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▲ Fig. 27 a. ▼ Fig. 27 b.

to 10 months, even if the patient visits the doctor within the first 5-10 weeks. These patients are usually subjected to an endoscopic examination which establishes the diagnosis of gastritis, and the patient is given relevant treatment, whereas the true character of their complaints is not established [45].

▲ Fig. 27 c.

O Fig. 27a-c. Patient T., age 19. Diagnosis: gastric cancer. Anamnesis: the patient complained of epigastric pain for about 6 months. Primary endoscopy revealed ulcerous defect on the anterior wall of the stomach. Examination of bioptates did not reveal signs of inflammation or tumor cells. The absence of improvement suggested X-ray examination. a Stomach X-ray (tight filling, vertical position, anterior projection): markedly disfigured stomach body, uneven contours, eroded at some points (arrows). b Stomach X-ray (double contrast, horizontal position, anterior projection): stomach walls are thick and rigid due to circular intramural infiltration (arrows), with some irregular rounded spots with contrast medium at the periphery (ulcers). Conclusion: infiltrative-ulcerous cancer of the stomach. c Endophotograph (following X-ray examination): 2.5-cm ulcer with rough floor covered with necrotic tissues, with thick converging folds. Infiltration into adjacent mucous membranes. Histologically, non-differentiated cancer

This situation can be explained as follows: First, the physician is not on the alert while examining the young; cancer occurs far less frequently in young patients than in the aged. But physicians should never underestimate the danger of cancer even in persons under 20 (O Fig. 27). Second, most carcinomas of the young are characterized by intramural growth (in 70-75% of cases). Therefore, any patient presenting with gastrointestinal complaints must be examined by both X-ray and endoscopy [45, 53].

To complete our discussion of the clinical symp -toms of gastric cancer we should return to the problem of its early diagnosis. When the diagnostic search begins only after the appearance of clinical symptoms, radical change is necessary. In most cas es gastric cancer need not be diagnosed only at the clinical stage of its development; indeed, this must be done earlier, because gastric cancer belongs to the group of diseases that are diagnosed mainly by instrumental methods. The situation with early diagnosis of gastric cancer may be improved only if a complex of diagnostic tools, including a primary X-ray survey of the entire stomach and subsequent endoscopy, is used. In other words, risk group patients should be examined. It must also be noted that in view of recent advances in technology, the diagnostic algorithm of patient examination for gastric cancer must include ultrasonography, computed tomography, and magnetic resonance tomography. These should be regarded as methods additional to the traditional X-ray investigation and endoscopy.

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