540 DISEASES OF THE STOMACH. 



Such a cancerous ulcer may attain twice the size of the hand, and 

 the proliferations be sufficient to encroach considerably upon the space 

 in the stomach. 



Alveolar or colloid cancer rarely appears as scattered nodules ; it 

 more frequently occurs as diffuse degeneration. It also usually com- 

 mences in the submucous tissue, but soon induces degeneration of all 

 the coats of the stomach ; in the wall, which has become several lines, 

 or even half an inch thick, no trace of the original structure can be 

 found ; it consists almost entirely of innumerable small cavities (al- 

 veoli), which contain a gelatinous fluid. Microscopic examination of 

 the latter shows the cellular formation characteristic of gelatinous can- 

 cer. In alveolar cancer, also, the mucous membrane is destroyed, the 

 alveoli are evacuated, the free surface appears ragged and discolored ; 

 but the loss of substance never becomes very deep, for, while the 

 destruction goes on above, there is new production belowv 



The cancerous degeneration often extends to other organs, particu- 

 larly to the lymphatic glands, the pancreas, liver, transverse colon, or 

 omentum. The breaking down of the growth may also extend beyond 

 the stomach to these organs, and give rise to communication between 

 the stomach and the intestines, or, after adhesion of the stomach to the 

 anterior wall of the abdomen, perforation outwardly may occur. Al- 

 veolar cancer alone rarely affects the organs above mentioned ; but it 

 frequently induces diffuse degeneration of the peritonaeum and conse- 

 quent ascites. 



If the breaking down of the cancer advances to the peritonaeum be- 

 fore the stomach has become adherent to the neighboring parts, its 

 contents may escape into the abdomen, and fatal peritonitis result. 



If the cancerous degeneration leads to stricture of the pylorus, 

 which, by nodular prominences and angular curvature of the contracted 

 portion may still more increase the difficulty of the escape of the con- 

 tents of the stomach, dilatation of the stomach will result. If, on the 

 other hand, the cancer be located at the cardiac portion, or, if there be 

 degeneration of a large portion of the wall of the stomach, as happens 

 particularly in alveolar cancer, the stomach may become smaller. 



In many cases the diseased pylorus remains at its normal locality, 

 being attached by adhesions ; but in many others it moves freely, and, 

 from its weight, sinks down in the abdomen even as low as the sym- 

 physis pubis. 



SYMPTOMS AXD COURSE. Cases occur where it is impossible to 

 recognize cancer of the stomach with certainty during life. In elee- 

 mosynary and hospital practice, patients not unfrequently come under 

 treatment who are emaciated to skeletons, indifferent, and so apathetic, 

 that thev make no complaints, and cannot give any history of theii 



