Diagnosis

So far as the recognition of the malignant nature of the disease is concerned, the sarcomata do not offer any particular difficulty. The intractable character of the gastric symptoms, coupled with the progressive emaciation, physical debility, and cachexia, indicates a profound disturbance of the processes of digestion and assimilation, while the discovery of a growing tumour connected, with the stomach, or of metastases in other viscera, demonstrates at once the existence of a neoplasm. A more interesting question is the clinical differentiation of sarcoma from carcinoma. A diagnosis of round-cell sarcoma of the stomach may often be made by attention to the following facts: (1) The disease usually occurs before thirty-five years of age, so that the younger the patient, the greater the probability that the malignant affection is sarcomatous in character. (2) In many cases there is slight but continuous pyrexia, accompanied by rapid, and. profound, anaemia, while in carcinoma fever is usually absent during the early stages of the complaint and the cachexia much more gradual in its development. (3) Enlargement of the spleen is by no means infrequent, but is rarely met with in cancer unless the organ is involved in the growth. (4) According to Kundrat, the tonsils are apt to enlarge and the follicles upon the sides of the tongue may become swollen or ulcerated. (5) Secondary deposits in the skin occur in a notable proportion of the cases, and permit of excision and microscopical examination. It should be remembered, however, that sarcomatosis has been met with in true cancer of the stomach (Leube). (6) A large nodular tumour due to infiltration of the omentum, and a greatly enlarged liver with secondary growths in its substance, are rarely met with. (7) Persistent albuminuria is often observed in sarcoma but is exceptional in cancer. (8) The discovery of pieces of morbid growth in the vomit renders the diagnosis certain (Eiegel, Westphalen).

The spindle-cell and myo-sarcomata are chiefly characterised by their comparatively slow growth, a smooth, firm, and movable tumour, the frequent absence of pain, vomiting, and anorexia, and by the tendency to repeated haemorrhage.

When the tumour occupies the lesser sac of the peritoneum it may be mistaken for a cyst of the pancreas. It should be noticed, however, that in the latter disease pain after food, vomiting, and haematemesis are usually absent, while the tumour itself is firmly fixed, is smooth, elastic to the touch, and tends to come forward between the lower border of the stomach and the colon. In every case of doubt an exploratory operation should be undertaken.

Treatment

The medicinal treatment is the same as that of gastric cancer. The diet must be carefully regulated and the food peptonised if necessary. Symptoms of fermentation may be allayed by the administration of antiseptics and the employment of lavage, while severe pain requires the exhibition of morphine and other sedatives.

Many of the recorded cases have been subjected to surgical treatment, with considerable success so far as the immediate objects of the operation were concerned. Torok, Dock, Schopf, and others have removed considerable portions of the stomach affected by the round-cell growth, and in at least one case (Schopf) there was no recurrence at the end of a year. The solid tumours are especially favourable for extirpation, as they are often pedunculated and involve a comparatively small area of the gastric wall. Hartley removed a large fibro-sarcoma and Kosinski a cystic angio-sarcoma with apparent success; while in Cantwell's case the excision of a spindle-cell sarcoma weighing twelve pounds gave great relief to the patient for eight months. If one may judge from the morbid anatomy of the disease, the surgical treatment of sarcomata of the stomach will prove far more successful than can ever be expected in carcinoma, but it is too early as yet to determine the prospects of a permanent cure.