The fact that glandular tumours occasionally develop above the left clavicle has long been known, but the frequency of their occurrence and their clinical significance have been much exaggerated. Thus, while some writers refer to the presence of palpable glands in that position as pathognomonic of gastric cancer (Friedreich, Henoch), others state that they may be detected in the majority of the cases. To both these statements we are obliged to take exception. In the first place, in most diseases that are accompanied by great emaciation one or more glands may be felt in the left supraclavicular fossa, while not a few examples of malignant disease of the stomach present old tubercular lesions in that position. Again, among a series of cases of gastric cancer which we examined with special reference to this point, nearly 11 per cent, exhibited supraclavicular glands which could be easily felt, but in no instance did microscopic examination after death indicate any malignant infection of the cervical lymphatics. On the other hand, the gradual development of a glandular tumour in the neck, axilla, or groin, which tends to become adherent to the skin and subjacent structures, must always be regarded as an indication of considerable importance. In our hospital series tumours of this character were observed above the left clavicle in 3 per cent., above the right clavicle in 0.5 per cent., in the left axilla in 1 per cent., and in the inguinal region in 2 per cent.
As a rule the glandular enlargement does not appear until a late stage of the disease, and almost invariably indicates extensive infection of the mediastinal or mesenteric lymphatics, but when the gastric symptoms are latent the glandular tumour is occasionally the first sign to attract attention (Lepine).
Enlargement of the glands in the left axilla is usually secondary to involvement of those above the clavicle, while a growth in the right supraclavicular space indicates the existence of metastases in the right pleura or lung. An affection of the inguinal glands is most common on the right side, and often accompanies a diffuse infection of the mesenteric, lumbar, and sacral glands, but it is occasionally associated with metastases in the ovary or other pelvic viscera. In cases of general carcinosis all the superficial glands are apt to become enlarged.