Malignant Lesions of the Stomach

Abstract

it is administered, and the delay of a therapeutic test may be enough to transform a resectable growth into an inoperable one. Gastrectomy is always preceded by exploration, and exploration should not be deferred indefinitely. In gastric cancer there always comes a day when for the last time resection is possible and another day when for the first time it is impossible, but it is not given to either the physician or the surgeon to know when those days will come.In this connection, another word of warning should be issued. Two patients in the Charity Hospital series entered the hospital complaining of the same symptoms for which shortly before they had been submitted to appendectomy through McBurney incisions and which were proved to be caused by cancer of the stomach. Ochsner 2i has personally observed 6 such cases. One way of improving the results of gastric carcinoma would seem to be to make the diagnosis of chronic appendicitis with very great caution in the so-called cancer years, and never to perform an appendectomy at this time of life through a McBurney incision.3. Any improvement in the results of gastric cancer rest first with the patient. Until he presents himself to the physician no treatment is possible. Once he has sought medical advice, however, the responsibility becomes the physician's, who must turn him over to the surgeon without delay. In other words, as Hunt25 expresses it (he is a surgeon who advocates gastrec¬ tomy to the limit of possible indications), the patient's hope of salvation lies not in the surgeon but in the medical man whom he first consults. Cooper20 has recently demonstrated statistically the correctness of this observation, and my own series proves it, too.The idea is not new. Welch,14 writing in 1885, called attention to it then. He was speaking of gastrectomy, of which his opinion was necessarily low, since it was based on 27 fatalities in 37 cases, when he said "It is therefore but a feeble glimmer of hope which is now admitted to the hitherto relentlessly fatal forecast of this disease. . . . These results are certainly not calculated to awaken much enthusiasm for the opera¬ tion." It is highly significant that, feeling as he did, he should have continued : "The opinion entertained by the physician as to the propriety of surgical inter¬ ference in gastric cancer is not ... a matter of indif¬ ference, for cases of gastric cancer come first into the hands of the physician, and generally only by his recom¬ mendation into those of the surgeon."In short, in what Mayo said in 1900,1 in what Welch " wrote in 1885, lies the clue to such improve¬ ment in the results of cancer of the stomach as we are likely to achieve in the present state of our knowledge. The basic problem, when once the patient presents himself to the physician, is how soon the physician turns him over to the surgeon, how soon the surgeon operates, on suspicion if he cannot positively eliminate the posŝ ibility of gastric carcinoma. I do not in any way desire to detract from the heavy responsibilities which are c...

Carcinoma of the Stomach: a 10-year Survey of Results and of Factors Affecting Prognosis

“…The favourable effect of a long history of symptoms on the type of surgery possible has already been mentioned, and is here underlined by the favourable effect on survival afterwards. The prognostic importance of a long history of symptoms has previously been reported by Balfour (1937), Walters, Gray, and Priestley (1942), and Swinnerton and Truelove (1952). The explanation of the facts may be that there is a variation in the growth rate of the tumours, as suggested by Park and Lees (1951), with particular reference to carcinoma of the breast, or that some individuals have a greater resistance to the disease.…”

The Dilemma of Gastric Ulcer—benign or Malignant?

“…We believe that the low incidence of malignancy in the gastric ulcers reported here is due to the fact that in suspected cases the lesion was considered malignant and therefore resected. In several series (1–3), from 10 to 20 per cent of gastric ulcers were found to be malignant at operation. This general experience has led to more rigid diagnostic criteria and an increased suspicion of every gastric ulceration.…”

“…The five‐year survival rate following gastric resection for small gastric cancers is 40 per cent greater than that for patients with gastric cancer of all sizes. In general, the smaller the cancer the higher the five‐year survival rate (3). The smaller growths seem to have a lower incidence of high grades of malignancy.…”

Gastric cancer in young adults

“…Sarcoma of the stomach is much less common than carcinoma and is usually stated to constitute about I per cent of all malignant gastric neoplasms (Balfour and McCann, 1930; Walters, Gray, and Priestley, 1942; Iason, 1953). Marshall and Meissner (1950), however, reported 41 sarcomata in 1171 operations for malignant disease (3.5 per cent) and Stout (1953) 71 sarcomata in 541 malignant tumours (13 per cent) seen in the laboratory of surgical pathology at Columbia University.…”