The results of cancer of the female genitalia after irradiation

586

TIlE

AMERICllN

J. L. Faure’s practised this

Halban:

JOURNAI,

best results ligation.

Abdominal

C:yn&kologie,

have

been

and Vaginal

1923,

xlvii,

OF

OBS’l~I~TRICS

achieved

Operation

in

AND

the

for

GYNECOLOGY

series

of cases

Carcinoma.

in

which

Zentralblatt

he

fiir

1480.

The writer has collected his cases since 1910, having operated alternately by abdomen and vagina. The material between 1910 and 1918 consisted of 374 cases, of which 157 were operate,d upon-77 by laparotomy, and SO by the vaginal route. The results so far as cures were concerned were identical, though the primary mortality after laparotomy was practically twice that after operation by the vaginal route. Injuries to the bladder, ureters, and rectum were much more ilumerous in the cases done by abdominal section. It would appear that the individual malignancy of various cases of carinoma has more to. do with the endresults than has any form of operation. The abdominal and vaginal routes are absolutely of equal value, and it is possible that a combination of the two may iu certain cases improve results. In certain eases with a cardiac or lung complication, the vaginal method is usually less dangerous and can be undertaken with local anesthesia. This, however, implies the necessity for good vaginal technic which becomes less frequently noted among the younger gynecologists. LITTLE.

Goss& and Monod: Paris

Medical,

Indications 1924,

xiv,

for Surgery

in the Treatment

of Uterine

Cancer.

1%.

While the treatment of cancer of the cervix has undergone a radical change since the employment of the x-ray and of radium has been perfected, these authors feel that the treatment of cancer of the body of the uterus remains There remain certain indications for surgical intervention in strictly surgical. cases of cancer of the cervix. Among these, Gosset and Monod enumerate the following : Atresia of the vagina or even of the cervical canal; ankylosis of the hipjoints or other reasons why the vagina is inaccessible; coexisting infections. In the case of pyosalpinx in the presence of advanced carcinoma, they have found They have it expedient to remove the former and apply radiation afterwards. also found that an induration which was supposed to be an extension of the carcinoma sometimes disappears after such an operation, making the case appear more favorable than at first. In operable cases, they prefer to apply radium four or six weeks before operation. In removing such uteri after a thorough application of radium they have, in 17 cases, found unchanged cancer nests in the surrounding tissue. For this reason, the authors have come to the conclusion t.hat, except in far advanced cases, the best results are obtained by combining radium and surgery. R. E. WOBUS.

Opitz,

E.:

Medizinische

The Results Klinik,

of Cancer 1923,

xix,

of the Female

Genitalia

after

ImdiatiOn.

1215.

While there is no doubt that x-ray and radium kill the cells upon which they act, the problem of treating cancer by x-ray and radium is not simple because we must try to prevent damage to the tissue immediately surrounding the cancer Histologic examination of cancer cells an’d we must also avoid systemic danger. subjected to irradiation does not reveal the biologic effects which result from the irradiation. It is well known that disturbances in one group of cells (by irradiation or otherwise) produce an effect on the entire organism. From his own experience and from that of others, Opitz claims the following

REVIEWS

statements are true: direct relationship to

The the

AND

result

of

dosage

direct

used.

587

ADSTRACTS

irradiation Occasionally

of a carcinoma one finds a nest

has no of very

active carcinoma cells in completely necrotic connective Cssue, the result of irradiation. Since connective tissue cells are more resistant than carcinoma cells (epithelial cells) we here have an example of carcinoma cells resisting even a Nearly all cancers except those of the female high so-called carcinoma dose. genitalia, the skin and the thyroid, show very poor results from irradiation. Isolated cancer cells cannot be killed even with ten times the so-called cancer dose; for they become active again when implanted. Hofbauer obtained the same results in Yulvar carcinoma by irradiating the hypophysis as he did by direct irradiation. The results of irradiation are better when the neighboring tissue Increasing the dose does not result in hastening is irradiated at the same time. the healing but rather retards it. Local treatment is, therefore, not as important as some believe. Under the influence of irradiation a change takes place in the body which prevents the further growth of cancer and destroys the cancer cells. The results are essentially the same whether irradiation is local or general. Irradiation causeg a chemical substance to be found all over the body but This explains the apparently local most of it is found at the site of formation. &e&s of irradiation. The presence of this chemical substance has been shown by Behme. Instances have been seen where after treatment patients had remained well for years and then the cancer cells which had remained dormant became active again and killed the patients. Seitz believes in the employment of a definite dose for carcinoma of the uterus because he does not believe in a biologic conception of carcinoma. Ospitz discards the idea of a carcinoma dose because he considers not alone the carcinoma hut the entire sick individual. Opitz does not think that there is such a thing as a stimulating dose of irradiation for carcinoma and hence #does not fear to use small doses of x-ray and await results. On the other hand, too large a single dose may kill the patient. De’ath in such a ease is due to the sudden liberation of the products of carcinoma,necrosis before an immunity has been established. J. P. GREENHILL. Pfeiffer, fuer

J.: Metastases Gynaekologie,

of Carcinoma of the Uterus 1923,

cxx,

Gland.

to Bartholin’s

Arehiv

305.

This is the second case reported of metastases to Bartholin’s gland of carcinoma originating in the uterus. The patient was a para-iv, sixty-one years old. The connective tissue of the gland was split by abnormal cell rests, consisting of large, irregular, polygonal cells rich in plasma but without any intercellular substance. The tumor tissue penetrated into all the surrounding structures. RALPH

Burckhaxd: Zeitschrift

The &multaneous fiir

Geburtshiilfe

Occurrence und

of Carcinoma

Gytiologie,

1924,

A. REIS.

of the Uterus and Ovaries. Ixxxvii,

350.

From a review of the literature, and a careful consideration of the anatomic relations in both lymphatic and blood stream metastasis, the author believes that in his own case, and usually, the primary seat of the disease is in the uterus, while the ovaries are secondarily affected. The reverse may, however, hold true in some cases, and rarely the two carcinomata may be independent. MANARET

SCHULZE.