Cancer and other tumours of the stomach / by Samuel Fenwick and W. Soltau Fenwick.

  • Samuel Fenwick
Date:
1903
Catalogue details

Licence: Public Domain Mark

Credit: Cancer and other tumours of the stomach / by Samuel Fenwick and W. Soltau Fenwick. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    usually ascribed to infection of the systemic arteries. As, however, this explanation does not account for the limitation of the disease to the trunk, we prefer to attribute it to a direct extension by the parietal lymphatics ; and, in two cases where the skin of the thorax exhibited numerous nodules, we were able to prove after death that the mischief had spread from the anterior mediastinum into the intercostal glands, and thence into the intercostal lymphatic vessels. The coeliac glands constitute an important intermediate centre between the stomach and the receptaculum chyli. They are often much enlarged in growths of the cardia and of the posterior wall, and sometimes form a nodular tumour, which can be detected during life. Softening and ulceration of their substance may lead to occlusion of the inferior vena cava or to destruction of the vertebral column (Brun). In nearly every case they transmit the disease to their pancreatic, hepatic, and splenic tributaries. Invasion of the receptaculum chyli marks the last stage in the process of lymphatic infection. Through the medium of this reservoir the disease may be propagated backwards to the mesenteric, lumbar, and sacral glands, and thence to those situated along the course of the iliac vessels and in the inguinal region. Extension of the mischief in an upward direction takes place through the thoracic duct, which is sometimes found to be diseased throughout its entire length or occluded by masses of cancer cells (Fenger). This condition is usually associated with extensive infiltra- tion of the glands in the posterior mediastinum and of those at the roots of the lungs and at the bifurcation of the trachea. In about 3 per cent, of all cases of gastric cancer a glandular enlargement occurs above the left clavicle, owing to the infection of the cervical tributaries of the thoracic duct, while in rare cases a similar condition above the right clavicle indicates the involvement of the right lymphatic duct. C. VASCULAE INFECTION Carcinoma of the stomach is apt to involve the vessels in its neighbourhood either by direct extension or through the medium of the lymphatics. As a rule the veins are more affected than the arteries, and, in addition to a general infiltration of their walls, they not infrequently present masses of epithelial