Carcinoma of the Stomach.
Symptoms.—As gastric carcinoma does not frequently succeed chronic dyspepsia (chronic gastritis or a prolonged gastric neurosis) and only in a small percentage (approximately 5) follows or is ingrafted upon gastric ulcer, dyspeptic symptoms do not usually long precede the develop ment of the disease. Commonly the pa tient, who has been in fair health, grad ually loses vigor, and develops gastric symptoms, slight and obscure at first, but later becoming prominent and obvious.
There is gradual, but steadily increasing, debility; emaciation; anaemia, which late in the course of the disease may be of high degree; a cachectic hue of skin; anorexia; eructations; nausea and vom iting; constipation; lifematemesis (or oftener mekena or meltena?inesis), and gastric pain (not as severe as in ulcer); and later a gastric tumor may be palpa ble. The course may be rapid, death occurring in two to six months from the onset,—the writer recently saw such a case,—or more usually extends over a period of from one and a half to two and a half years. Coincident rather marked loss of strength and progressive emacia tion is a common and usually early symp tom, antedating often the appearance of distinct gastric symptoms. The anaemia, moderate at first, becomes marked as the disease progresses. It is of the secondary type, not resembling, save in a few in stances, the characteristics of pernicious anminia. The blood-count rarely falls below 50 per cent., and though poikilo cytosis may be present, and, in advanced cases, nucleated red blood-corpuscles, the large corpuscles are wanting. There is usually a moderate grade of leucocytosis, and, though not distinctive of cancer of the stomach as was at first held, absence of a digestive leucocytosis, when the growth favors marked stagnation of the stomach-contents, with diminution in or absence of the secretory gastric functions. The cachexia, as the term is applied to the hue of the skin, consists of a pale-yel lowish hue, which may be associated with brownish stains (the cachexia ehloasma).
The heart's action is usually enfeebled, due, in the later stage, to a fibroid degen eration. CEdema of the feet, eyelids, and ankles is then common. Toward the termination of the disease a subnormal temperature is common; but, preceding the fatal issue. fever of an irregular course may be present. Occasionally, in the course of the disease, fever due to a septic complication may occur. A dis taste for food, and especially for animal food, is usual. Occasionally cases are en countered, as the writer has noted in sev eral instances, in which the appetite is well preserved to the end. Nausea is apt to be a prominent symptom, before the occurrence of vomiting is usual. It is more common than in ulcer. The tongue may be coated or clean; as the disease advances, with the ingrafted and extending gastritis, the tongue becomes more or less habitually furred. Vomit ing is a usual symptom, especially with carcinoma involving the cardia or the pylorus. It is infrequent at first, but, as the disease progresses, is of daily occur rence. It may occur immediately after food is taken, as in cancer of the cardia, or, in that of the pylorus, not for an hour or more after meals. The character of the vomit depends upon the seat of the disease and its stage: briefly, plus the presence of blood, it has the character of that noted in dilatation of the stom ach, with absence of free HCI. The vomit is usually of offensive odor, the color depending upon the character of the food taken and whether there be bright-red or altered blood mixed. Microscopically are found food-elements, epithelium (commonly of no character istic variety), various micro-organisms, among which is, perhaps, the Oppler Boas bacillus. Sarcinw are far less often encountered than in benign pyloric stenosis with preservation of secretion of IIC1. Fragments of the tumor are rarely found in the vomit; less rarely minute bits of the growth are encoun tered in the wash-water.