File:The diagnosis and treatment of diseases of women (1907) (14598219697).jpg

Identifier: diagnosistreatmecros (find matches)
Title: The diagnosis and treatment of diseases of women
Year: 1907 (1900s)
Authors: Crossen, Harry Sturgeon, 1869-
Subjects: Genital Diseases, Female Gynecology Gynecology Women Generative organs, Female
Publisher: St. Louis : Mosby
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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REATMENT OF CARCINOMA OF CERVIX 677 where they may grow. This has happened in several reported cases. Where anincision must be made tlirough infiltrated tissue, it is safer to make it with thecautery, as that destroys all cells with which it comes in contact. It must be kept in mind also that it is impossible to be certain in any case thatthe parametrium is not involved, no matter how early the case nor how perfectlynormal the parametrium feels. Sampson has demonstrated conclusively thatin some cases the carcinoma sends out, by direct growth, very fine prolongationsinto the parametrium and, in other cases, the carcinoma cells make short excur-sions into the lymph spaces of the parametrium. In such cases, there is nochange in the parametrium appreciable to the examining finger. It is evident then that any operation, whether vaginal or abdominal, that doesnot remove the parametrium, is not admissible as an operation for the cure of car-cinoma of the cervix, except in certain rare cases.
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Fig. 622. The Essentials for any Radical Operation for Cancer of the Cervix Uteri. The excision of structuresas here indicated must be carried out, whether the operation be abdominal or vaginal. (Kelly—OperativeGynecoJogy ) Any operation, whether vaginal or abdominal, that does remove the parametrium, is admissable in that it fulfills one of the essential requirements. Whether thework is done by way of the vagina or by way of the abdomen, is a matter of sec-ondary importance. The essentials of the operation are shown in Fig. 622. One point to be kept in mind is the removal of the uterus and parametriumintact. The broad ligament, including the tubes and ovaries, should of course beremoved. It is in the lower part of the broad ligament, however, that the infiltra-tion extends the farthest and that the principal operative difficulties are metwith. I prefer the abdominal route as a rule in operating for cancer of the cervix, 678 MALIGNANT DISEASE OF THE UTERUS but I have no serious obje

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