1. Ulcer

In ulcer there is, as a rule, clear tongue, a circumscribed spot painful to pressure, some connection of the pains with the period of gastric digestion, intervals perfectly free from pain, very large hemorrhages, not recurring very frequently, and, as a rule, no real anorexia. In cancer, on the other hand, the tongue is almost always thickly furred, the painful area generally extends over the greater part of the gastric region, the pains not having much relation with the digestive period, the hemorrhages are rather small and very often recurring, and real anorexia or aversion for food exists.

2. The benign stenosis of the pylorus gives along history of sickness interrupted by intervals of almost perfect euphoria, extending over different periods of time (one year to two or three months); the gastric contents generally show the presence of free hydrochloric acid and an increased degree of acidity. Malignant stenosis of the pylorus gives a short clinical history, no intermissions, and the gastric contents most often do not contain free hydrochloric acid and reveal the presence of lactic acid in considerable quantities. The degree of acidity is variable, sometimes being greatly increased through organic acids.

3. Chronic Gastric Catarrh

A severe form of chronic gastric catarrh may at the beginning give rise to considerable difficulty in establishing the diagnosis between the two conditions. Sometimes this will be at first impossible. By keeping the patient under observation for a certain length of time the diagnosis will often clear up, the chronic catarrh will improve under rational treatment, while cancer of the stomach will either show no amelioration whatever or only a very slight one, the main symptoms of the disease continuing in the same way as before the institution of the treatment.

4. Achylia Gastrica

In achylia gastrica the tongue is sometimes clear, the gastric contents showing no juice whatever, no mucus, very little fluid of neutral or very slightly acid reaction (acidity, 2 to 6), no ferments, no lactic acid. The particles of food are very coarse. The stomach is empty in the fasting condition of the patient; there are no hemorrhages. In gastric cancer the tongue is always furred, the gastric contents, as a rule, include considerable quantities of mucus, and the degree of acidity is much higher, even if there is absence of free hydrochloric acid. The fragments of food are not so coarse as in the former condition, lactic acid is frequently present, and numerous micro-organisms are almost always present in the contents.

5. Severe Form Of Gastric Neurasthenia

A mistake between gastric cancer and severe forms of neurasthenia will not occur frequently. The neurotic condition which can be found in the patient, implicating several other organs besides the stomach, will help to establish the true diagnosis.

Duration And Prognosis

The malignant process usually terminates fatally about one year from the commencement of the symptoms. Cases, however, are met with in which the disease runs a more protracted course, eighteen months to two years. On the other hand, very acute, so-called foudroyant cases are observed which end in death in from four to six weeks. The duration of the disease depends, firstly, upon the situation of the neoplasm, which causes more disturbances and rapid death when occupying and occluding the cardiac or pyloric orifice; secondly, upon the character of the growths (some of which, as, for instance, the medullary form, develop rapidly); and thirdly, upon the complications which arise either from ulceration and hemorrhage or from cancerous metastasis.

The prognosis of cancer of the stomach is always hopeless. Oser justly said, the only hope for the patient can be that the physician has made a mistake in the diagnosis. No specific remedy has as yet been discovered for this ailment, and even surgery has not been able thus far to combat this malady successfully.

Treatment

The treatment comprises: A. Surgical interference; B. Medical treatment.