Perigastric adhesions are a frequent cause of the extension of malignant disease to neighbouring tissues, and it is by no means rare to find a large secondary tumour in the substance of a solid viscus immediately contiguous to the cancerous ulcer. Should the latter have perforated the whole thickness of the gastric wall, the process of sloughing or disintegration often spreads to the more recent deposit, with the result that a cavity forms in its centre which communicates directly with the stomach. This condition is most common in connection' with soft growths of the lesser curvature, and owing to the size and close proximity of the liver it usually affects the right hepatic lobe. The cavity itself varies from the size of a walnut to that of an orange, and possesses highly vascular walls, which are covered with nodular or fungoid masses. Occasionally a short sinus connects the stomach with the hepatic abscess; while in rare instances the fusion of several secondary deposits gives rise to a multilocular cavity in the liver, which communicates with the stomach by two or more openings. In those cases where the neoplasm is situated close to the cardiac orifice the left lobe of the liver is more often affected than the right.
The frequent invasion of the gall-bladder by growths of the pylorus usually leads to its complete destruction. Occasionally, however, when bilious obstruction has previously arisen from pressure upon the common duct, subsequent perforation of the gall-bladder gives rise to the formation of a gastro-biliary fistula, but this condition rarely persists.
Implication of the pancreas, with the production of a cavity in its substance, is usually associated with a primary growth of the posterior wall of the stomach. Sometimes large pieces of the gland slough off and are found in the stomach or in the sac of the abscess ; or the whole thickness of the organ is destroyed and the malignant disease invades the vertebral column.
Owing to the infrequency of cancer at the fundus, the spleen is rarely destroyed by a primary growth of the stomach, and in only one of our cases (0.4 per cent.) did it contain an abscess which communicated with an aperture in the gastric wall. In one instance a growth of the pylorus was found to have produced a sloughing cavity in the tissue of the uterus, to which it had become adherent. Renal abscess is very rare and almost exclusively met with on the right side.