Benign tumours of the stomach are rare, and unless they invade the orifices may produce no symptoms, though when ulcerating they may simulate malignant disease.
It may be possible for a considerable tumour to develop around a chronic gastric ulcer and to simulate cancer, both in its physical signs and symptoms. As a rule the length of time during which the symptoms have continued will give rise to a suspicion of ulcer, but on the other hand cancer is well known to be predisposed to by ulcer, and in such cases the presence of a well-marked tumour cannot but fail to give rise to a suspicion of cancer.
The presence of free hydrochloric acid in the vomit or in the lavage after a test meal, though in favour of ulcer, is no certain guide, for it is well known that in ulcus carcinomatosum the vomit contains an excess of free HCl.
On several such cases I have operated and performed a gastroenterostomy on finding the disease too extensive for removal; but the complete recovery of the patients and a return to perfect health have shown that the disease must have been simple.
On two occasions I have performed partial gastrectomy for what appeared to be cancer, and only on microscopic investigation has the disease been found to be simple. On one occasion I found a large tumour of the cardiac end of the stomach which I could not remove. The abdomen was closed and a bad prognosis given, but the patient recovered and is well some years later.
The points that may help in the diagnosis are the duration of the disease and the great pain and tenderness in ulcer. Even when the abdomen is opened it is not always easy to differentiate the two diseases, but the absence of nodules on the growth and of secondary nodules in the omentum together with the presence of discrete, though enlarged, lymph-glands, may be of some help, though in certain cases the only way to decide is by the microscope.