This is much less characteristic than in cases of simple ulcer. It chiefly exists over the site of the growth, and is especially noticeable when the disease has infected the omentum or some other neighbouring structure. As a rule, a rapidly growing tumour of the body of the stomach is more tender than a circumscribed scirrhus of the pylorus, and not infrequently the maximum pain is felt at some little distance from the centre of the mass, where the neoplasm is invading fresh tissue or has undergone ulceration. General tenderness over the region of the stomach may be observed in cases of pyloric stenosis where the viscus is inflamed and filled with gas, and in most of those in which the organ is affected by diffuse cancerous infiltration. Manipulation of a tumour is often followed by severe pain, which persists for several hours and is sometimes accompanied by vomiting.
Some writers have asserted that the pain of gastric cancer is often referred to certain areas of the skin which present an extreme degree of hyperaesthesia. According to Head, the stomach receives its sensory nerve-supply from the sixth, seventh, eighth, and ninth dorsal segments, the two former supplying the cardia and the last-named the pylorus ; consequently, in cases of organic disease of the viscus cutaneous tenderness should exist in front from the level of the nipple to the umbilicus, and posteriorly from the fifth to the twelfth dorsal spine. Each area is also supposed to present certain specially tender points, those for the sixth dorsal area being just below the nipple and at the angle of the scapula ; those for the seventh near the tip of the ensiform cartilage and below the angle of the scapula ; while for the eighth and ninth they are situated anteriorly in the nipple line and posteriorly below the inferior angle of the scapula. The same observer states that there are painful and tender areas upon the scalp which correspond to the dorsal cutaneous areas, the occipital region corresponding to the tenth dorsal and the parietal to the ninth. If these facts were correct they would obviously constitute a very valuable aid not only in the diagnosis of gastric disease generally, but in the exact location of an ulcer or a growth. Unfortunately, the results of clinical experience do not confirm the supposititious value of these statements, for although we have carefully examined several hundred cases of gastric disease, we have never been able to demonstrate either that cutaneous hyperesthesia is a constant accompaniment of an ulcer or a growth, or that its situation corresponds in any way with the location of the lesion in the stomach. The only affection which, in our experience, is frequently associated with tender areas in the regions mentioned is subacute gastritis with flatulent distension of the stomach or colon, and even in this disorder they vary greatly in position at different periods of the day. As an indication of gastric carcinoma we regard superficial tenderness as not only valueless but absolutely misleading.