Oncology Diseases

This may be induced by loss of blood, either quickly, as in hemorrhage, or gradually, as in the severe primary and secondary anemias. The anemia may be local and due to causes which interfere with the blood supply to the brain, as narrowing of the vessels by endarteritis, pressure, narrowing of the aortic orifice, or it may follow an unequal distribution of the blood in consequence of dilatation of certain vascular territories.  Thus, rapid distention of the intestinal vessels, such as occurs after the removal of ascitic fluid, may cause sudden death from cerebral anemia. […] Anemia of the cerebral vessels may be caused by pressure of fluid in the ventricles. The partial anemia results from obliteration of branches of the circle of Willis by embolism or thrombosis. Ligature of one carotid sometimes causes a transient marked anemia and disturbance of function on one side of the brain. […]

The effects of anemia of the brain are well illustrated by a fainting fit in which loss of consciousness follows the heart weakness. When the result of hemorrhage, there are drowsiness, giddiness,  inability  to stand, flashes of light, and noises in the ear; the respiration becomes hurried; the skin is cool and covered with sweat; and gradually, if the bleeding continues, consciousness is lost and death may occur with convulsions. In ordinary syncope the loss of consciousness is usually transient and the recumbent posture alone may suffice to restore the patient to consciousness. In the more chronic forms of brain anemia, such as a  result from the  gradual impoverishment of the blood, as in protracted illness or in starvation, the condition known as irritable weakness results. Mental effort is difficult, the slightest irritation is followed by undue excitement, the patient complains of giddiness and noises in the ears, or there may be hallucinations or delirium.

An interesting set of symptoms, to which the term hydrocephaloid was applied by Marshall Hall, occurs in the debility produced by prolonged diarrhea in children. The child is in a semi-comatose condition with the eyes open, the pupils contracted, and the fontanelle depressed. […] The coma may gradually deepen, the pupils become dilated, and there may be strabismus and even retraction of the head, symptoms which closely simulate basilar meningitis.

Osler, W. (1892). The Principles and Practice of Medicine. New York: D. Appleton & Company. Pg. 868-869.

Entered by: Ayushi Chintakayala, 7/1/2020

This is usually epithelioma. It is not an uncommon disease, and occurs more frequently in males than in females. The common situation is in the upper third of the lobe. At first confined to the mucous membrane, the cancer gradually increases and soon ulcerates. The lumen of the tube is narrowed, but when ulceration is extensive in the later stages the stricture may be less marked. Dilatation of the tube and hypertrophy of the walls usually take place above the cancer.

The cancerous ulcer may perforate the trachea or a bronchus, the lung, the mediastinum, the aorta or one of the its larger branches, the pericardium, or it may erode the vertebral column. In my experience perforation of the lung has been the most frequent, producing, as a rule, local gangrene. The earliest symptom is dysphagia, which is progressive and may become extreme, so that the patient emaciates rapidly. Regurgitation may take place at once; or, if the cancer is situated near the stomach, it may be deferred for ten or fifteen minutes, or even longer if the tube is dilated.

The rejected materials may be mixed with blood and may contain cancerous fragments. In persons over fifty years of age persistent difficulty in swallowing accompanied by rapid emaciation usually indicates esophageal cancer. The cervical lymph glands are frequently enlarged and may give early indication of the nature of the trouble. Pain may be persistent or is present only when food is taken. In certain instances the pain is very great. I saw an autopsy on a case of cancer of the esophagus in which the patient gradually became emaciated, but had no special symptoms to call attention to the disease. These latent cases are, however, very rare.

Osler, W. (1892). The Principles and Practice of Medicine. New York: D. Appleton & Company. Pg. 342.

Entered by: Ayushi Chintakayala, 6/18/2020

This may be primary, and, if so, is associated with gallstones in about 90 per cent of all cases; or secondary to disease in the liver or neighboring organs.

It usually starts in the fundus of the bladder. The symptoms are chronic jaundice, occurring in about 70 per cent of the cases; persistent pain and tenderness, subject to severe exacerbations; occasionally vomiting, hematemesis, melena, ascites, and fever; in about two thirds of the cases the presence of a firm, tender, and uneven tumour, which, unless adherent, moves with respiration, and extends downward and toward the umbilicus from the usual site of the gallbladder; and the development of cachexia.

Carcinoma may be primary in the ducts, especially the common duct, but this is not common. There is severe jaundice and enlargement of the gallbladder […].

