Rieva Rosh

Carcinoma and other neoplasms of the male breast.

Cancer of the male breast is rare and the end-results are disappointing. Among the factors that contribute to the poor prognosis is the fact that to many physicians mammary carcinoma in the male is something of a myth—an oddity in medicine—and for that reason inconsequential. Unfortunately, both the medical profession and the layman underestimate any mammary lesion in the male, and diagnosis is made too late for adequate intervention to effect a cure. The infrequency of tumors of the male breast may be explained on both anatomical and physiological grounds. Most textbooks of anatomy present an erroneous impression of the male mammary gland. Cunningham and Gray pass over the subject superficially, describing the male breast as a vestigial and rudimentary organ, and one is left with the impression that it contains only scraps of glandular tissue. A good anatomical description is to be found in the paper by Andrews, whose observations are based on sections of normal breasts taken from subjects of all ages. I...

Radiation Therapy of Carcinoma of the Thyroid

Most papers on carcinoma of the thyroid are from centers where great numbers of patients with thyroid disease are treated. The volume of patients seen and operated upon permits the observation and treatment of a large number of early malignant neoplasms. The experience with thyroid carcinoma in a general hospital is quite different. At Bellevue Hospital only 64 cases of thyroid carcinoma have been seen since 1924 in the Radiation Therapy Department. These cases, unlike those seen at centers of thyroid treatment, are for the most part far advanced. Many of the patients were referred from other institutions where surgery had been done but no radiation had been given until recurrence or metastasis occurred. There are many interesting and informative papers on carcinoma of the thyroid. Lahey, Hare, and Warren (8, 15, 16, 27) have written a series of reports on the findings at the Lahey Clinic. In the most recent paper a series of 231 cases is summarized. Another series, that of the Cleveland Clinic, was recen...

Protracted External Irradiation in the Treatment of Carcinoma of the Mouth and Throat

THIS presentation is a preliminary report of clinical and laboratory work done in a further attempt to determine the comparative clinical values of radium and x-rays. The work was carried out in the Radiation Therapy Division of Bellevue Hospital as part of the regular therapeutic service of the Cancer Division, and with the assistance of a fellowship established through the courtesy of William R. Warner & Company, and Schering & Glatz. Three distinct methods of irradiation were employed: high voltage x-rays generated at 200 K.V., a small 100-milligram radium pack, and a 5-gram pack. The latter radium was loaned to Bellevue Hospital by Radium Belge. The physical measurements and experiments were carried out with special apparatus designed for this work, and the physical problems associated with this study were worked out by one of us (C. B. B.) Purpose of the Work Two years ago, there were reported simultaneously two technics for treating neoplasms of the mouth and throat: one by Coutard, who advocated pr...

Carcinoma of the Cervix with Bone Metastasis

Bony metastases associated with malignancy of the breast, prostate, and thyroid gland are of frequent occurrence. While direct pelvic extension or local metastases occur often, especially in neglected and untreated cases of carcinoma of the cervix, distant metastases from carcinoma of the cervix uteri, especially to bone, are very rare. From the Mayo Clinic, Ford (1) reports 14 cases of bone metastases associated with carcinoma of the cervix, the tibia being involved in two cases. Albers-Schonberg reports 564 postmortem examinations of carcinoma of the cervix, 0.83 per cent of which showed metastases to long bones. Wertheimer reports 13 cases of metastases from carcinoma of the cervix, but only one case with involvement of both tibias. Jeaneney (2) reports one case of metastasis to the tibia from primary squamous-cell epithelioma of the cervix, Grade 4. Monad (4) reports one case of metastasis to the sternum from a carcinoma of the cervix. In our series of 233 cases we have had only one case showing metas...

