It is usually taught that the orifices of the stomach are most frequently attacked by scirrhus, while the body of the organ is the seat of the medullary and adenomatous forms of carcinoma. This statement, however, is hardly borne out by the results of a microscopical investigation. In forty-two cases of pyloric cancer we find that twenty-nine were described as ' spheroidal-cell,' and thirteen as ' cylindrical-cell.' Of the former, twenty-one presented an excess of fibrous stroma, and may therefore be regarded as ' scirrhus,' while in eight there was a preponderance of the cellular elements, which is characteristic of the medullary variety. It is worthy of notice that the scirrhus was usually limited in extent, and by its contraction had produced stenosis of the pyloric orifice, while the more diffuse infiltration of medullary cancer often gave rise to a rigid patency of the valve. Of the thirteen examples of adeno-carcinoma, six took the form of a diffuse infiltration, five of soft fungating growths, and two of a narrow ring which encircled the stomach about three inches from the pylorus. Owing to the non-contractile nature of the disease, marked stenosis of the orifice was seldom observed. Nineteen cases of cancer of the cardiac orifice were examined, of which sixteen possessed a spheroidalcell and three a cylindrical-cell structure. Of the former, fourteen exhibited comparatively little stroma, and usually formed soft tumours or deep ulcerations, while in the other two the orifice was greatly narrowed by the contraction of the fibrous elements of the growth (scirrhus). The three examples of adenocarcinoma occurred as soft ulcerating tumours near the lesser curvature, on the inner side of the oesophageal opening. Out of fourteen cases where the posterior wall or lesser curvature was primarily affected, eight were spheroidal-celled and six cylindrical-celled, while an examination of eleven cases of infiltration of the entire stomach showed that nine consisted of spheroidal-celled cancer and only two of the cylindrical-celled type.
Curvatures and surfaces
From these facts several general conclusions may be drawn.
(1) Neither of the two fundamental forms of carcinoma exhibits a special predilection for any particular region of the stomach.
(2) Circumscribed tumours of the orifices which produce stenosis are usually hard spheroidal-celled (scirrhus). (3) Diffuse infiltrations of the pyloric region or of the greater portion of the viscus, if accompanied by a contraction of the tissues, are usually of the spheroidal-cell type, while those which give rise to rigidity, without marked diminution in the capacity of the organ, are frequently of the cylindrical-cell variety. (4) A ring of new growth, which separates the stomach into two cavities of unequal size, is usually composed of adenocarcinoma, but globular or flattened tumours and malignant ulcerations are most often spheroidal-celled cancers. (5) Adenocarcinoma is comparatively rare as a primary growth near the oesophageal opening.