In every other gastric disease the symptoms that ensue from the disturbance of digestion are not only the first to attract attention, but continue of primary importance throughout the whole course of the malady. But in cases of carcinoma the secondary or constitutional phenomena always seem out of proportion to the disease in the stomach, and often constitute for some time the sole sources of complaint. In this category loss of flesh, diminution of energy and strength, and progressive anaemia are the most conspicuous, and increase in severity in spite of all efforts at treatment. Another fact which seldom fails to impress itself upon the minds of onlookers is the strange pessimism exhibited by the patient, who will continue to avow that he is growing worse even when his symptoms show signs of remission, or even subside for the time. Equally rebellious are the strictly local phenomena. If flatulence is the chief cause of complaint, it remains uninfluenced by the administration of those medicinal remedies which usually relieve it, while the pain after food is rarely removed by the most careful attention to diet. In like manner, the substitution of liquids for the solid forms of nourishment often seems to increase rather than to allay the tendency to emesis, and no temptation by favourite dishes can overcome the increasing dislike to meat and other kinds of food. Sooner or later, to these various causes of suspicion there is added a symptom which at once directs attention to the serious nature of the gastric lesion : during an attack of vomiting, or as a result of the employment of a tube, the ejecta are found to contain altered blood, or the patient suffers from a veritable attack of haematemesis. Unlike, however, the haemorrhage from a simple ulcer, the loss of blood does not relieve the previous symptoms, while the anaemia to which it gives rise continues to increase, and is unaffected by the administration of iron.
Examination of the stomach rarely fails to throw some light upon the nature of the disease. Even at a comparatively early period the hydrochloric acid of the gastric secretion is found to be much diminished, and within a short time it can no longer be detected in a free state; while in most cases the disappearance of the free mineral acid is associated with the production of lactic acid and the presence of the Oppler-Boas bacillus. Dilatation of the stomach is almost invariably present when the growth affects the pylorus, and as the organ increases in size the attacks of emesis exhibit a peculiar periodicity of recurrence, while the passage of a tube in the early morning reveals the existence of food-stagnation. Just as haemorrhage is the most important of the various local symptoms, so the detection of a tumour constitutes the physical sign of the greatest moment. The period at which a tumour develops varies in different cases, but when once a tender growing mass attached to the stomach is discovered, further evidence as to the nature of the disease may be regarded as superfluous. In other cases equally important evidence is derived from the infection of organs outside the stomach. Thus, the liver may enlarge and present several palpable growths in its substance, or small tumours may appear in the skin of the abdomen near the umbilicus, with, perhaps, a cord-like induration of the linea alba. In other instances, again, the pleurae or the lungs exhibit signs of disease, ascites or jaundice develops, the glands above the left clavicle become enlarged, or the veins of the legs are affected by thrombosis. Examination of the blood always indicates the existence of secondary anaemia, the slight degree of leucocytosis which normally occurs after meals may be absent, the sulphocyanide of potassium in the saliva tends to disappear, and perhaps small particles of the morbid growth may be detected in the vomit or the washings of the stomach.