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□ Fig. 57a-d. Patient B., age 73. Diagnosis: gastric cancer. a Stomach roentgenogram (tight filling, vertical position, anterior projection): the stomach cavity is diminished, the notch is straightened, the lesser curvature is short, depressed, uneven contours; the walls are rigid (arrows). b Stomach roentgenogram (double contrast, horizontal position, anterior projection): diffuse thickening of the stomach walls due to intramural infiltration, invading the upper part (arrows). Conclusion: Infiltrative cancer of the stomach. c Macrospecimen of a resected stomach: the wall is firm, mucosal relief is smoothed down due to intramural infiltration (white

arrows); the relief of the cardiac rosette (cardioesophageal junction) is also leveled (black arrows). d Fragments of a macrospeci-men (strips): the stomach wall is thickened due to intramural infiltration (arrows). Histologically, signet-ring cell carcinoma

▲ Fig. 57 d.

There is now a significant prevalence of diffuse and mixed forms in morphogenesis of cancer, predominantly with intramural submucous growth of the tumor (D Fig. 57). There is also an almost complete disappearance of purely exophytic forms of gastric cancer. At least, they occur so rarely that it is hardly reasonable to account for them while compiling radiological semiotics. And the existing classification of gastric cancer (including the endoscopic classification of 1962) also requires revision.

Thus, in view of the changes that have taken place in the morphological manifestations of cancer (the most important aspect) and also in view of the changed accents in the frequency of primary tumor locations in various parts of the stomach, we will discuss the two major radiological signs of gastric cancer. These include uneven contours of the stomach at the phase of its tight filling with barium sulfate suspension and thickening of its wall, which is detectable by the double-contrast technique (D Fig. 58). Naturally, while placing special emphasis on these two symptoms, we do not rule out consideration of the stomach mucosal relief, which is also requisite. Two aspects will be considered here. First, the condition of the relief should be assessed not at the beginning of the examination (with the first gulps of the contrast medium, as is commonly recommend

ed) but rather during evacuation of the contrast medium from the stomach after its examination at the phase of tight filling. Second, the mucosal relief

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