GASTEIC CAECINOMA. 359 



towards the point where the lymphatic trunks leave the stomach. 

 It shows little tendency to pass beyond the pylorus to the 

 duodenum, the lymphatic communication not being at all free in 

 this situation. Extension along the greater curvature is slight, 

 since the lymphatic trunks soon pass away to the coeliac glands. 

 The glands in the portal fissure may be directly implicated and 

 compress the portal vein and bile ducts. 



Carcinoma of the greater curvature infects the inferior gastric 

 glands and may cause diffuse infiltration of the great omentum 

 or perforate the transverse colon, causing a gastro-colic fistula. 

 Sometimes it compresses the vessels of the transverse colon, 

 causing local necrosis of this portion of the bowel. 



Carcinoma of the cardiac orifice can only infect one or two 

 glands of the lesser curvature, since the lymphatics of this region 

 soon reach the coeliac glands. The growth may invade the 

 oesophagus and spread along it in longitudinal columns corre- 

 sponding to the course of the lymphatics. There is a free com- 

 munication between the subserous and submucous lymphatics of 

 the stomach and the oesophagus . 



Enlarged coeliac glands sometimes form a nodular tumour. 

 They are in a position to receive pulsation from the aorta, 

 occlude the inferior vena cava, or invade the spinal column. 

 They are early infected in gastric carcinoma, and any radical 

 operation should include their removal. Their ducts join with 

 those from the intestines and discharge into the receptaculum 

 chyli which lies on the right side of the second lumbar vertebra 

 under cover of the right crus of the diaphragm. By backward 

 propagation the lumbar, mesenteric, sacral, iliac and even the 

 inguinal glands may be involved. Forward infection invades 

 the thoracic duct, the glands of the posterior and superior 

 mediastina and even those at the root of the neck, particularly 

 one on the left side above the clavicle, known as Virchow's gland. 



Miliary carcinomatous deposits may occur on the under sur- 

 face of the diaphragm, and in the superficial lymphatics of the 

 liver, being derived from the lymphatics of the portal fissure. 

 The diaphragm may be traversed and the right pleura invaded 



