Cancer may affect the entrance, the exit, or any intermediate part of the stomach, but it more often affects one of the openings than elsewhere. Cancer of the stomach is essentially a disease of the latter half of life, and more often affects men than women. We will first consider cancer at the entrance of the stomach.

I. Cancer Of The Oesophagus

The entrance to the stomach consists of the gullet or oesophagus. It may be affected by cancer in any part of its course, but the disease is far more common at the opening into the stomach than any other part of the tube. The symptoms of the disease are few. The first indication of anything wrong is a difficulty in swallowing, due to the food "sticking" in some part of the passage or meeting with some obstruction. This symptom is at first not very pronounced, and it may occur only occasionally as the result of a spasm produced by irritation of the diseased part. After a time, however, a stricture is formed, the difficulty becomes more obvious, and it is seen that the food will not go down without difficulty. By and by a dilatation occurs above the seat of stricture, a pouch is formed in which food collects, and some of the food is regurgitated. An examination with an oesophageal tube shows the existence of an obstruction, and pain is caused by the passage of the tube through the stricture. When the cancer ulcerates, blood, mucus, and sometimes pus are brought up with the regurgitated food. On testing the reaction of the latter with litmus paper it is found to be alkaline, whereas food brought up from the stomach is usually acid. As the disease progresses there is a more or less constant pain which increases with the growth of the cancer and implication of nerves and surrounding structures. The patient emaciates and his abdomen becomes flat. The prognosis is very bad and the duration of the disease uncertain.

The treatment of such a case will tax the ability of the nurse and her skill in the use of the stomach tube. So long as the patient can swallow soft and liquid foods he may have three or four pints of milk and raw eggs, strong soup, potted or pounded meat, fish, or fowl, puree of potatoes and other vegetables, fine oatmeal, arrowroot, and other farinaceous foods, such as Allenburys', Savory and Moore's, and Benger's or Mellin's, and plenty of sugar, glucose syrup, or other nourishing liquids or semi-liquids. Butter can be freely mixed in many of these foods. Cream and cod-liver oil are useful forms of fat.

When the patient can no longer swallow such foods he must be fed three times a day by means of a stomach tube. The nurse must give a good meal while she is about it. It may consist of 1 1/2 pints of milk, three or four raw eggs, or 6 or 7 ounces of pounded meat, and one of the farinaceous foods, and a little water or other liquid at the end of the meal. When it becomes absolutely, impossible to pass the stomach tube she must resort to rectal feeding. After resting from the use of the stomach tube for a few days it occasionally happens that the stricture relaxes and the tube will again pass readily. The patient should then be fed as before. But when the disease is sufficiently advanced to render the use of a stomach tube necessary the question of an operation to make the feeding more easy should be considered by the patient and his friends. The operation consists in the formation of an aperture into the stomach through the anterior abdominal wall (gastrostomy). This operation will save the patient much pain, render the introduction of a tube quite easy, feeding can then be abundant, and the life of the patient will be prolonged.