CARCINOMA of the stomach may escape detection even when all modern aids to diagnosis are readily available. The occasional appearance of obscure cases in clinical practice should make physicians alert to the possibility of gastric cancer in patients who may not manifest the usual gastric symptoms.
When the tumor involves the lower esophageal or pyloric orifice it is common for symptoms to develop relatively early. In involvement of the esophagus there may be pain or substernal distress during or shortly after eating, associated with a sense of fullness in the upper abdomen, as well as belching or anorexia. In the pyloric lesion symptoms of gastric retention appear fairly early in the disease process and are manifested by a sense of pressure, anorexia, and vomiting or eructation of food, often bile-stained and containing red or coffee colored blood.
The greatest problem in the diagnosis of gastric cancer presents itself when the tumor involves the cardia without extension to the esophagus or when the greater curvature of the stomach is the site of malignant change. As long as the magenstrasse permits a free flow of food from the esophagus to the duodenum the real cause of the patient’s symptoms is sometimes overlooked. Such an error is especially apt to occur when the patient is well nourished, has a good appetite, has insignificant indigestion or none at all, and when a mass cannot be palpated on abdominal examination.
When the patient is under the age of forty and the symptoms are limited to. . .