THE EARLY DIAGNOSIS OF MALIGNANT DISEASE

By Geoffrey Keynes, M.A., M.D., F.R.C.S. John Bale, Sons & Danielsson, Ltd. 2s. 6d. net.

 

THIS is a very excellent little volume which should be in the hands of every physician and surgeon. The little book is so clearly written that it will be understandable to every layman who is interested in the cancer problem. The author is Assistant Surgeon to St. Bartholomews Hospital and Surgeon to the Mount Vernon Hospital, and he obviously knows this subject thoroughly well.

It is a misfortune that medical science is interested principally in the diagnosis of cancer and not in its prevention and that it scorns every treatment apart from surgery. Cancer is a disease of civilization. The more advanced is civilization, the more frequent is cancer. The disease is more frequent in the towns than in the country. It is practically unknown among the blacks in Africa, but is very frequent among the white men who live among the cancer-free natives. On the other hand cancer is frequent among the negroes of the African coast towns and of the United States.

Cancer is two or three times as frequent among sailors who live on devitaminized and demineralized food stuffs as among agricultural labourers. Obviously the cancer incidence might be greatly reduced, not by fighting the disease with knife, burning iron and radium, but by preaching to the people that they should live like agricultural labourers rather than like sailors.

Furthermore, orthodox medicine is practically helpless and teaches that there is no treatment for cancer except surgery. However, every able homoeopathic physician knows better. Homoeopathy has to its credit hundreds of undoubted cancer cures of patients who after an exploratory operation were told that nothing further could be done for them. Evidence of this will be found in my book Cancer, the Surgeon and the Researcher.

The author is not interested in the causation of the disease ad does not mention it. Neither does he mention the possibility of relieving pain, and curing the disease by dietetic and by safe medicinal means. He teaches that early diagnosis and surgical treatment is the only remedy available. This gospel has been proclaimed by the surgeons for decades. Most doctors send patients with obscure swellings immediately to the surgeon and the surgeon, without hesitation, cuts, burns or uses radium without enquiring whether the swelling is cancerous or not.

Under these circumstances one would have imagined that the cancer mortality would have declined or would, at least, have remained stationary. The holocaust of early operations should have had some effect upon the cancer death rate. Unfortunately the result of the surgical mania has been most disappointing. During the last twenty years the deaths from cancer in this country have, roughly speaking, increased from thirty thousand to sixty thousand a year. Twenty years ago one out of every sixteen deaths was due to cancer, now one out of every eight deaths is due to cancer.

Notwithstanding my criticism of the attitude of the doctors, surgeons, and researchers towards the cancer problem, I would like to repeat that this book is of considerable value and I hope that it will be widely read. I will give a quotation characteristic of the book:.

“What are the earliest signs that the greatest vigilance can detect?.

Consistency.– Any variation in the consistency of a breast as between its different parts should arouse a suspicion of cancer. It sometimes happens that mastitis is not uniformly developed, and the epithelial changes may, indeed, be almost confined to one lobule. There will then be a perceptible increase in the resistance of this lobule to the fingers, and to distinguish it from an early cancer may be almost impossible.

In the great majority of breasts affected by mastitis the change is diffuse and more or less uniform, so hat there is ample justification for suspecting any localized change. In general it may be sad that any breast lesion, however small, that is really hard in consistency, is most probably a cancer.

Illustrative Case.– A patient, aged 42, had noticed a painless thickening in her left breast for three months. On examination the upper half of the breast was found to contain thickened area about 2 cm. in diameter. Its limits were very indefinite, and no lump could be detected with the flat of the hand. It conformed in all particulars to a localized chronic mastitis, but the presence of an area which felt firmer than its surroundings suggested that it ought to be investigated.

The suspected area was excised, and found to contain a very small carcinoma infiltrating its surroundings. The excision was followed by radium treatment, and six years later the patient is quite well with an apparently normal breast.

Sometimes the real consistency of a malignant lesion may be masked by the overlying normal tissue, and then the diagnosis may be almost impossible to make.

Illustrative Case.– A patient, aged 59, complained of dragging pain in the right breast, which was very pendulous. On examination a slightly thickened tender area was found in the outer part, but it was soft in consistency, and presented no features suggesting carcinoma. No treatment beyond supporting the breasts was advised, and three months later the thickening was found to be somewhat more pronounced. Excision of the affected area revealed a small cancer on the deep surface.

Radium treatment was given and the patient remained for eighteen months without any local recurrence, when she died with metastases in the lungs, showing that the disease, though clinically very early had already been widely disseminated when treatment was undertaken.

Effect on the Skin.– Obvious puckering of the skin is nearly always a late sign, and long before this has occurred a faint dimpling of the skin can be detected, perhaps only to be seen in an oblique light when the skin is moved in relation to the lesion.

The effect produced on the skin by a cancer depends on two things; (a) Its distance from the skin; (b) the amount of fibrous reaction it produces. If the growth is cellular or separated from the skin by much fat or gland, it may have no effect on the skin in its early stages, and the absence of puckering or dimpling cannot be taken as a criterion.

Effect on the Nipple.– The nipple, being directly connected with the mammary gland by the lactiferous ducts, is a sensitive index of any contraction going on within the gland, and therefore of the presence of a cancer. But long before retraction of the nipple, which is a late sign, has developed, slight deviation as compared with the other side can be detected. Again, however, a cancer which is cellular or is situated in an outlying portion of the breast, may in its early stages have no effect whatever on the nipple.

Discharge from the Nipple.– Many patients with cystic mastitis have a greenish or pale brown discharge from the nipple and this is not affected by the presence of a cancer. If, however, the discharge is blood-stained, action should always be taken. The blood is diagnostic of a neoplasm in one of the larger ducts, and even though the neoplasm is possibly an innocent papilloma it is a source of real danger and should be removed.

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