Localized Lesion Symptoms

There are no diagnostic, characteristic, or pathognomonic symptoms of stomach cancer. As indicated previously, the lesion may occasionally be detectable when it is entirely silent. Usually, however, the early symptoms fall into one of several somewhat arbitrary and overlapping categories:

1. Constitutional symptoms-& quite vague and ill-defined decline in health and energy with some weight loss, anorexia, weakness, malaise, and lassitude. There is nothing to direct suspicion to the stomach as the seat of the trouble, except the loss of appetite.

2. Ulcer symptoms-a syndrome entirely compatible with peptic ulcer with all of the well-known "typical" or "atypical" features. The condition may initially be diagnosed as an "ulcer" and the patient treated-often with pronounced, though temporary, success-by means of diet, antacids, antisecretory agents, antispasmodics, etc.

3. Nonspecific upper gastrointestinal symptoms. These may include the following:

(a) Anorexia

(b) "Indigestion"

(c) Heartburn

(d) Belching

(e) Dysphagia

(f) Bloating

(g) Epigastric pain or discomfort

(h) Nausea

(i) Vomiting

(1) Simple retention type

(2) With or without hematemesis

Barely the clinical picture of an acute abdomen may present as the result of gastric perforation due to a malignant ulcer.

The onset and persistence of these symptoms-rather than any special characteristic of them-in an individual in the cancer age group should serve to single him out for particular evaluation.

In general, the nature, severity, sequence, and progression of the symptoms are a composite refection of the combined effects of the size, location, type, and growth potential of the tumor plus that indefinable something called host resistance.

This maxim is, of course, true of cancer in general. A few examples will serve to illustrate its special pertinence to stomach cancer:

1. A lesion located in the cardia may produce dysphagia and the type of almost immediate vomiting and regurgitation characteristic of esophageal or high obstruction.

2. A lesion located in the pyloric or prepyloric region may produce symptoms of pyloric obstruction with the retention type of delayed vomiting.

3. A predominantly ulcerative lesion, regardless of location, is more likely to produce earlier symptoms, including those of the ulcer-cycle syndrome, than the tumor in which the mucosa remains intact. Generally speaking also, an ulcerative lesion is more often associated with anemia, melena, and hematemesis.

4. A lesion that is small in size or whose location is in an area in which it interferes little with gastric function or whose growth is predominantly in the stomach wall rather than the lumen may be well established before it produces any symptoms.

5. A lesion of rapid "growth potentiar in an individual with low "tumor resistance" may achieve incurability very rapidly. With "low growth potentiar and high "tumor resistance," the reverse is true. The terms used are in quotation marks because, although they represent situations that undeniably appear to exist, there is almost complete ignorance regarding their basic nature and significance.

Signs

Physical signs are rarely present in the genuinely early case. When found, they tend to be rather nonspecific in character. They include:

1. Evidence of weight loss or anemia

2. Epigastric or upper abdominal tenderness

3. Epigastric mass

The presence of overt physical signs which point to the stomach as the source of the trouble is usually regarded as indicating a poor prognosis.

Advanced lesion Symptoms

Intensification, persistence, and progression of any or all of the symptoms noted under the early lesion.

Appearance of the following physical findings, plus those already mentioned, in any combination or sequence may be characteristic of late stomach cancer. 1. Adenopathy, especially supraclavicular ("Virchow's node")

2. Enlargement and nodularity of the liver

3. Ascites

4. Jaundice

5. Nodularity and/or fixation of the umbilicus

6. Mass in the pre-rectal cul-de-sac (rectal or Blumer's shelf)

7. Ovarian mass (Krukenberg tumor)

Stomach cancer may spread and present virtually anywhere; the foregoing are the more common manifestations of advanced disease.