Castration in Malignant and Non-Malignant Disease

Abstract

It appears that sex hormone production is reduced or inhibited after irradiation castration and following surgical ablation of ovaries or testicles. When the growth-stimulating influences of sex hormones are withdrawn, clinical observations show definite alterations of certain pathological conditions. There also follow certain histological and physiological changes which influence the general state of health and may be concerned with both the origin and the progress of malignant disease. Human castration of the male by orchiectomy, creating defective masculinity, has been practised from remote antiquity by some Orientals. Historical records indicate that great numbers of eunuchs were created in ancient Egypt, Greece, and other countries both for religious and secular purposes. In fact, the demand for the high-pitched falsetto voice in a man singing in religious ceremonies has been abandoned only within recent years. When the earliest records were compiled, it was recognized that not only was fertility terminated by castration, but that certain other abnormal changes ensued, affecting growth and mental development. Recent medical research has explained some of the phenomena of castration and it is my purpose to call attention to a few of the phases which concern us in the control of disease. Castration may be performed in the human being (15, 16) for two purposes: first, to halt fertility; second, to induce specific changes, particularly in the endocrine system. Two methods are employed, the surgical and the radiological. In surgical castration it is intended that the entire influence of the testicle or ovary be terminated by complete ablation of the organ, while in radiological castration certain components of usefulness may be retained while those whose elimination is essential to accomplish the desired purpose are destroyed. Two classes of disease will be considered—malignant and non-malignant—both of which are in some way influenced by the activity of the sex organs. One of the most essential objects of castration is to modify the action of the growth-stimulating hormones—estrone in the female and androsterone in the male. The true role played by these important hormones in physiological processes essential to the proper development and maintenance of health is rapidly being elucidated through experimental investigations on animals and in clinical research. Changes, both objective and subjective, appearing in the breasts with menstruation have long been recognized and studied. These have taken on a new significance since Rosenburg (1) discovered and interpreted the mechanism of the sex cycle in the breast. Ingleby (2) writes: “The sex cycle in the breast was discovered by Rosenburg in 1922. A revolution in the interpretation of pathological lesions followed. Proliferation of glandular elements during the premenstrual phase is far more rapid than the growth of any carcinoma.