Butler, G.R. (1901). The Diagnostics of Internal Medicine: a Clinical Treatise upon the Recognised Principles of Medical Diagnosis. D. Appleton & Company. Pg. 805.

Entered by: Ayushi Chintakayala, 6/18/2020

Edited by: Sonia Y. Khan, 8/4/2020

It is often impossible to differentiate primary and secondary cancer of the liver unless the primary seat of the disease is evident. As a rule, cancer of the liver is associated with progressive enlargement; but in some cases may not be enlarged. Gastric disturbance, loss of appetite, nausea, and vomiting are frequent. Progressive loss of flesh and strength may be the first symptoms. Pain or a sensation of uneasiness in the right hypochondriac region may be present, but enormous enlargement of the liver may occur without the slightest pain. Jaundice, which is present in at least half of the cases, is usually of moderate extent, unless the common duct is occluded. Ascites is rare, except in the form of cancer with cirrhosis, in which the picture is that of the atrophic form. Pressure by nodules on the portal vein or extension of the cancer to the peritoneum may induce ascites.

Inspection shows the abdomen to be distended, particularly in the upper zone. In late stages, when emaciation is marked, the cancerous nodules can be plainly seen beneath the skin, and in rare instances even the umbilications. The superficial veins are enlarged. On palpation the liver is felt below the costal margin, descending with each inspiration. The surface is usually irregular, and may present large masses or smaller nodular bodies, either rounded or with central depressions. With diffuse infiltration the liver may be greatly enlarged and present a smooth surface. The growth is progressive, and the edge of the liver may ultimately extend below the level of the navel. Although generally uniform and producing enlargement of the whole organ, occasionally the tumor in the left lobe forms a solid mass occupying the epigastric region. By percussion the outline can be accurately limited and the progressive growth estimated. The spleen is rarely enlarged. Pyrexia is present in many cases, usually continuous, ranging from 100 to 102 degrees F; it may be intermittent, with rigors. Thismay be associated with cancer alone, or with suppuration. Edema of the feet, from anemia, usually supervenes.

Osler, W. & McCrae T. (1892/1925). The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine (10th ed, pp. 590). New York: D. Appleton & Company.

Created by: Taha Jilani, 06/23/2021

Entered by: Rachel Johnson, 11/05/2021

The following are the most important and suggestive features:
     (a) Epigastric pains, often occurring in paroxysms.
     (b) Jaundice, due to pressure of the tumor in the head of the pancreas on the bile-duct. The jaundice is intense and permanent, and associated with dilation of the gall-bladder, which may reach a very large size.
     (c) The presence of a tumor in the epigastrium. As the tumor rests directly upon the aorta there is usually a marked degree of pulsations, sometimes a bruit. There may be pressure on the portal vein, causing thrombosis and its usual sequels.
     (d) Symptoms due to loss of function of the pancreas are less important. Fatty diarrhoea is not very often present. In consequence of the absence of bile the stools are usually very clay-colored and greasy.
     (e) A very rapid wasting and cachexia. Of other symptoms nausea and vomiting are common. In some instances the pylorus is compressed and there is great dilatation of the stomach.

The points of greatest importance in the diagnosis are the intense and permanent jaundice, with dilation of the gall-bladder, rapid emaciation, and he presence of a tumor in the epigastric region. Of less importance are features pointing to disturbance of the function of the gland.

Osler, W. (1909). The Principles and Practice of Medicine (7th ed.). London: Appleton and Co. Pg. 579-580.

Entered by: Erin Choi, 7/9/2020

The distinctive pathological feature, in addition to the anaemia, is the enlargement of lymphatic glands from hyperplasia of their cellular constituents, and the formation of lymphatic tumors in situations where lymph glands, normally, are not found. The affected glands may be greatly enlarged. They may undergo cheesy or fatty degermation. If opened, they discharge a milky liquid. The glands most frequently affected are cervical; next in the order of frequency are the mediastinal, lumbar, inguinal, axillary, mesenteric, and the iliac. In a considerable number of cases the spleen is enlarged, either with or without the presence of lymphoid tumors, and in a small proportion of cases this is true of the liver.

Flint, A. (1879). Clinical medicine: a systematic treatise on the diagnosis and treatment of diseases ; designed for the use of students and practitioners of medicine. London: Churchill. Pg. 184.

Entered by: Erin Choi, 6/22/2020