Preventable Diseases

by Woods Hutchinson

The nature of the process is a revolt of a group of cells. The cause of it is legion, for it embraces any influence which may detach the cell from its normal surroundings,—"isolate it," as one pathologist expresses it. The cure is early and complete amputation of not only the rebellious cells, but of the entire organ or region in which they occur.

A cancer is a biologic anomaly. Everywhere else in the cell-state we find each organ, each part, strictly subordinated, both in form and function, to the interests of the whole.

Here this relation is utterly disregarded. In the body-republic, where we have come to regard harmony and loyalty as the invariable rule, we find ourselves suddenly confronted by anarchy and revolt.

The process begins in one great class of cells, the epithelium of the secreting glands. This is a group of cell-citizens of the highest rank, descended originally from the great primitive skin-sheet, which have formed themselves into chemical laboratories, ferment-factories for the production of the various secretions required by the body, from the simplest watery mucus, as in the mouth, or the mere lubricant, as in the fat-glands of the hair-follicles, to the most complex gastric or pancreatic juice. They form one of the most active and important groups in the body, and their revolt is dangerous in proportion.

The movement of the process is usually somewhat upon this order: After forty, fifty, or even sixty years of loyal service, the cells lining one of the tubules of a gland—for instance, of the lip, or tongue, or stomach—begin to grow and increase in number. Soon they block up the gland-tube, then begin to push out in the form of finger-or root-like columns of cells into the surrounding tissues.

These columns appear to have the curious power of either turning their natural digestive ferments against the surrounding tissues, or secreting new ferments for the purpose, closely resembling pepsin, and thus literally eating their way into them. So rapidly do these cells continue to breed and grow and spread resistlessly in every direction, that soon the entire gland, and next the neighboring tissues, become packed and swollen, so that a hard lump is formed, the pressure upon the nerve-trunks gives rise to shooting pains, and the first act of the drama is complete.

But these new columns and masses, like most other results of such rapid cell-breeding in the body, are literally a mushroom growth. Scarcely are they formed before they begin to break down, with various results. If they lie near a surface, either external or internal, they crumble under the slightest pressure or irritation, and an ulcer is formed, which may either spread slowly over the surface, from the size of a shilling to that of a dinner-plate, or deepen so rapidly as to destroy the entire organ, or perforate a blood-vessel and cause death by hemorrhage. The cancer is breaking down in its centre, while it continues to grow and spread at its edge. Truly a "magnificent scheme of decay."

Then comes the last and strangest act of this weird tragedy. In the course of the resistless onward march of these rebel cell-columns some of their skirmishers push through the wall of a lymph-channel, or even, by some rare chance, a vein, and are swept away by the stream. Surely now the regular leucocyte cavalry have them at their mercy, and can cut them down at leisure. We little realize the fiendish resourcefulness of the cancer-cell. One such adrift in the body is like a ferret in a rabbit warren; no other cell can face it for an instant. It simply floats unmolested along the lymph-channels until its progress is arrested in some way, when it promptly settles down wherever it may happen to have landed, begins to multiply and push out columns in every direction, into and at the expense of the surrounding tissues, and behold, a new cancer, or "secondary nodule," is born (metastasis).

In fact, it is a genuine "animal spore," or seed-cell, capable of taking root and reproducing its kind in any favorable soil; and, unfortunately, almost every inch of a cancer patient's body seems to be such. It is merely a question of where the spore-cells happen to drift and lodge. The lymph-nodes or "settling basins" of the drainage area of the primary cancer are the first to become infected, probably in an attempt to check the invaders; but the spores soon force their way past them toward the central citadels of the body, and, one after another, the great, vital organs—the liver, the lungs, the spleen, the brain—are riddled by the deadly columns and choked by decaying masses of new cells, until the functions of one of them are so seriously interfered with that death results.

Obviously, this is a totally different process, not merely in degree, but in kind, from anything that takes place as a result of the invasion of the body by an infectious germ or parasite of any sort. There is a certain delusive similarity between the cancer process and an infection. But the more closely and carefully this similarity is examined the more superficial and unreal does it become. The invading germ may multiply chiefly at one point or focus, like cancer, and from this spread throughout the body and form new foci, and may even produce swarms of masses of cells resembling tumors, as, for instance, in tuberculosis and syphilis. But here the analogy ends.