OO Introduction

The clinical symptoms of gastric cancer were established on the basis of the concept dominant in the 1960s, according to which the intestinal forms of gastric cancer are representative of the entire diagnostic aspects of this problem, the clinical symptoms included. We have already stated that this concept should be corrected.

We plan to discuss two main questions:

1. What new can be added to the known clinical symptoms of gastric cancer? (This chapter deals with this problem.)

2. What signs of gastric cancer can currently be detected using X-ray methods? (This problem will be covered in more detail in ▼ Chap. 5.)

If we describe the currently accepted clinical symptoms of gastric cancer, based on the analysis of a great number of monographs, manuals, papers, etc., we must conclude that they need serious revision and correction. This is connected with the rapidly changing morphological signs of gastric cancer. No one today doubts that the intestinal forms of gastric cancer have switched with its diffuse and mixed forms; the latter two have become prevalent, whereas the intestinal forms have decreased in incidence accordingly. Beginning in the 1960s in connection with the development of endoscopy, which is recognized as an indispensable tool for diagnosing gastric diseases, the use of X-ray examination of the stomach has decreased substantially [31]. This has not improved the diagnosis of gastric cancer. The reason is that endoscopy is useful mainly in cases of intestinal-type gastric cancer, which is known to show actively on the surface of the gastric mucosa (O Fig. 18). It is also useful in advanced cases of mixed gastric cancer, when changes in the mucous membrane are accessible for endoscopic visualization. Tissue specimens taken from such patients are suitable for his-tological verification of gastric cancer. Meanwhile, the diffuse forms of gastric cancer that originate in the deep parts of the mucosa develop inside the stomach wall and remain inaccessible for endoscopic visualization for a long period of time [24, 38, 98, 185].

□ Fig. 18a-o. Female patient A., age 58. Diagnosis: gastric cancer. a Stomach X-ray (tight filling, vertical position, anterior projection): contours of the lesser and greater curvatures of the stomach body are uneven (arrows). b, c Series of X-rays (tight filling, vertical position, anterior projection): the contour of the lesser curvature is uneven and eroded (arrows). d Stomach X-ray (tight filling, vertical position, anterior projection) taken after additional portion of barium meal. The contour of the greater curvature is not changed; uneven contour of the lesser curvature (considerable depression) remains stable (arrow). e Stomach X-ray (tight filling, vertical position, left oblique projection): so-called filling defect with a small niche which does not extend beyond the stomach contour (arrow). f Stomach X-ray (double contrast, horizontal position, anterior projection): significant thickening of

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