Cancer of the Breast

There are few problems of radiation therapy which have given rise to more contention than that of the employment of radiation in the treatment of breast cancer. Is it at all worth while? Is it best administered as an adjunct to surgery, preoperatively or postoperatively, or should it be given solely for palliation in advanced cases? What part does it play in the control of the primary cancer, in prolonging life, in destroying metastatic foci? All these questions have been raised and shuttled to and fro between surgeon and radiation therapist, between general practitioner and specialist. Advocates of one view or the other have offered statistics of all kinds, mostly, however, representing a biased selection. Bellevue, the largest municipal general hospital in the country, offers an opportunity for intensive investigation and study of all types of cancer in all stages and in sufficient number to permit one becoming conversant with all phases of the disease. Since it offers its services gratis, there can be ...

Vertebral Involvement in Hodgkin's Disease

THE incidence of bone involvement in Hodgkins disease is much higher than we have been led to believe by reports in the literature, and a more frequent complete radiologic investigation of the skeleton in cases suspected of Hodgkins will, not infrequently, show osseous involvement, even though this may not be clinically suspected. Jenkinson states that in the study of his cases there was evident a similarity between bone metastases of carcinoma and bone changes in Hodgkins disease. Reisner and Brada state that in their series of Hodgkins cases, 74 per cent presented bone involvement, and in approximately 50 per cent of these, the lesions were situated in the spinal column. Bone involvement, however, is usually considered a late development in the course of the disease. As in carcinoma, the vertebra, ribs, pelvis, and femora are most frequently the site of changes in Hodgkins disease. Lock-wood, Johnson, and Narr report a case of a boy, aged 15 years, in whom a roentgenogram revealed definite bone des...

Intravenous pyelography as an aid in classification of carcinoma of the cervix.

The factors which determine the ultimate outcome in carcinoma of the cervix are multiple. The radiosensitivity of the tumor and the clinical stage of the disease at which adequate treatment is instituted are, however, the most important guides to prognosis. There is considerable disagreement as to the correlation of pathological groupings and successful results. Actually, it has been our impression, and that of many others, that in carcinoma of the cervix, the extent and duration of the disease are of greater significance in determining the prognosis than the microscopic evidence of the degree of malignancy. We feel that the amount of success obtained in treatment depends largely on the extent of the disease. A clinical classification before radiation therapy is instituted is therefore of the utmost importance. Since 1938, the classification of carcinoma of the cervix as outlined by the Cancer Committee of the League of Nations has been adhered to closely in the Radiation Therapy Department at Bellevue Ho...

Steroids in Cancer of the Breast

Carcinoma of the breast in the female, like carcinoma of the female pelvic organs, is one of the most frequent causes of death from cancer. The U. S. Bureau of Vital Statistics gives the mortality rate as 12 per 100,000, and the yearly number of deaths from this cause is approximately 16,000. This high death rate is a direct challenge to the medical profession, and the difference of opinion as to the treatment of choice in operable cases is evidence of the dissatisfaction with the low survival rate from the various procedures employed. Every effort to increase the salvage of these patients whether by operation, irradiation, hormone therapy, or some combination of these is worth the gravest consideration. Bellevue Hospital (New York), the largest municipal general hospital in the country, offers an opportunity for intensive investigation and study of all types of cancer in every stage and in sufficient number to permit one to become conversant with the many phases of the disease, as well as the different m...

Roentgen Rays in the Treatment of Cervical Lymphadenitis

As early as 1898 Pfender mentioned roentgen rays in the treatment of scrofula, and in 1903 Pfahler and others published the first reports of encouraging results following radiotherapy of tuberculosis of the lymph nodes. Since then many clinics have demonstrated the value of roentgen rays in the treatment of cervical lymphadenitis, indicating that roentgen irradiation is one of the most important therapeutic agents in the management of that disease. In 1922 Lahey and Clute reported the end-results of surgical treatment but they emphasized that the best results were obtained in patients who were treated early and in whom complete excision of the nodes was possible; if sinuses or abscesses were present, chances of complete cure were not so good. In 1940, Lahey, Hare, and Haug showed that 80 to 90 per cent of patients responded to x-ray radiation, so that radical operative measures proved unnecessary. They stated that radical operation leaves poor cosmetic results and that there is a higher percentage of recu...