544 



THE DIGESTIVE SYSTEM. 



wall, 30 ; fimdus, 19 ; multiple tumors in 45 cases. Carcinoma of the 



stomach is rare in childhood. l 



Carciiiomata of the stomach occur in various forms. There may be 



larger or smaller, flat 

 or rounded or lobu- 

 lated growths project- 

 ing from the inner 

 surface of the stomach 

 (Fig. 316). The mu- 

 cous membrane over 

 them may be intact 

 or with a portion of 

 the tumor may ulcer- 

 ate. The destructive 

 process may advance 

 so that some of the 

 ragged or smooth- 

 edged ulcers may 

 reach a large size. 

 The wall of the stom- 

 ach may be involved ; 

 peritoneal adhesions 

 may form, or perfora- 

 tion may occur. On 

 the other hand, the 

 carcinoma may grow 

 in the form of a dif- 

 fuse infiltration of the 

 wall of the stomach 

 (Fig. 317). Such tu- 

 mors are less liable to 

 ulcerate. They may 

 be overlooked or mis- 

 taken for a chronic in- 

 flammatory lesion. 



Metastatic tumors 

 in the liver, the lymph- 

 nodes, and the peri- 

 toneum are common, 

 but such metastases 

 may occur in any part 

 of the body. 



The most common 

 type of carcinoma of 

 adeno- carcinoma, in which 



FIG. 317. GELATINOUS CARCINOMA OF THE STOMACH. 



Showing the infiltrating form of tumor occupying the pyloric end of the 

 stomach and advancing along the wall. 



the stomach is the medullary, or so-called 



1 See Osier and McCrae, on "Carcinoma of the Stomach in the Young," New York 

 Med. Jour., vol. Ixxi., p. 581, 1900. 



