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142 R A D I U M
"Operability.—Radical operations were performed in 60 of the 220
cases of carcinoma of the cervix regarding which we have sufficient
data for study. On the basis of this figure the operability in this series
was 27.3 per cent. Among 91 cases of carcinoma of the fundus, a radical
operation was performed on 70. making an operability of 76.9 per
cent."
"Although various reporters have published operability percentages,
it is obvious that their figures cannot be used as a basis of comparison
unless the judgment of each reporter as to the standard of operability
is known."
"Of particular interest in this discussion of operability- is the short
duration of symptoms and the extent of involvement at the time of operation.
Thus, among the cases of cancer of the cervix, in three cases
in which the symptoms had been recognized for less than a month, two
were diagnosed as inoperable and the vagina was involved in one. In
36 cases in which the duration of symptoms had been less than a year,
30 were inoperable and the vagina was involved in six. These figures
emphasize certain points to be made later regarding earlier recognition
of carcinoma of this organ."
"Incidence.-—Our figures show the highest incidence of both carcinoma
of the cervix and carcinoma of the fundus between the ages
of 50 and 60 years. This is later than the findings of most reporters
who place the highest incidence between the ages of 40 and 45 years.
As to the occurrence in married and unmarried women, but six of our
cases of cancer of the cervix occurred in single women. A similar relation
exists in the case of carcinoma of the fundus, our series showing
78 cases among married women as contrasted with 10 among unmarried.
These figures, combined with the lack of recognition of early symptoms,
emphasizes the" importance of Kelly's suggestion that '(1) The
physician attending a woman at labor should, six or eight weeks later,
make an examination and find out what lesions remain,' and '(2) Every
woman who has borne children should have a careful gynecological examination
at least once every year until she is 55 years old.' as in view
of the' symptomless early stages only by direct examination can one
surely catch the very firststages of carcinoma of either portion of the
uterus. This point is emphasized also by the fact that among our cases
hemorrhage or other discharge was noted as the first symptom in 122
out of 132 cases of carcinoma of the cervix in which the first symptom
was noted, and in 60 of the 68 cases of carcinoma of the fundus in
which the first symptom was noted. It will require a very long period
of propaganda and instruction of the public and medical profession at
large to assure that every' woman above the age of 40 will surely look
upon any abnormal discharge from the uterus as a suspicious symptom
upon its first appearance, especially during the period of the menopause."
"Predisposing Causes.—The preponderating incidence of carcinoma
of the uterus in married women, especially in women who have bome
children, indicates that laceration and irritations of the cervix are certainly
to be considered as primary predisposing causes. Poeltse reports
that chronic endocervitis preceded cancer in 34 out of 48 cases. Ewing
maintains that polypoid myomas of the cervix are usually malignant
at all ages and that the presence of a myoma in this region, therefore,
is to be considered as a definitely premalignant condition."