—In regard to the method of treatment there is but one which needs to be seriously considered, all others being fallacious and irrational. It is by operative removal alone that every hopeful case should be treated at the earliest possible date. Patients may dread the knife and some men may fear to use it. Nevertheless the above statement holds true. Even then cure is not obtained unless the knife be used thoroughly. Treatment by plasters is barbarous and unscientific, as well as uncertain and absolutely unsurgical. None of the popular remedies is of the slightest value. Treatment by the Röntgen rays should be reserved for the hopeless cases or for postoperative protection. Eradication is, therefore, the only scientific surgical relief.
Any growing tumor in the breast of a woman which cannot be clearly recognized as perfectly innocent demands operative removal, and the operation itself should be made thorough if success is to be attained. In the presence, then, of lymphatic involvement, of any adhesion or infiltration of the overlying skin, or of the surrounding textures, or of retraction of a nipple, or of fixation of the breast upon its base, operation should be advised without any reference to the question of pain. Equally important is it to decide when not to operate. When the condition is disseminated, when the presence of cancer in any other part of the body can be demonstrated, when the lymphatics of the neck are notably involved, when the arm is already swollen from obstruction to the return circulation, when the skin presents numerous miliary nodules, or when from disturbance of the heart or of respiration—i. e., chronic cough—it might appear that there is involvement of the bronchial nodes, with consequent pneumogastric irritation, then it may be held that the case is so far advanced that it is useless to subject the patient to the risk entailed by operation. There are exceptions, however, even to this statement; such as an evidently hopeless case that has reached the stage of ulceration, in which discharge is offensive or hemorrhage recurring, when operation may be done for temporary and with humane purposes.
Fig. 525
Cancer of male breast. (Buffalo Clinic.)
Fig. 526
Recurrent carcinoma eight months after incomplete operation in a woman seventy-five years of age, showing the extensive nodular, ulcerating surface surrounded by cancerous masses under the skin. The edema of the right arm from the circulatory obstruction occasioned by metastatic growths about the axillary vessels is well shown. (Parker.)
Recurrence is to a large extent inseparably connected with the matter of both early and thorough removal. Only when this can be practised should any hope of radical cure be offered. While the results attained by modern methods are very encouraging, they nowise contradict this statement. The discreet operator will, therefore, be guarded in giving a favorable prognosis or making promises. [Fig. 526] illustrates many of the sad features pertaining to recurrence.