. In absolutely inoperable cases treatment by the toxins of erysipelas may be tested. In all cases where pain is severe opiates should be administered, which under these circumstances are anodyne, stimulant, and almost nutritive. Patients in this condition should not be allowed to suffer, and opium in assimilable form should always be administered to any amount necessary.
Fig. 250
Sarcoma of periosteum of humerus. (Pemberton.)
Fig. 251
