10. Metastases

As mentioned above in speaking of pathology, metastatic tumors frequently occur. Thus enlarged glands of hard consistence and nodular character are suggestive of cancerous deposits. A nodular infiltration of the liver, presenting a hard and uneven surface, is very frequently met with in gastric cancer. A carcinomatous metastasis in the thorax is accompanied by the symptoms of pleurisy (dulness, pains, friction sound). Although these metastases, as a rule, appear quite late, still if present they may help to clear the diagnosis.

1Boas: "Spec. Diagnoetik undTherapie der Magenkrankheiten," 2te Aufl., p. 185.

11. Condition Of The Blood

Laache 1 first described a decrease of the number of red blood cells in this affection, while Haeberlin 2 found that the haemoglobin was greatly diminished. According to this writer, the quantity of the latter is only fifty per cent of the normal. Eisenlohr3 and Schneider 4 found an increase of the leucocytes. While all these conditions are of some importance, as suggestive of cancer, they are by no means specific and are met with in other affections.

Recently Schneyer 5 has stated that the usual increase in the number of leucocytes, which is found normally during the period of gastric digestion, is absent in all cases of gastric cancer; that is, the number of leucocytes in the fasting condition and at the height of gastric digestion remains the same. This symptom promises to be of great value, and it should certainly be further investigated.

12. Condition Of The Urine

Klemperer6 and Muller7 discovered that the urine in cases of gastric cancer contains more nitrogen than the amount introduced with the nourishment. It has been found, however, that this symptom is not constantly present. Besides, the elucidation of this fact necessitates quite complicated and laborious investigations, which can be made only in clinics, but not in private practice. The amount of chlorides is frequently found diminished, while the indigo-forming substances are often increased. Peptonuria is occasionally observed; it always indicates that there is absorption from an ulcerated area (neoplasm) within the digestive tract, and is therefore of importance.

1 S. Laache: "Die Anamie," Christiania, 1883.

2 Haeberlin: Munchener med. Wochenschrift, 1888, No. 22.

3Eisenlohr: Deutach. Arch. f. klin. Med., Bd. 30, p. 495.

4G. Schneider: Inaugural Dissertation, Berlin, 1888.

5Schneyer: Zeitschr. f. klin. Med., 1895.

6G. Klemperer: Berl. klin. Wochenschr., 1889, No. 40.

7Fr. Muller: Zeitschr. f. klin. Med., Bd. 16, p. 496.

B. Symptoms Produced By The Position Of The Growth

These may be divided into three groups, according to the location of the growth.

(A) Cardia. Subjective Symptoms

Dysphagia is one of the principal symptoms of cancer of the cardia. The patient first notices that he cannot eat as fast as he would like. Frequently he has to stop in the middle of a meal, experiencing a sensation as if the food would not go down into the stomach. This occurs only if solid food is taken. The patient, as a rule, learns to help himself by drinking several mouthfuls of water when such an impediment occurs. Very soon these difficulties increase in severity and in number, and the patient can hardly partake of solid substances without drinking liquids with them. Still later, the patient finds it impossible to partake of solid food, as he cannot force it down into the stomach even by means of water. Whenever he tries to do so, the food remains within the oesophagus and causes a feeling of extreme discomfort and oppression. The patient is then usually obliged to eject it after much straining and retching. Liquid food is at this time the only diet on which the patient subsists. Still later, when the stenosis is of a very high degree, the patient is unable to partake even of a sufficient quantity of liquids, as he can force through the stenosed cardia only very small amounts or none at all.

Besides these difficulties in eating and drinking, the patient often complains of either pains or a burning sensation at the scrobiculus and somewhat above it. "Vomiting," or, more correctly, ejection, of some mucus with or without food particles from the oesophagus often occurs, especially at night, in the recumbent position of the patient.