The medullary cancer grows in soft, nodular masses, following the course of the lymphatics and involving all the coats of the stomach. It shows a tendency to early extensive ulceration. It has a scanty stroma, in which are inclosed alve oli containing irregular cylindrical and polyhedral cells. The medullary cancer has no common seat, although its predi lection, like that of the other varieties, is for the pyloric region.
The scirrhous variety, as its name indi cates, is of characteristic firmness, due to the abundance of stroma and the small amount of alveolar tissue. No tumor nodules proceed from its growth, but merely dense thickening of the infiltrated stomach-wall. It affects almost exclu sively the pylorus, which it stenoses, con verting the latter into a rigid, tubular ring. Its surface tends to show flat ulcerations.
The colloid or alveolar cancer shows large alveoli distended with translucent colloid material. It had a tendency to widely involve all the stomach-coats, to spread to other parts, and may form col loid metastases in other organs. It shows no marked inclination toward ulceration.
Various distortions may occur in the stomach as the result of the growth of the cancer, involving one or the other of the orifices, the body of the stomach, or through formation of adhesions to ad jacent organs. There may be atrophy of the stomach when the cardia is in volved; massive or, occasionally, no dila tation, with involvement of the pylorus: or a greatly thickened or contracted stomach, with affection of its body.
Metastatic cancerous growths are very common, occurring in the adjacent ab dominal lymphatics (but also in the axil lary, cervical, and the inguinal glands), the liver, the peritoneum, omentum, in testine, pancreas, pleura, lung, and les.: frequently in other organs and parts.
With extensive ulceration, which oc curs especially in the medullary cancer, a tendency to perforation of the stomach wall, as in simple ulcer, exists. Among other micro-organisms, more or less con stantly found on the surface of the car cinoma, the so-called Oppler-Boas bacil lus has, in the past few years, excited some attention. It is an unusually-long and non-motile organism, with one end narrow and the other thick. It is a lactic-acid producer, but is not pathog nomonic of carcinoma. It occurs in car cinoma involving the pylorus, and has been found in benign pyloric stenosis, when dilatation and coincident stagna tion of food is present, with absence in the secretion of free HCI.
In the course of cancer of the stomach there occurs an interstitial gastritis with granular degeneration of the gland-cells and subsequent atrophy of the mucosa: in consequence of this there is, from usually an early period in the disease, a diminution in the secretion of IICI and of the ferments, and in the latest stage of the malady 11C1 no longer occurs in recognizable amounts. and the ferments
are present only in trace.:.
Treatment.—The treatment of cancer of the stomach is, of course, merely pallia tive. However early recognized, its cure is impossible. In the future, with more exact diagnostic methods, its early recog nition, before debility and cachexia and the occurrence of metastasis render a radical operation futile, may permit ex cision of the growth to be sometimes of avail.
Life may be prolonged by the use of lavage and a suitable diet. Lavage is of the utmost utility in obviating the effects of autointoxication, in relieving stagna tion occurring in the stomach-contents, and thus improving the condition of the motor function and holding somewhat in check the coincident gastritis. Under its influence intelligently carried out, symp tomatic improvement is sometimes re markable, though unfortunately nearly always short-lived. If lavage can be suitably carried out (as is outlined under the treatment of dilatation), it should never be omitted from the treat ment.
The diet is practically that already given in the treatment of dilatation of the stomach, but carbohydrates and fats must be more liberally permitted. With preserved motility, far less restriction as to these substances is necessary, and, in deed, whatever is desired in the way of wholesome food, if it does not tend to create nausea and vomiting, may be al lowed. If butter is well borne, it, as well as olive-oil, is permitted, because of the high caloric value of fats. Concentrated nutriment (finely-scraped beef, somatose, sanose, whipped eggs) and predigested foods are usually essential with marked involvement of the pylorus and result ing stagnation in the stomach. More license in the choice of food is permitted when lavage is systematically employed. The use of a papain and a diastasie prep aration is advisable when predigested food is not given. (See the treatment of dilatation.) Carbonated drinks are inadvisable, al though champagne is often well borne. If stimulants are constantly indicated, well-diluted whisky is the best, but a good claret, or Burgundy if it agree, may be allowed.