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R a d i u m 243
comparative statistics will be of little or no value, and theory and individual
impressions must be our guides.
Knowing the early and widespread metastases that may develop
in carcinoma of the breast, surgeons have operated as early and as thoroughly
as possible. Yet too many failures have resulted. Deaver says.
"We can never be sure that every malignant cell has been removed,-however
early and well localized the disease seems to be at the time of operation,
nor do the most complete operative procedures in such cases
insure freedom from recurrence. When the disease is localized to a
small area of the breast and the case is in other respects a suitable one
for operation, we may be led to hold out the hope of surgical cure; only
to have the patient die of early metastatic involvement of the viscera."
So, too, we have great difficulties with radiation. We certainly cannot
cure cancer by radiation excepting in those areas where we can deliver
enough of the rays to destroy the malignant cells, either directly
by the effects of the rays on the cancer cells, by the indirect action of
the rays in stimulating the connective tissue, or |>erhaps by stimulating
the development of some substance in the tissues which destroys the
cancer cell.
All of us have seen recurrent cancer of the breast disappear, and
1 have patients that have remained well ten and twelve years. We have
also seen widely distributed metastatic disease disappear. It would seem,
therefore, that if these same patients had been treated early -before
operation—by radiation, the primary disease should also have disappeared
more easily. We have also seen primary cancer of the breast
disappear, but in such cases there is always the thought in the minds
of some that the lesion probably was not carcinoma.
Certainly, if we can hold out a reasonable hope of cure by radiation.
patients will present themselves for treatment much earlier, and I believe
that such hope can be entertained. It is my present custom, so far as
1 am able, to get a surgeon's opinion and cooperation in each case. Then
I have been telling the patient, the family physician, or the family, that
with our present knowledge one of two procedures should be followed:
(i) There should alwavs be a roentgenogram of the chest made
to rule out metastasc*. (2> There should be a thorough preliminary
course of radiation given to the breast and to the lymphatics leading
from the breast. The amount of radiation given should be just under
an erythema dose with the high voltage rays, or at least with rays filtered
through six millimeters of aluminum. Such a treatment will usually
require two weeks. At the end of this time we should either do a complete
surgical removal, or should implant radium needles throughout the
tumor.
I am not sure which of these two procedures is best. By combining
roentgen ray treatment with surgery, il would seem that we are getting
all the possible good from surgery, and adding an extra precaution
against recurrence or metastasis. It does not. however, eliminate the
fear of operation which makes the patients come late. I am inclined
to believe that, when we have perfected our technique, the radiation
treatment will be the method of choice. It may be possible even to avoid
the use of the radium needle's. When this is possible, we shall have
eliminated all fear and will surely get the patients at an earlier stage.
Whether the patient is operated upon or whether the radium needles
are used, there should be a second course of deep x-ray treatment given.
Primary Cancer of the Uterus.—This subject has been more thoroughly