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It will readily be understood that the less thoroughly or radically the growth has been removed, the more do we depend upon radium or the X-rays for bringing about a permanent cure, and that in advanced cases of sarcoma and in cases in which, on account of their anatomical situation, removal by operation is necessarily incomplete, the prospect of cure is still more dependent on the use of radium or of the X-rays.
This may be observed in sarcoma of the kidney, the growth taking place along the renal vein until it projects into the vena cava. [Illustration: FIG.
The features are those of a rapidly growing sarcoma involving a nerve-trunk, with agonising pain and muscular cramps, followed by paralysis from destruction of the nerve fibres. The removal of the tumour is usually followed by recurrence, so that high amputation is the only treatment to be recommended. Metastasis to internal organs is exceptional.
Once the skin is broken the tumour fungates through the opening. Sarcomas vary in malignancy, especially as regards rapidity of growth and capacity for dissemination. They are usually solitary in the first instance, although primary multiple growths are occasionally met with in the skin and in the bones. Many varieties of sarcoma are recognised, according to its structural peculiarities.
X-ray appearances in periosteal tubercle: the surface of the cortical bone in the area of disease is roughened and irregular by erosion, and in the vicinity there may be a deposit of new bone on the surface, particularly if a sinus is present and mixed infection has occurred; in syphilis the shadow of the bone is denser as a result of sclerosis, and there is usually more new bone on the surface hyperostosis; in periosteal sarcoma there is greater erosion and consequently greater irregularity in the contour of the cortical bone, and frequently there is evidence of formation of bone in the form of characteristic spicules projecting from the surface at a right angle.
In these conditions, a malignant transformation of the fibroma into sarcoma is to be suspected. Motor disturbances are exceptional, unless in the case of tumours within the vertebral canal, which press on the spinal medulla and cause paraplegia. [Illustration: FIG.
#Primary Tumours.# Lympho-sarcoma, which may be regarded as a sarcoma starting in a lymph gland, appears in the neck, axilla, or groin as a rapidly growing tumour consisting of one enlarged gland with numerous satellites.
New growths taking origin in the synovial membrane are rare, and are not usually diagnosed before operation. They are attended with exudation into the joint, and in the case of sarcoma the fluid is usually blood-stained. If the tumour projects in a polypoidal manner into the joint, it may cause symptoms of loose body.
Sarcomata, if allowed full progress, may attain great size. Plate 10 shows an enormous sarcoma of the buttocks in an adult negro. Fascial sarcomata are often seen of immense size. Senn shows a tumor of this variety which was situated between the scapulae.
The alveolar sarcoma commences as a hard lump and increases in size until the epidermis gives way and an ulcer is formed. [Illustration: FIG.
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