Volume 1
A Textbook of the theory and practice of medicine ... / edited by William Pepper.
- Date:
- 1893-94
Licence: Public Domain Mark
Credit: A Textbook of the theory and practice of medicine ... / edited by William Pepper. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
1023/1082 page 997
![Cancer of the Pancreas. Cancer of the pancreas is of chief clinical importance among the neo])lastic tumors of this organ. Lymphoma and sarcoma are of rare occurrence, are productive of similar symptoms to those from cancer, while tuberculosis and the syphilitic gumma are anatomical curiosities. Etiology.—The statistics with reference to the frequency of cancer of the pancreas and its limitation as to size and to the age of occurrence are not based wliolly on the primary or secondary occurrence of this lesion. Accord- ing to Willigk and Lebert, cancer of the pancreas occurs in about 6 per cent, of cancers, and Segr6 finds that rather more than two-thirds^of the patients thus aflFeeted are males. It is usually a disease of adult life, being rarely found before the age of thirty years, althougli a case of cancer of the pancreas has been ob- served in a child of two years, and the disease may be present at birth. The immediate cause of cancer of the pancreas is unknown, and its association with pancreatic calculi is rare. Morbid Anatomy.—The anatomical varieties of cancer are the hard, scirrhous, soft, encephaloid or medullary, gelatinous, and cylindrical-celled. The disease is either primary or secondary, and involves any part of the gland, or the entire organ may become diseased. It frequently affects the head, which may be transformed into a mass of tlie size of a child's head, although smaller tumors are much more common. The softer varieties may be exceed- ingly vascular, and are at times the occasion of a fatal haemorrhage into the peritoneal cavity or a serious bleeeding into the duodenum or stomach. Extension of the disease into adjacent parts is frequent. The neighboring lymphatic glands may become cancerous; nodules may be found in the liver or spleen. The peritoneum may become affected, and adhesions are frequent between the diseased pancreas and the stomach, colon, liver, spleen, gall-blad- der, and small intestine. Those portions of the pancreas not cancerous may present no abnormal a])pearauces, or the entire gland may be replaced by can- cerous tissue. The frequent limitation of the disease to the head of the pan- creas often leads to obstruction or obliteration of the central end of Wirsung's duct or to compression of the common bile-duct. In the latter case the gall- bladder may be found dilated by a colorless fluid. Symptomatology.—There may be no suggestive symptoms, and cancer be found after death, perhaps sudden, from other causes. As a rule, symptoms of digestive disturbances without apparent cause precede the more characteristic signs. A loss of appetite, perhaps an aversion to meat, a sense of epigastric fulness, belching, nausea, and vomiting are frequent. On the other hand, polyphagia, polydipsia, and polyuria may be present. The vomitus may con- tain blood, especially in the later stages, from ulceration of the surface of the tumor. The stools may become loose or irregular ; they may also contain blood from ulceration, although more constantly quantities of undigested muscular fibre may be found when meat is eaten and there is no diar- rhoea : they are rarely fatty. Pain is likely to be complained of, and is,](https://iiif.wellcomecollection.org/image/b21508677_0001_1023.jp2/full/800%2C/0/default.jpg)
