Topographical Relations Of Cancer Of The Stomach. Size

As regards size, two varieties of tumors may be distinguished. One is characterized by growing very little above the surface and involving large areas of mucous membrane. The other extends only over a small portion of the mucosa, and may develop extensively in thickness. The first form of tumors belongs to the medullary or colloid type, and is not met with very frequently. These growths present a flattened surface, covered with rough, nodular masses. Blood extravasations and adhesions to the neighboring organs are of frequent occurrence. The second form belongs to the scirrhus variety. The tumor involves a small circumscribed portion of the stomach, and tends to grow in depth and height.

Localization

The development of cancer within the stomach may take place at various situations, at its orifices (cardia or pylorus), or within the organ itself. The recognition of the localization of the cancer is much more important than the distinction of the various forms, because each of the three different localizations of the cancer is accompanied by a characteristic train of symptoms, making its recognition possible during life, and requiring a special plan of treatment. As regards the frequency with which the different regions of the stomach are affected by can-(ier, Brinton found the following relation: Out of 360 cases the pylorus was affected in 219 instances, a proportion of exactly 60 per cent; 36 cases were cancer of the cardia, a proportion amounting to exactly 10 per cent; in the remaining 30 per cent the lesion was scattered over the greater and lesser curvatures. The fundus is attacked least frequently of all: among 1,300 cases of cancer of the stomach reported by Welch, only 19 were situated in the fundus. The figures given by Lebert,1 Katzenellenbogen,2 and other writers, agree very closely with Brinton's figures.

It is easily seen that the localization of the cancer is very markedly different from that of ulcer, for in the latter affection the orifices of the stomach are the least frequently affected.

The Shape Of The Stomach

The different situations of the cancer influence the shape and the position of the stomach. The organ is found to be retracted and small in size in all cases of cancer of the oesophagus and cardia. The viscus is very much dilated in cases of cancer of the pylorus. The shape of the stomach may be distorted in case the tumor, situated near the pyloric orifice, descends by reason of its weight and drags the organ down into the pelvis. Distortions and contractions of the stomach may also be developed as a consequence of inflammatory adhesions with adjacent viscera.

1 Lebert: "Traite pratique des maladies cancereuses," Paris, 1851, p. 97.

2 Katzenellenbogen: "Beitrage zur Statistik des Magencarci-noma." Inaug. Diss.,. Jena, 1878.

Gastric cancer is almost always primary, and sec-ondary growths of the stomach must be considered as a great rarity. Cancer of the stomach may, however, coexist with a primary cancer of some other organ, as, for instance, the uterus and ovaries. Ewald mentions a case in which he found an immense cysto-sarcoma of the uterus and a carcinomatous infiltration of the pylorus.