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R a d i u m 99
casionally a carcinomatous hemorrhage may accidentally occur a day
or two before or after the normal period, and thus simulate a prolongation
of the normal How but. as a rule, it is definitely intermenstrual
in type.
Owing to the age at which carcinoma of the fundus usually develops,
the irregular bleeding of the cancer is often attributed to the
menopause or to a recurrence of the menses. A slight amount of bleeding
frequently follows straining at stool, and this is often attributed by
the patient to hemorrhoids. The origin of the hemorrhage can be easily
determined by instructing the patient to insert a small piece of cotton
or gauze into the vagina prior to defecation and examining same shortly
after the bowels have moved. The discharge is thin, irritating, often
bloody and malodorous. The foul odor depends upon the amount of
degeneration which has occurred on the surface of the cancer. Some
authors state that discharge is usually the first symptom, and this may
be true. A small amount of discharge is. however, less noticeable than
a small amount of bleeding and for this reason, the latter is the more
important symptom.
An analysis of our case histories shows that in Si per cent of our
patients, hemorrhage was the first symptom, and in the remainder discharge
was noticed prior to the bleeding. Hemorrhage, however, occurred
in all at a later date, whereas in a few of our early cases discharge.
while perhaps present in small quantity, probably was not noticed bv
the patient. In carcinoma of the fundus, hemorrhage is worth about
75 points in the diagnosis, and discharge about 25; whereas in carcinoma
of the cervix, the symptom of hemorrhage is of even greater diagnostic
value, probably being worth 90 points and discharge 10 points. Hemorrhage
and discharge are the only subjective symptoms of much value;
pain, cachexia, loss of weight, etc.. generally indicate an advanced anil
hopeless condition.
The ini|H>rtance of early diagnosis cannot be overestimated. The
subjective symptoms during the early stage are by no means characteristic.
In our series, less than 25 per cent were early cases. A study
of the present scries proves that two factors stand out dominantly as
reasons for the advanced stage in which most of these cases were when
first observed. The first is that the lesion is painless during the early
stage. Nothing will bring a patient to a physician more quickly than
pain, and the absence of this symptom during the early stage of all
uterine cancers is an important and unfortunate factor. The second
reason that patients are prone to disregard the early symptoms is that
the menopause itself is usually irregular; probably not one woman in
ten passes through this period of life without some irregular bleeding.
Many women, therefore, disregard the slight irregular bleeding or slight
discharge which are the only symptoms of the cancer during its early
stage, under the belief that the hemorrhage is the result of the menopauuse
and, if she inquires among her friends, this opinion is almost
sure to be confirmed.
The reason that this misapprehension is so firmly established in the
lay mind and so difficult to eradicate, is that in 90 per cent of women
the irregularities are due to some benign condition, and as a result the
belief becomes more firmly fixed. Carcinoma of the fundus often develops
after the menopauses and after the woman has gone through a
more or less prolonged period of irregular bleeding, and under such