Localization of the tumor within the boundaries of a given part of the stomach is the basic factor influencing the onset, the character, and terms of development of clinical symptoms. Thus, a tumor originating in the immediate vicinity of the cardiac sphincter relatively soon invades the abdominal segment ofthe esophagus to cause dysphagia (□ Fig. 119). With a tumor located at a distance from the cardia, e.g., on the posterior wall or the greater curvature, this symptom occurs much later or not at all (□ Fig. 120). But the initial site of the tumor does not determine the development of this or that clinical symptom exclusively. It also has a significant effect on the formation of radiological signs. Every experienced radiologist knows that there is a great difference between the traditional X-ray picture of cancer of the cardia and that presented by cancer of the posterior wall of the upper part of the stomach and the stomach fundus (□ Figs. 121 and 122). Secondary changes characterizing further progress of the tumor differ as well. In some cases, these are invasion of the esophagus, in others the diaphragm, and in still others the splenic hilus, the pancreas, etc. [63, 82, 147, 151].

Thus, tumors originating in various locations of the upper part of the stomach can differ in at least three aspects:

1. Clinical symptoms

2. Signs of blastomatous affection detectable by radiological methods

3. Complications associated with further growth of the tumor

Our experience and the data in the literature show that the traditional X-ray examination, based on the classical method of the first gulp and examination of the mucous membrane relief against the background of the air bubble, can diagnose proximal gastric cancer in 75-92% of cases [31, 38, 42, 52]. But these are generally advanced forms of cancer, in which diagnosis does not lead to cure. Although there are publications regarding early cancer of this part of the stomach, diagnosis of this tumor remains very complicated, and in some cases infeasible.

□ Fig. 121 a-c. Female patient B., age 69. Diagnosis: gastric cancer. a Stomach roentgenogram (tight filling, vertical position, anterior projection): organic changes are not detectable. b Stomach roentgenogram (double contrast, vertical position, left lateral projection): the specific radiating pattern of the cardiac rosette is absent (arrows). c Stomach roentgenogram (double contrast, vertical position, left lateral projection): atypical relief of the cardiac rosette (arrows). Conclusion: Infiltrative cancer of the cardiac part of the stomach. The patient was operated. Histologically, signet-ring cell carcinoma.

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