A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
=Treatment.=--Complete removal of the uterus is the only curative
treatment for cancer of the cervix. If the disease is seen in the
earliest stages, amputation of the cervix beyond the limits of the
growth seems, theoretically at least, to be a proper plan of treatment.
Practically, however, the operator can never be certain that the
excision is made in healthy tissue. The senses of touch and unaided
sight are not capable of defining the limits of malignant infiltration.
Moreover, it must be remembered that the endometrium is very often
involved secondarily from a cancerous focus in the cervix. Complete
removal of the uterus should therefore always be practised in all cases
in which there is a possibility of removing all of the disease.
The manner of performing this operation will be described subsequently.
The cases that are not suitable for the operation of hysterectomy
are those in which the disease has extended to structures that are
surgically inaccessible. Such cases include those in which the bladder
or the rectum are involved, those in which the vagina is extensively
implicated, and those in which the disease has extended into the broad
ligaments or the cellular tissue of the pelvis.
When the bladder is involved, there are dysuria, vesical pain, and
tenderness on vaginal pressure upon the base of the bladder, while the
urine is altered in character, containing blood, pus, and, in the
later stages, broken-down necrotic tissue. Involvement of the rectum is
manifest by digital examination.
When the broad ligaments are involved the uterus is held rigidly in the
pelvis or is drawn to one side, and the bases of the broad ligaments,
palpated through the lateral vaginal fornices, are thick and hard.
When the cellular tissue of the pelvis is generally involved the
whole vaginal vault feels indurated and the uterus seems fixed in the
unyielding matrix.
In examining with the view of determining the practicability of
hysterectomy, it is important to distinguish between cancerous and
simple inflammatory involvement of the broad ligaments. The uterus may
be fixed in the pelvis by inflammatory adhesions resulting from old
tubal disease, and yet the cancer of the cervix may be strictly local
and in a stage suitable for hysterectomy. In the simple inflammatory
cases the adhesions are more attenuated, are higher in the pelvis, and
lie chiefly posterior to the uterus. They are not directly continuous
with the cervix. Frequently the enlarged tube and the adherent ovary
may be felt. When the uterus is fixed by cancerous involvement of
the broad ligament, we readily feel that it is the base of the broad
ligament that is involved. The induration is broad, it is directly
continuous with the induration of the cervix, and it lies to the side
of the uterus.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Elsewhere in the archive
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account