In a very large proportion of cases adhesions are found at the time of operation between a cancerous tumour of the stomach and adjoining organs, especially the pancreas, liver and biliary passages. This not only adds to the difficult}" of the operation but also tends to invasion of the neighbouring organs by continuity. These adhesions are due either to local inflammation set up by the growth or to extension of the malignant neoplasm.
Gussenbauer and Winiwarter state that adhesions are found in 63 per cent, of cases of pyloric cancer, a statement which my personal experience on the operating table would lead me to believe is even below the mark.
Extension through the blood-vessels is much commoner in sarcoma than in cancer of the stomach, but there are many examples of metastasis to the lungs, brain and other organs in true gastric carcinoma that can only be accounted for by vascular extension. Extension by way of the portal vein to the liver is the best example of vascular diffusion of cancer, but if infective particles pass through the portal meshwork in the liver they may be diffused by the general circulation to any part of the body.
Extension through contact is seen when the abdominal wall opposite to a fungating growth in the stomach becomes involved and when the various tissues and organs forming the stomach bed become invaded without there being any direct channel either through the lymphatics or bloodvessels to account for the extension.
Although secondary cancer of the stomach may occur subsequent to cancer of the oesophagus, breast, gall-bladder, intestine and other organs, it is not of importance from a surgical standpoint.
Cancer of the stomach may occur at any period of life, from early infancy up to extreme old age, but it is most frequently met with from forty to seventy. In the census reports for 1890 the death rate from cancer of the stomach was 10.24 per 100,000 living in the registration area. On analysis this yielded 3.22 between the ages of fifteen and forty-five; 34.45 between forty-five and sixty-five, and 79.96 over sixty-five years (Osier and Macrae, Cancer of the Stomach, p. 6).
I have operated for cancer of the pylorus at the early age of 21, and for cancer of the colon at the age of 14.
The white races seem more predisposed to cancer than the black ; Osier gives the actual incidence as 6 whites to 1 coloured.
The various estimates of the relative frequency of cancer of the stomach in the two sexes enables one to say that it is decidedly more frequent in males than females. Osier gives it as 5.2 to 1 ;
Brinton 2 to 1 ; Reiclic 1.8 to 1 ; my own experience in 110 operations on the stomach for cancer has differed considerably in hospital and private. Of 55 hospital patients 30 were males and 25 females : 1.2 males to 1 female. Of 54 private patients 44 were male to 10 female ; 4.4 males to 1 female.