Carcinomatous diseases affect the stomach very frequently, and carcinoma of the stomach is moreover the most common carcinomatous disease of the digestive tube. It must be carefully distinguished, as we shall have occasion to explain more fully, from mere hypertrophy, the non-malignant thickening of the gastric membranes, with which it is sometimes confounded.

"We find all the different species of carcinoma, the fibrous, the medullary, the areolar, occurring at this point; though in various degrees of frequency. Fibrous cancer is the most common, the pure genuine medullary cancer less so, and the areolar variety is very rare. Often enough we find the first two, and sometimes all three, occurring in primary, but more particularly in secondary, combination.

a. Fibrous cancer appears as thickening of the submucous cellular stratum, which congeals into a resisting, whitish, fibro-lardaceous mass, and unites intimately with the mucous and the muscular coats. The latter becomes pale, and gradually undergoes a change which is characteristic of all kinds of cancer. It increases in thickness, and at the same time degenerates into a pale yellowish-red areolar tissue, the interstices of which are filled up by a slightly translucent and apparently crystalline substance. The increase of the muscular coat is uniform, whereas that of the submucous cellular tissue is commonly irregular, and we thus see lobulated protuberances formed on the inner surface of the stomach.

Fibrous cancer is the one most easily and most frequently confounded with hypertrophy of the gastric coats. The distinguishing signs are the preponderating increase of substance in the submucous cellular tissue and its want of uniformity, the accompanying cartilaginous hardness and closeness of texture, the fusion with the mucous and muscular coats, and particularly the alteration in the muscular tissue just described (John Muller).

The mucous membrane itself undergoes further peculiar changes. It sometimes degenerates into an areolar cancerous tissue, which discharges large quantities of a gelatinous mucous fluid; or it is converted into erectile tissue, as a fungoid growth, which becomes the seat of encephaloid infiltration, suppurates, and partially exposes the submucous scirrhous cellular tissue; or lastly, it most frequently becomes the seat of a sloe-black softening with hemorrhage, and we thus find the scirrhous submucous cellular tissue invested by a thin, gauze-like black remnant of the mucous membrane, or it is quite denuded, merely retaining here and there a few solitary black convolutions of vessels at its surface.

The scirrhus, too, at once becomes the seat of various metamorphoses. It may, after it has been denuded of its mucous membrane, become gangrenous in large patches or in round circumscribed spots, the tissue exfoliating by layers, so as to give rise to deep, smooth excavations in the crude cancer; or it may become developed into a more highly-organized carcinomatous formation, such as medullary sarcoma, accompanied by bleeding fungoid tissue; this is soon destroyed by a suppurative process, leaving an ulcer which is surrounded by an elevated lardaceous margin.

/B. Medullary cancer of the stomach occurs independently of its secondary appearance in the metamorphosis of fibrous cancer, primarily in various forms: aa. In the shape of soft and even liquid, milky, medullary, infiltration of the erectile tissue, into which the mucous membrane has degenerated, the other coats remaining normal (vide p. 43).

/B/B. As a lardaceous, medullary degeneration of the submucous cellular stratum to a greater extent.

yy. As knotted tumors between the gastric coats, and here too chiefly in the submucous cellular tissue.

Medullary carcinoma is distinguished in this form also, by its extensive growth, and by its rapid metamorphosis, accompanied by vascular fungoid degeneration.

r. Areolar cancer presents, in the degeneration of the mucous and submucous cellular tissues, the characters generally peculiar to this form.

We often, as has been remarked, find these varieties of cancer occurring simultaneously; in the stage of metamorphosis in which more particularly a consecutive complication is seen, the fibrous cancer at the base gives rise to an areolar cancer, from which, in its turn, medullary cancer shoots up in the shape of a peripheral erectile growth.

The Stomach

The Stomach is either the primary or the secondary seat of disease. In the former, the most usual case, the cancerous degeneration extends from the stomach to other organs, attacking the lymphatic glands which are contiguous to the head of the pancreas and the biliary ducts, the pancreas itself, the glands of the lumbar plexus, and, finally the fibrous investments of the vertebral column, the liver, the transverse colon, the omentum, etc. In the latter case, which is of much less frequent occurrence, the stomach is secondarily attacked, the morbid affection commencing in neighboring tissues, and particularly in the conglomerations of lymphatic glands, from which it extends to circumscribed portions of its posterior parietes. In this variety, the cancerous ulcer may proceed beyond the stomach, establishing communications with the transverse colon or with other portions of the intestine, and it may even force its way outwards after a previous union of the stomach and the abdominal parietes has been effected, and the latter have been destroyed.