Cancer of the Intestine.
Only a small per cent of malignant growths are located in the intestinal canal, variously estimated at from four to eight per cent.
Etiology.—Cancer generally occurs in the second half of life, or from the fortieth to the sixty-fifth year of age, and is more often found among males than females. Aside from heredity and age, various sources of irritation, such as fissures, ulcers, hemorrhoids, and fistulas, predispose to carcinoma by furnishing a suitable soil for the development of the malignant germ, whatever that may be; and the frequency with which cancer locates itself in the rectum sustains this view.
Pathology.—The predilection for certain parts of the intestine is shown in the examination of two hundred and forty-three cases of cancer of the intestine, in the Pathologic Institute of Vienna. Thus, five were in the duodenum; six in the ileum; none in the jejunum; one hundred and eighteen in the large intestine; one in the vermiform appendix; fourteen in the cecum; sixty-three in the colon in general; forty in the sigmoid flexure; and one hundred and fourteen in the rectum. (See Nothnagel's "Encyclopedia of Medicine.")
The varieties of cancer found in the intestine do not differ from those occurring in other portions of the body; namely, scirrhous, encephaloid, colloid, and cylindrical-celled epithelioma.
Beginning in the mucous membrane, it soon invades the entire intestinal wall, frequently encircling the entire lumen, and in this way gives rise to intestinal obstruction; or it may be a diffuse, nodular mass, involving but one side of the gut.
The encephaloid and cylindrical-celled epithelioma are soft, fungoid in character, and rapidly ulcerate, while the scirrhus are slow in developing, and are late in ulcerating. Above the cancerous mass there is dilatation of the bowel, which forms a depot for fecal accumulations. The cancerous mass often invades contiguous parts. Fatal hemorrhage may result from deep ulceration, which sometimes attends these cancerous growths.
Symptoms.—There are no characteristic symptoms in the early stage, and in some cases they run their course with but little evidence of their malignant character, cachexia and anemia, that always attends carcinomatous growths. Where the growth develops rapidly there is generally slight fever, the temperature in the morning being 99° or 100°, and in the evening 101° or 102°. At other times the temperature is normal or subnormal.
The first symptoms, in some cases, will be evidence of occlusion, the patient being obstinately constipated, or diarrhea may attend, the stools consisting of a dark-brown, thin liquid, and very offensive; or the patient may pass small quantities of mucus, pus, and blood, with occasionally little balls of fecal matter, resembling the feces of sheep, or again it may be ribbon-shaped.
Pain is a common symptom, though varying in character. It may be dull, the patient complaining of soreness and tenderness on pressure, or it may be sharp, lancinating, and darting in character.
If the growth be located in the duodenum, there will be evidence of obstruction of the pancreatic and bile ducts, and dilatation of the stomach. If located in the lower part of the large intestine, there will be pain in the sacral region, extending to the genital organs. If in the sigmoid, the stools are apt to consist of mucus, pus, and blood. Rectal cancer is apt to be attended with intense pain in defecation, followed by tenesmus and exhaustion.
The patient early takes on a cachectic appearance, the skin becomes dry and harsh, and emaciation is rapid. The tumor mass may usually be felt through the flat abdominal walls; it may be movable or tied down by adhesion, and fixed. The mass is usually tender, any manipulation causing pain. The appetite is often retained and the tongue clean.
Diagnosis.—This is not always readily made. The age of the patient, heredity, constipation, cachexia, sharp, lancinating pain, emaciation, small bloody stools, and a palpable nodular mass, are the chief diagnostic symptoms.
Prognosis.—It is always unfavorable, the patient dying in from three or four months to three or four years.
Treatment.—Where the growth is located in the duodenum, there is generally dilatation of the stomach, which favors a retention of food, and fermentation of the gastric contents. To relieve this unpleasant condition, frequent washing out of the stomach by the lavage tube will prove beneficial. The diet should be nutritious and easily digested, and better if given in fluid form.
The bowels should be kept open by use of the small strychnin, aloe, and belladonna pill. Morphia may be necessary to allay the severe pain. In rectal cancer, where the pain is intense, an opium suppository will give relief, or a small gelatine capsule containing one grain of powdered opium may be pushed within the rectum, where it will cause less tenesmus than a larger suppository. Where there is an offensive diarrhea, an antiseptic and disinfectant enema should be given several times per day.