In all the forms of cancer of the cervix there is present to a greater or less extent a general induration of the cervix. The elasticity or resiliency of the cervix is diminished or lost; this is shown not only by the sensation upon palpation, but by the fact that the cervix is not capable of dilatation, by sponge tent or otherwise, as in the normal condition.
In the last stages of the disease the gross appearance is the same in all forms of cancer of the cervix. The cervix may fill the whole vaginal vault, sometimes hypertrophied to the size of the adult fist. The presenting mass is ulcerated, gangrenous, and covered with friable vegetations bathed in thin fetid pus and blood. The vaginal vault itself is usually involved by extension of the disease. The body of the uterus is found to be enlarged, and the mass of the cervix is held rigidly in the pelvis by the thickened cancerous broad ligaments.
In some other cases, instead of a protruding mass we discover an immense crater in the vaginal vault--a crater with indurated edges and sides, surmounted by the body of the uterus. The size of the crater shows that the destruction of tissue has extended far beyond the normal limits of the vaginal and supra-vaginal cervices. The interior of the crater presents an ulcerated, sloughing surface.
There is no condition which should be mistaken for cancer of the cervix in the last stages. A sloughing uterine polyp presents superficially a similar appearance, but the gangrenous mass will be found surrounded by a ring or collar, often very attenuated, of healthy cervical tissue, and the presenting tumor is usually elastic to the touch, not unyielding and friable like the cancerous mass.
In the early stages of cancer the appearance resembles closely the erosion of a bilateral laceration of the cervix. In the simple laceration, however, the erosion is soft, not indurated; there are no palpable edges; the cervix is not brawny; and it will be found that the simple erosion yields to local treatment, while the cancerous erosion does not.
Syphilitic ulceration and the ulceration of lupus are very rare upon the cervix. Syphilitic ulceration sometimes presents all the gross appearances of cancer. The history, the microscopical examination, and the therapeutic test will enable one to make a differential diagnosis.