Cancer of the Cardiac Part

The diagnosis of tumors of the cardiac part of the stomach is associated primarily with the anatomical properties of this region. These include: pronounced relief, permanently changing zone of the functioning cardia, and the specific distribution of muscle fibers in this part of the stomach wall. Compression and palpation are impossible here.

It is necessary to note that the traditional method of detecting tumors of the upper part of the stom-

ach does not meet the requirements of modern gas-tro-oncology. The opinion is still held that dysphagia is the most specific symptom of cancer of the upper part of the stomach. Meanwhile, practical experience shows that this symptom appears, as a rule, at those stages of the disease when radical surgery is already impracticable or has little effect (D Fig. 118) [9, 18, 155].

In order to increase the efficacy of practical radiology in revealing cancer of the upper part of the stomach, it seems reasonable to divide this type of cancer into five groups according to the type of tumor:

1. Tumors of the cardia. Depending on the initial localization, this group should be subdivided into the following:

a. Cancer of the cardia proper b. Supracardiac cancer c. Subcardiac cancer d. Precardiac cancer e. Retrocardiac cancer

2. Tumors of the anterior wall of the upper part of the stomach

3. Tumors of the posterior wall of the upper part of the stomach

4. Tumors of the stomach fundus

5. Tumors of the greater curvature of the upper part of the stomach

D Fig. 118 a-f. Female patient E., age 67. Diagnosis: gastric cancer. a Roentgenogram of the upper part of the stomach (double contrast, vertical position, anterior projection): wall of the fundus is thickened due to intramural infiltration (arrow). b Roentgenogram of the upper part of the stomach (double contrast, vertical position, left lateral projection) at the moment of contrast medium passage through the gastroesophageal junction: the abdominal segment of the esophagus is unevenly narrowed (black arrows) due to spreading infiltration (white arrow). c Roentgenograms of the upper part of the stomach (double contrast, horizontal position, left posterior oblique projection): more distinctly visualized is thickening of the fundus walls due to intramural infiltration (black arrows); atypical relief of the cardiac rosette (white arrows). Conclusion: Infiltrative cancer of the upper part of the stomach with invasion of the esophagus. In order to estimate spread of infiltration onto the neighboring organs and tissues, the patient was examined by computed tomography. d, e, f Computed tomograms (tight filling with E-Z-CAT DRY, supine position): the wall of the fundus is thickened due to intramural infiltration spreading to the left crus of the diaphragm and the spleen (arrows). Endoscopic examination proved to be infeasible due to markedly narrowed esophagus.

D Fig. 119 a-c. Patient D., age 58. Diagnosis: gastric cancer. a Stomach roentgenogram (tight filling, vertical position, left lateral projection) at the moment of contrast medium passage through the gastroesophageal junction: the abdominal segment of the esophagus is unevenly narrowed, its contours are uneven and eroded, the walls are rigid. b Roentgenogram of the upper part of the stomach (double contrast, horizontal position, left posterior oblique projection) at the moment of contrast medium passage through the gastroesophageal junction: mucosal folds terminate near the cardia; the contours of the abdominal segment of the esophagus are uneven and eroded. c Roentgenogram of the upper part of the stomach (double contrast, horizontal position, left posterior oblique projection): atypical relief of the cardiac rosette (cardioesophageal junction); termination of mucosal folds is distinctly visualized. Conclusion: Infiltrative cancer of the upper part of the stomach with invasion of the esophagus. Histologically, signet-ring cell carcinoma.

□ Fig. 120 a-e. Patient I., age 62. Diagnosis: gastric cancer. a Stomach roentgenogram (tight filling, vertical position, anterior projection) at the moment of contrast medium passage through the gastroesophageal junction: uneven narrowing of the abdominal segment of the esophagus (white arrows), uneven and eroded contours of the body and the upper part of the stomach (black arrows). b Stomach roentgenogram (double contrast, horizontal position, left lateral projection): atypical relief of the cardiac rosette (cardioesophageal junction), the walls are rigid and thickened due to diffuse circular intramural infiltration (arrows). c, d Roentgenograms of the upper part of the stomach (double contrast, horizontal position, left lateral projection) at the moment of contrast medium passage through the gastroesophageal junction: uneven narrowing of the abdominal segment of the esophagus, uneven contours (arrow). Conclusion: Infiltrative cancer of the upper part of the stomach with invasion of the abdominal segment of the esophagus. e Endophotograph: the cardiac part is greatly narrowed due to spread of tumor which embraces the stomach walls circularly. Histological examination of the bioptates verified signet-ring cell carcinoma.

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