By "silent" I mean without symptoms—without any indication to the patient that a serious process is present. Patient after patient is seen with an extensive growth of long duration but with only a short period of local symptoms. The first visit to the physician shows a large growth or ascitic fluid from peritoneal carcinosis. The advancing carcinoma causes only such minor disturbances that the patient hardly notices them. Thinking back, when questioned, she recalls that the abdomen has been a little larger for a year or so or that there was bloating or some frequency of urination, but only in the last few weeks was there enough disturbance to make her feel that perhaps an examination was advisable. Some examples from my experience will serve to illustrate the point. REPORT OF CASES Mrs. S., aged 56, had a gradual loss of weight for two years but no local symptoms till