6. Fever

The occurrence of fever in gastric cancer does not belong to the regular symptoms. It is, however, met with oftener than is generally believed. It usually appears in the latest stages of the disease, and is always a bad omen; for frequently the fatal issue is then impending. In rare instances the rise of temperature occurs at certain periods of time, and pre-sents a marked similarity to a fever of malarial origin. Hampeln 1 relates a case presenting this peculiarity. In most instances the fever does not show any regularity, is, as a rule, not very high, and accompanied by frequent intermissions. The fever is probably due either to an inflammatory process which occurs in the neighborhood of the neoplasm, or, more frequently, to the absorption of toxic material from ulcerated areas of the tumor. The latter circumstance is also responsible for a comatose condition which is sometimes met in these cases, especially in the last stages of the disease.

7. Constipation

More or less obstinate constipation exists in the majority of cases of gastric cancer. According to Ewald, the bowels remain regular in only four to five per cent of the cases. The constipation may at times alternate with diarrhoea; the latter is the result of a catarrhal condition of the intestinal mucous membrane, due to the irritation of hard scybala or to the products of decomposition. Frequently diarrhoea appears whenever sloughing of the neoplasm occurs. It often indicates imminent danger, and is not unfrequently the proximate cause of death.

8. Cachexia

Cachexia is met with in almost all cases of gastric cancer after the disease has progressed long enough, and is, if present, an important symptom. Its absence, however, by no means militates against the existence of cancer. Brinton regarded cachexia as pathognomonic of cancer, being the resuit of a humoral disease. At present, however, most writers agree that the cachexia is brought about in most instances not by specific poisons circulating in the blood, but by subnutrition. From my own experience, I can state that I have frequently made the diagnosis of gastric cancer in people who presented a very healthy appearance, and who had not become emaciated. The diagnosis in some of these cases was later verified either by an operation or at the autopsy. In one case of cancer of the pylorus in a man, forty-two years of age, who had slightly lost in weight but who was yet well nourished, in the first few weeks of treatment an increase in weight of eight to ten pounds was effected. The same patient was operated upon some time afterward, the pylorus being Tesected, but he succumbed one year later.

1 P. Hampeln: Zeitsclir. f. klin. Med., Bd. 8, p. 232.

9. Oedema

In the first stages of cancer malleolar oedema sometimes appears for a short time. Boas l found this symptom in twelve per cent of his cases. This oedema fugax is, however, not a pathognomonic sign, as it may occur, according to Boas, in other affections of the stomach of a non-malignant type. Ascites or anasarca, or both, frequently appear in the last stages of the disease.