458 MUCOUS MEMBRANES. 



Compared with carcinoma of the middle third of the oesopha- 

 gus, cancerous affections of the cardia and other regions are 

 uncommon. I have met, however, on two separate occasions, 

 with a very superficial and much softer variety of cancer, which 

 had invaded large sections of the oesophageal tube in a very 

 diffuse way. 



§ 398. The stomach has an especially rich repertoire of 

 carcinomata ; we find, with nearly equal frequenc}^ a soft, a 

 hard, and a colloid form of glandular cancer, as well as a 

 columnar epithelioma. All the varieties of glandular cancer 

 agree in their origin from the mucous membrane proper, extend- 

 ing secondarily to the submucous tissue. I lay stress upon this 

 fact, because an essential distinction used to be drawn between 

 " submucous " and " mucous " cancers of the stomach. It is 

 true that the transition above alluded to usually occurs at a very 

 early period, and that the cancerous proliferation advances much 

 more rapidly in the wider spaces of the submucous tissue, with 

 their numerous lymphatic networks, than in the mucosa proper. 

 Hence it is, therefore, that the cancer frequently takes the form 

 of a laminar infiltration of the wall of the stomach, over which 

 the mucous membrane extends, either unaltered or simply atro- 

 phied, and is freely moveable, while it is bound down to the 

 subjacent growtli at one point only. Now it is from this point 

 that the morbid process originally sets out ; this is the oldest 

 part of the disease. In most of the cases which come under our 

 notice, it is occupied b}^ an ulcer, which has destroyed the place 

 of origin of the cancer, and has accordingly made it impossible 

 to decide, whether the glandular elements of the mucous mem- 

 brane had any share in the first development of the disease, or 

 not. All the more valuable are the statements made by 

 Waldeyer {Virchoivs Archiv., vol. xli.), who succeeded, not- 

 withstanding these obstacles, in establishing the origin of the 

 morbid growth from the mucous follicles and peptic glands. 



A very usual post-mortem appearance in soft cancer of the 

 stomach, is that of a single ulcerated patch, several square 

 inches in area, surrounded by a border of mucous membrane 

 thickened by infiltration with cancerous elements. The tumour 

 has originated, as very often happens, on the lesser curvature, 

 and has extended downwards from this point both along the 

 anterior and the posterior wall of the organ. The ulcerated 



