Next in frequency to fibroid growths is the occurrence of cancer. It always attacks the cervix in the first instance, and especially that portion which projects into the vagina; the primary occurrence of carcinoma at the fundus uteri is so extremely rare, that the above observation may be considered as an absolute rule. It is contrasted in this respect with fibroid and tubercular disease of the uterus, and it presents a similar contrast in reference to its extension and ulcerative destruction.

According to our observations, fibrous cancer very rarely affects the uterus; the most common form is the medullary, either by itself or complicated with the former.

Opportunities very rarely present themselves of investigating the early stages of cancer in the dead subject; according to a few observations, fibrous carcinoma, when closely examined, appears to consist of dense whitish, retiform fibres, differing from the normal texture of the vaginal portion of the uterus in which they are found, and in their very minute meshes a pale reddish-yellow or grayish translucent substance is deposited. This morbid growth is inserted into the uterine tissue without well-marked boundaries; it occupies a various extent, and from accumulating at certain points, gives rise to the irregular nodulated character and the well-known induration which accompanies the enlargement of the cervix.

Medullary cancer in the first instance appears as an infiltration of a white lardaceo-cartilaginous or lax encephaloid matter, in which the uterine fibre disappears; as the deposit increases the vaginal portion assumes an uneven nodulated character, and appears hard and elastic to the touch. Cancer of the uterus very rarely presents itself in the shape of isolated globular growths.

As the cancerous degeneration proceeds, and especially on the commencement of the stage of metamorphosis, with its consequent new formations, particularly if they belong to the medullary variety, the lower segment of the uterus undergoes a very considerable and rapid enlargement. At last we find a callous, loose, spongy ulcer developed in the usual manner, which discharges a very fetid, greenish-brown, sanious and sanguineous fluid, and as it extends, generally causes a progressive infiltration of cancerous matter. The tumefaction of the cervix and the fungoid excrescences not unfrequently close up the orifice, and the consequent enlargement of the womb will be the larger, the more copious the secretion of the mucus.

Cancerous degeneration of the uterus is generally confined, in a very remarkable and distinct manner, to the vaginal portion; still there are frequent exceptions to this rule, as the disorganization is sometimes found to extend with great rapidity to the body, and even to the fundus of the uterus; this is particularly the case if the os tincae has already been attacked by ulceration. The disease may spread downwards and involve the vagina, thus establishing vaginal cancer. It may extend in other directions, and thus give rise to cancerous degeneration of the rectum, the bladder, the pelvic, cellular, and adipose tissue, and the periosteum; the uterus thus becomes fixed in the pelvis, and at last we find the peritoneum attacked, cancerous growths being formed upon it and its tissue, or perforating it, especially in the shape of medullary masses.

Cancerous ulceration spreads in the same direction; in rare cases we find the greater part of the uterus, and even its fundus, destroyed. The destructive process, when attacking the vagina, sometimes predominates on the anterior, sometimes on the posterior surface; sometimes it attacks both equally, and may extend downwards almost to the external orifice. It also involves the degenerated parietes of the rectum and of the bladder, and generally produces extensive communications between their cavities and the original cancerous sinus (ulcerous cloacae). It finally extends in the shape of sinuous passages, through the remainder of the cancerous mass that fills the pelvic cavity, to the pelvic bones. In this manner a large cavity with fungoid parietes is at last established, which occupies the greater part of the uterus and the vagina, and opens into the cavities of the rectum and the bladder; above it is closed in by the fundus uteri and the adherent rectum and cervix vaginae, as also by the caecum and small intestine, which are agglutinated to these parts, and at last it penetrates into the cavity of the peritoneum or the intestines. The contents of the cavity are cancerous ichor mixed up with faecal matter, urine, and portions of gangrenous tissue.

The temporary and tumultuous periods of development presented by the peritoneal inflammations of the pelvic and hypogastric regions, which accompany and characterize the metamorphic and ulcerative stages, and which not unfrequently extend from the original layer over the entire peritoneum, are important occurrences in the progress of cancerous disease.

Uterine cancer is, in most cases, a primary disease, and generally remains for a long time, if not throughout the sole carcinomatous affection of the organism. However, it is sometimes developed concurrently with or consecutively to mammary and ovarian cancer; or it is accompanied by degenerations of the adjoining tissues above mentioned, and of the lymphatic glands, which must be explained upon the theory of propagation by contact; or again, it is associated with cancer of the peritoneum, of the liver, the stomach, and the breasts, with cancer of the bones, with mollities ossium, ovarian cancer, and universal cancerous deposit, as a consequence of the resulting cancerous dyscrasia.

Uterine cancer most frequently occurs between the fortieth and fiftieth year; still there are many cases on record in which it appeared between the thirtieth and fortieth year, and even earlier.

The cases of spontaneous recovery from uterine cancer are of extreme rarity, but they do occur; the carcinoma and the cancerous ulceration are then limited to the cervix, the internal orifice forming the boundary; the loss of substance heals with a funnel-shaped cicatrix.