should manifest changes. The most important characteristics are those obtained by the double-contrast technique owing to incomplete stretching of the mucosal folds in the presence of hyperplasia or the presence of two to three folds converging toward the part of the stomach wall which is thickened or has uneven contours. This is confirmed today by acknowledgement of the existence ofthe so-called hyperplas-tic or gigantic-fold forms of diffuse gastric cancer
(□ Fig. 59). In other words, the study of the mucosal relief must concentrate on the two major signs which we propose to consider, namely, uneven contours of the stomach and thickening of its wall (□ Fig. 60). Our vast experience suggests that assessment of these two signs makes it possible to rule out the existing scheme of their recognition. The two symp -toms are characterized by the variety of their manifestations - from minute irregularities of the stomach contours and insignificant thickening of the stomach wall over very small areas, detectable with the double-contrast technique, to large affections of 3-4 cm. We have cases illustrating dynamic growth of these two symptoms. As a rule, this occurred in patients in whom endoscopic examinations (both visual inspection and microscopy of tissue specimens) failed to discover the initial signs of diffuse infiltration for a considerable length of time. According to modern regulations, however, only en-doscopic verification - to be more particular, only histological verification of the diagnosis of gastric cancer - may be regarded as a sort of official indication for radical surgery [72, 178, 259].
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