In carcinoma of the cardia there is increasing and persistent dysphagia and a sensation as if a foreign body were present in the region of the cardia, espe cially after the ingesting of food and drink. Regurgitation of solid food im mediately after it is swallowed is usual.
Retching and vomiting are common, the vomited matter consisting of mucus and but little or no food, save when a di verticulum has formed into which the food passes. Emaciation and debility are more rapid than in cancer of other parts of the stomach, but marked cachexia is usually absent. Hiccough is often pres ent associated with retching. Pain, when present, is situated behind or near the xiphoid appendix. There may be retrac tion of the epigastrium. An obstruction at the depth of sixteen to seventeen inches from the incisor teeth is encountered in the attempt to pass the stomach-tube or oesophageal Bougie. On the extremity of the tube after removal there is apt to be blood-stained mucus, and the lateral eye of the tube is apt to contain food elements, blood, and mucus, and even a bit of the growth.
Diagnosis.—The diagnosis is usually a matter of little difficulty in the pres ence of the various symptoms already detailed, such as nausea and vomiting; the characteristic (small and frequent and grumous in appearance) gastric h'emor rhage; the emaciation, debility, and anae mia; increasing cachexia; the presence of tumor; the absence of free HU in the stomach-contents, with the presence of lactic-acid formation. The diseases with which carcinoma is oftenest confused are ulcer, chronic gastritis, benign steno sis with dilatation, and a profound gastric neurosis. A separation is commonly easily made except in the cases of car cinoma ingrafted on ulcer. But here the further progress of the case; the lack of persistent improvement under treatment usually invariably curable in ulcer; the presence, more or less persistently, of blood or altered blood, in the removed contents or in the vomit, and the increas ing cachexia and anaemia tend to indicate the existence of ingraftcd carcinoma.
Etiology.—Carcinoma of the stomach is a common disease and of more frequent occurrence in this country than in Eu rope. Next to the uterus, the stomach is the most usual seat of primary cancer; secondary cancer, also, though rarely, occurs here. it is a trifle more frequent
in men than in women. Seventy-five per cent. of all cases occur between the for tieth and sixtieth years; 21 per cent. be tween the sixtieth and seventieth years; over 13 per cent. between the thirtieth and fortieth years, and nearly 3 per cent. between the twentieth and thir tieth years. Heredity, chronic gastritis, chronic ulcer, and traumatism of the stomach are factors of varying impor tance in etiology.
Pathology. — The most commonly noted varieties in their order of fre quency are: (a) cylindrical-cell cancer, or epithelioma; (b) the soft-glandular, or medullary, cancer; (c) the hard-glandu lar, or scirrhous, carcinoma; (d) the mu cous, or colloid, carcinoma. Many grada tions exist between these types. The scirrhus has the most chronic course, and the medullary the greatest tendency to ulceration, degeneration, and to give rise to metastases.
Situation. — Welch's statistics show that 60.8 per cent. occupied the pyloric region; 11.4 per cent, the lesser curva ture; S per cent. the cardia; 5.2 per cent. the posterior wall; 4.7 per cent. the whole or the greater part of the stomach; 2.6 per cent. the greater curvature; 2.3 per cent. the anterior wall; 1.5 per cent. the Nardi's; 3.5 per cent. were multiple growths.
When in the pyloric region a tendency to girdle this orifice is early shown, caus ing the ensuing stenosis so commonly met with in gastric cancer; when occu pying the body of the stomach the growth is usually limited to but a portion of its circumference.
The cylindrical-celled epithelioma has a firmer consistence than the medullary, although, like the last, it has a nodular formation, and shows on its surface fun goid elevations, from which hremorrhagic extravasations are frequent. Sections of it display an abundant stroma, in which are contained tubular spaces filled with columnar epithelium. Ulceration is com mon, but not nearly so frequent as in the medullary variety. The most fre quent seat of the cylindrical-celled can cer is, as of the scirrhous variety, the pyloric region close to the valve.