Cases are occasionally encountered in which the symptoms are either entirely absent or only appear at a late stage of the complaint. Three types of latency maybe observed: (a) Where gastric symptoms are completely in abeyance ; (b) Where they are replaced by those due to the cachexia or to some coexisting disease; (c) Where they are masked by those arising from cancerous infection of other organs.
(a) A complete absence of symptoms is very rare, and is chiefly met with in old people who are physically or mentally feeble. In such the sole indication of disease consists of general decay, associated with loss of flesh, anaemia, anorexia, constipation, and debility, and perhaps with flatulence and distension after meals. These symptoms steadily progress until the patient is obliged to take to his bed, when life slowly and almost imperceptibly ebbs away. In other instances sudden perforation (Watson), haematemesis (Surmont and Patoir), or haemorrhage from the bowel (Caven) occurs, and constitutes the first and only indication of a gastric lesion; while occasionally a casual examination of the abdomen reveals the existence of a large tumour of the stomach, the presence of which had been entirely unsuspected. Thus, Siredey relates a case in which a cancerous mass involving the pylorus and the greater curvature existed without any symptoms, while in the similar one recorded by Kepler the tumour was so movable that it was regarded as a floating spleen. In the following case the disease ran its course without exciting any suspicion of its presence.