Lewis C. Scheffey

Carcinoma of the pancreas with metastasis to the cervix uteri

Abstract According to Herbut 6 the most common secondary sites of a carcinoma of the pancreas are in the regional lymph nodes, liver, peritoneum, lungs, gall bladder, diaphragm, mediastinal nodes, and pleura. A case of metastatic cancer of the cervix arising in the pancreas is described. As far as we can ascertain this is the second report of pancreatic carcinoma spreading to the uterus, and we believe it is the first of its kind that definitely involved the cervix. As was shown, the anaplasticity of the tumor led to the incorrect interpretation of primary carcinoma of the cervix. Although metastatic tumors of the cervix are rare, it behooves one to remember that they do exist and that occasionally carcinoma of the cervix may not be a primary lesion.

Adenocarcinoma of the cervix in a twenty-two months' old child

Abstract 1.1. We herewith present a case of adenocarcinoma of the cervix in a twenty-two months old child, terminating fatally. 2.2. The histologic diagnosis has been concurred in by the above mentioned group of gynecologists and pathologists. 3.3. From a survey of the literature, we believe it to be the earliest case on record of an adenocarcinoma originating in or limited to the cervix uteri.

A twenty-five year evaluation of the treatment of carcinoma of the cervix with irradiation

Abstract 1.1. An evaluation and eritical analysis of the 485 patients seen and/or treated by irradiation for carcinoma of the cervix on the ward service of the Division of Gynecology, Department of Obstetrics and Gynecology at Jefferson Medical College Hospital, from Sept. 1, 1921, to Sept. 1, 1946, have been presented, with a follow-up record of 98.5 per cent. 2.2. Modification in the evaluation of five-year survival results, as contrasted with previous reports from this service, have been explained. 3.3. Transposition of all patients from the original Schmitz grouping to the International staging has been accomplished, with both classifications appearing for comparison in the statistical evaluations. 4.4. The question of the delay period in the diagnosis of pelvic cancer in the City of Philadelphia has been presented, with pertinent comment and data. 5.5. Methods applicable for earlier diagnosis and prophylaxis with respect to cervical carcinoma have been discussed. 6.6. The progressive evolution in our methods of utilizing irradiation therapy with x-ray and radium since 1921 has been compared with methods deseribed in previous reports and minutely analyzed, revealing increasing five-year survival rates as follows: 7.o 8.A. 1921–1936 27.9 per cent. 9.B. 1936–1942 34.6 per cent. 10.C. 1942–1946 47.6 per cent. 11.7. The three- and four-year trends with the continued use of the planned therapy initiated in 1942 have likewise been scrutinized, as well as certain operative procedures that have been performed additionally during the same period. 12.8. The occurrence of carcinoma of the cervical stump among the patients in this series has been commented upon. 13.9. Postirradiation complications have been discussed in some detail, indicating that increased survival rates have been accompanied by a higher incidence of bowel and bladder disturbances. Further improvement in irradiation methods is vital if serious damage to normal tissue is to be avoided in an appreciable percentage of patients so treated.

Further end-results in the treatment of carcinoma of the cervix

Abstract An analysis of a series of 156 patients with carcinoma of the cervix observed on the Gynecologic Ward Service, Jefferson Medical College Hospital, between 1921 and 1930, of whom 146 were treated, is presented, based upon a follow-up of 96.1 per cent of the patients seen, and of 97.9 per cent of the patients treated. An absolute curability rate of 19.2 per cent, and a relative curability rate of 20.5 per cent, and a five-year salvage of 25.3 per cent are presented. These are contrasted with the rates of 14.2 per cent, 15.0 per cent, and 20.7 per cent respectively, reported by the same authors five years ago, based upon the study of 63 patients observed between 1921 and 1925. Various phases of the analysis are discussed in detail, together with the exhibition of statistical tables.

End results in the treatment of carcinoma of the cervix

Abstract 1. 1. An analysis of a series of 293 patients with carcinoma of the cervix observed on the Gynecological Ward Service, Jefferson Medical College Hospital, from Sept. 1, 1921, to Sept. 1, 1936, of whom 277 were treated, is presented, based upon a follow-up study of 97.2 per cent of the patients seen and of 97.8 per cent of those treated. 2. 2. An absolute present-day salvage rate of 12.9 per cent, a relative present-day salvage rate of 13.7 per cent, and a relative five-year salvage rate of 23.1 per cent are presented. These are contrasted with rates of 19.2 per cent, 20.5 per cent, and 25.3 per cent respectively, published in 1936; and with rates of 14.2 per cent, 15.0 per cent, and 20.7 per cent respectively, published in 1931. 3. 3. Various phases of the analysis are discussed and compared with the previous reports, together with the exhibition of pertinent data.

The influence of repeated radiation on the salvage statistics of carcinoma of the cervix

I N THE study of carcinoma of the cervix, there has been a constant endeavor to reach a clearer and more complete estimate of the results of treatment. The term “cure ” has been given up since one can nevel be sure when that point has been reached. We speak of “salvage ” as representing the number of years at the end of which the patient is alive and apparently free of the disease. The trend towa.rd a more complete understanding of the effect of cancer therapy was shown a year ago by Kimbrough who pointed out the fact that 20 per cent of the five-year survivals among a series of patients observed at the Hospital of the University of Pennsylvania subsequently died of cancer. Similar findings at Jefferson Medical College Hospital were presented by the author in discussion. In 1936 Lynch suggested another viewpoint that, has impressed us at Jefferson. This dealt with reradiation. He said “ Cases are reported as five-year cures, although they have received several courses of roentgen therapy, or have been reradiated during what is intended only for an observation period to determine the efficiency of the chosen therapy. ” It is of this reradiation and its influence upon salvage statistics that we wish to speak. We have for a long while followed the plan of Ward, Farrar and Sackett in personally observing cancer patients at appointed intervals after treatment and of reradiating those in whom recurrences were detected. Our statistics deal with comparatively few cases when compared with those of Heyman, Healy and Ward, numbering but 248 from 1921 to 1934. This figure includes all patients with cervical cancer seen in the gynecologic ward service at Jefferson Hospital, and, with few exceptions? treated by Dr. Anspach and myself. During this time our ideas relative t,o treatment have undergone considerable change for various reasons and in certain details. In the beginnin,, (r operative treatment still seemed desirable in some instances and a few patient,s were subjected to piInhysterectomy, but since 1924 we have depended entirely upon radiation. At the outset, and during the period covered by this report, our available radium was in capsules screened with silver and brass (0.3 mm. ol’ silver, 1.0 mm. of brass), and with Ifone metal needles (0.3 mm. 1. We knew very little about filtration. Neither was the deep x-ray t.lel*apy the efficient means of radiation that it is at present. For the past, fca J-;ears lvc have been using high voltage x-ray therapy prior to t,he aplllication of radium, now screened with platinum (50 mgm. capsnlcs with 1.5