During about the same period, diffuse and mixed forms of gastric cancer started their ascending march, to slowly but steadily displace the intestinal forms of cancer. For this reason, in this and subsequent chapters we place special emphasis on the clinical symptoms of the diffuse (D Fig. 19) and mixed morphological forms of gastric cancer (D Fig. 20).

If we evaluate the symptoms based on modern ideas, we note that the discussion concerns mainly the clinical symptoms, characterizing a whole group of diseases of the so-called gastroenterological profile. These symptoms are almost unsuitable for the differential diagnosis of gastric cancer and noncancerous diseases of the stomach. We have already noted that during the last decades of the past century, diffuse and mixed forms of gastric cancer became the dominant morphological forms. Accordingly, the »old« set of clinical symptoms of gastric cancer became even more useless for diagnostic purposes (D Fig. 21).

□ Fig. 19a-e. Female patient T., aged 60. Diagnosis: gastric cancer. a Stomach X-ray (tight filling, vertical position, anterior projection): lower third of stomach body irregularly narrowed by circles; the walls are rigid, the angular notch is straightened, the lesser curvature is depressed over a significant length (arrow). b Target X-ray of the stomach (tight filling, vertical position, anterior projection): stable narrowing, uneven and eroded contours. c Stomach X-ray (double contrast, horizontal position, anterior projection): circular infiltration of lower third of the stomach body; the wall of the lesser curvature at the notch and the proximal antral part is thickened due to expansion of intramural infiltration in the distal direction; the wall of the lesser curvature is thickened over a long distance because of predominant spread of the tumor in the proximal direction (arrows). Conclusion: infiltrative cancer of the antral part and the body of the stomach. d Macrospeci-men of a resected stomach: part of the intramural infiltration of 3-4 cm on the greater curvature (arrows); relief of the lesser curvature with no visible changes (longitudinal folds persist). e Fragments of a macrospecimen (strips): gastric wall is thick over a long distance due to intramural infiltration (arrows). Histologically, a signet-ring cell carcinoma

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