Secondary Changes Accompanying Cancer Of The Stomach

Aside from the cancerous lesions, the affected area of the stomach is usually the seat of various anatomical changes. Thus thickening of the mucosa, caused by hypertrophy of the connective tissue and muscular fibres, is frequently observed. Ewald first observed that the whole mucosa may present characteristic lesions of chronic gastritis. At some places the glands have disappeared; at others they exhibit mucoid changes; while at still others cysts are found.

Cancerous Metastases

Secondary cancerous deposits in other organs are of frequent occurrence in cancer of the stomach. Out of 437 cases Brinton saw this complication in 210, or in 48 per cent. The medullary and colloid forms of cancer are more often asso-dated with secondary cancer than is the scirrhous form. Among the organs in which the secondary cancerous deposits appear, the liver takes the first place. Brinton gives the figure of secondary deposits in the liver as 25 per cent of all cases of gastric cancer, while Lebert gives the figure of metastasis in the liver as 40.9 per cent of all the metastases. This writer gives the following figures for the metastases in other organs: peritoneum, 37.5 per cent; lungs, 8.3 per cent; ovaries, 4.5 per cent. In some cases, however, the secondary cancer of the liver is associated with deposits in the other organs; for instance, the peritoneum, pancreas, kidneys. The intestines and lungs may be affected at the same time. The metastatic infection usually takes place by way of the blood current or the lymph vessels. In some instances, however, a direct extension in continuity of the cancerous growth to a neighboring organ may take place.

Thus the extension of a pyloric cancer to the liver or the gall bladder, or of a cancer situated at the greater curvature to the colon, or, again, of a cancer of the smaller curvature to the pylorus, is often observed.

The lymphatic glands are frequently found swollen, but in cancer of the stomach this symptom does not appear as often as in neoplasm in other organs. Brin-ton has observed this symptom in 23.5 per cent of these cases. The swelling of the glands is frequently caused by cancerous deposits in them; sometimes, however, they may be swollen simply in consequence of a condition of irritation.

The cancerous deposits may appear at one spot, forming a new tumor varying in size in the respective organs; sometimes, especially if the cancerous material has been carried through the lymphatics, numerous small deposits may exist, and the whole organ may then appear as if studded with miliary tubercles. This condition is frequently found in the pleura. It is at first quite difficult to decide at one glance the real nature of this tubercle-like deposit. The microscope will quickly solve the problem. Koch's bacillus is found in the real tubercles, while the cancerous deposits contain no bacilli and will show the characteristic structure of the neoplasm. While the cancerous deposits may at times appear in this form, simulating a tuberculous affection, the latter condition may occur independently in cases of cancer of the stomach; that is to say, both affections, viz., cancer and tuberculosis, may coexist in the same person.

Symptomatology

In a typical case the course of the disease is as follows: A person, usually of middle age, who has been previously in good health, experiences uncomfortable sensations after meals, impairment of appetite, more or less disturbance of sleep, and loss of strength. Although slight at first, these symptoms persist and remain obstinate to all methods of treatment. In the course of time they become more and more aggravated. Pains appear, which are always very annoying and sometimes show exacerbations of a very acute and intense form. While at first there is only belching and a mouthful of food is occasionally ejected, after a while vomiting appears and deprives the patient of the little nourishment he takes. Still later hemorrhages appear. Although the quantity of blood ejected is, as a rule, not large, this symptom, however, greatly debilitates the patient, as it usually occurs several times in succession. About the same time that the hemorrhage begins to appear, a tumor becomes perceptible in the gastric region. The patient now presents a cachectic appearance and falls off daily.

He becomes extremely weak and prostrated, and usually death from inanition follows.

In analyzing the symptoms accompanying a neoplasm of the stomach, it is important to divide them into: A, Those caused by the growth itself (general symptoms); and B, those produced by the position of the growth - (a) cardia; (B) pylorus; (c) stomach proper.