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Extra resources for Clinical Oncology: A Manual for Students and Doctors
Some carcinomas, such as malignant melanoma and cancer of the tongue, tend to invade the lymphatics very early. Others, for example squamous cell carcinomas of the skin or lips, spread to the lymph nodes rather late. 48 Basal cell carcinomas of the skin do not spread to the lymph nodes. The presence of cancer colonies in a lymph node is sure evidence of spread, and the sooner it appears after the onset of the primary lesion the more extensive it is likely to be. But there is nothing to prove that when there is no lymph node metastasis the cells have not passed through the node without leaving a trace and been destroyed elsewhere.
Such lesions occur in the uterine cervix, epidermis, lung, prostate (latent carcinoma) and breast (lobular carcinoma in situ). Study of the biological behaviour of carcinoma in situ of the uterine cervix has shown that a good percentage of these lesions ultimately progress into invasive carcinoma; the rest may remain as such or regress. Carcinoma in situ may not produce a grossly evident lesion but cytological examination of a smear from the lesion usually establishes the diagnosis and allows early curative treatment.
It has been established that leukremia is the chief neoplastic disease induced by ionising radiations. The main evidence for the carcinogenicity of ionising radiation is the number of cases of occupational exposure. It is now recognised that the lung disease among the miners of Joachimstal (Czechoslovakia) and of Schneeberg (Germany), known since the 16th century, was bronchopulmonary cancer, due to the presence of radioactive matter in the mines. Further recent evidence has come from the atomic explosions in Japan and from research into the long-term effects of exposing patients to radiation for diagnostic or therapeutic purposes.