(A) Cancer Of The Duodenum

In the duodenum the neoplasm almost always causes gastric symptoms similar in nature to those of cancer of the pylorus. Thus anorexia, pains, vomiting, and dilatation of the stomach will be the predominating features. If the tumor is situated near the pylorus in the superior horizontal portion of the duodenum it will be quite movable, and a differential diagnosis between cancer of the pylorus and that of the beginning of the duodenum will hardly ever be possible during life. In case the neoplasm is situated in the descending part of the duodenum, in the immediate neighborhood of Vater's papilla, icterus is often encountered. In such cases the initial symptoms may be jaundice and sometimes chills. The icterus may remain stationary or vary in intensity from time to time according to the degree of the obstruction of the duct caused by the neoplasm. Ulceration of the tumor may for a while open a passage for the bile and the jaundice'may then temporarily disappear. If the cancer is located below Vater's papilla, especially in the inferior horizontal part, the gastric contents will frequently show the presence of a large amount of bile. In the latter two instances the tumor, if accessible to palpation, is not movable.

On account of its deep situation it can frequently not be discovered.

(B) Cancer Of The Small Intestine

According to the region in which the neoplasm is situated, whether at the beginning of the jejunum or in the lower parts of the ileum, gastric or intestinal symptoms will predominate. There may be anorexia and vomiting, or, on the other hand, good appetite and apparently good stomach digestion, but obstinate constipation. The tumor is often accessible to palpation, and is as a rule very movable.

(C) Cancer Of The Large Bowel

Pains are frequently encountered at a localized spot in the region of the large bowel. They may exist before a tumor can be palpated and may be felt either in its immediate neighborhood or in almost exactly opposite portions of the colon. Thus cancer of the caecum may give rise to pain in the sigmoid flexure, and vice versa. These pains are rarely severe; as a rule they consist merely in a sensation of discomfort or in a feeling of tension. Besides these uncomfortable sensations of a more or less permanent nature, there may be more or less frequent attacks of colic. In the latter instance there may be violent excruciating pains in the abdomen, which may be relieved after passing of flatus or after a diarrhoeal movement. The attacks of colic are frequently caused by the commencing obstruction of the intestine, and therefore become gradually aggravated in nature. They may lead at last to a total obstruction and be the immediate cause of death. Constipation is one of the foremost symptoms of a neoplasm of the large bowel. It is encountered in the great majority of cases; in some instances it forms the first symptoms of the disease; at first it may be slight in nature, but becomes steadily more obstinate.

Ten or twenty days may pass without a spontaneous evacuation, and even cathartics are very slow in their action. The constipation as a rule is accompanied by the usual symptoms resulting from it, tension and fulness in the abdomen, poor appetite, occasionally pains. The constipation may at times disappear and give place to a period of diarrhoea. In some instances diarrhoeal evacuations may exist for many weeks, and they may be the predominating feature of the disease.