Stomach cancer

X-ray study represents one of the most important methods that facilitate the timely detection of gastric cancer. The ideal is, of course, early diagnosis, but even early statement of the presence of direct x-ray signs of cancer of the stomach cannot be definitely attributed to early detection. X-ray examination is carried out taking into account functional and direct signs of cancer, allows you to set the tumor in such cases when clinically does not occur even guess about it. The possibility of radiology, armed with modern technical equipment and a well-developed methodology of the study, currently has expanded greatly, and the circle unrecognizable tumors gradually and significantly narrows. First of all this contributes to the study of the relief of gastric mucosa, making became available recognize "minor" forms of cancer. Next important role in revealing such forms have methods of functional diagnostics.
Understanding x-ray pictures of stomach cancer promote understanding of different pathological forms. With regard to radiological method of research the most convenient is the division of cancer of the stomach into four main types (C. A. Dyachenko, 1956; I. A. Shekhter, 1959; B. A. Fanarjyan, 1961, 1964, and others):
1. Polypous cancer, which sharply limited tumor.
2. Cachepolicy or saucer-like cancer, representing izyaslavs tumor round or oval. Pitting the tumor is in the centre of it. The edges of the tumor Salobrena and sharply delimited from the rest of the stomach walls. They look like large kallania ulcers (Fig. 89).

Fig. 89. Saucer-like stomach cancer (x-ray).
Filling defect with great Barieva depot in the centre of the lower third of the body near the lesser curvature.

3. Wounded tumor with invasion of the surrounding tissues of the stomach.
4. Diffuse cancer, accompanied by a dense infiltration wall and diffuse spreading over her. The walls of the stomach shrink, circular cover the affected section of the stomach and narrowing the lumen.
List the forms are the primary, and in most cases, gastric cancer represents a defeat, which may be more or less strong combination of these forms.
Some ulcers from the beginning represent early izyaslavs tumor, causing create x-ray picture, typical for stomach ulcers. Gutman (1951) and its employees believe that in the vast majority of ulcers, especially large, located in the antrum, are cancerous ulcers. Such forms can relate to so-called "small cancer" of the stomach.
General x-ray symptoms of cancer is reduced to the elevation changes of the mucous membrane, the formation of filling defect, studied niche, changing patterns of the stomach, to the change of peristalsis and impaired motor function.
Initial signs of malignant neoplasms cause resistant strain relief mucous, which is reminiscent of the inflammatory changes "hypertrophic type", often referred to as "malignant relief". Such persistent strain relief mucosa sometimes difficult to differentiate from inflammatory changes, or neoplastic infiltration. Often x-ray picture without considering the related functional features in the area of the plot no pathology can still lead to the right decision diagnostic tasks. Substantial assistance in such circumstances renders the application of the above-described pyramidon-adrenaline samples and methods stimulate peristalsis of the stomach.
In the study of the relief of gastric mucosa shows how the folds drop closer to the tumor. Sharp break folds at the edge of the tumor is observed mainly in the expansive growing tumors. The disappearance of wrinkles without abrupt breakage can occur when the tumors developing in the submucosal layer. In such cases one can observe a gradual transition from the site of the damage to normal mucosa. Folds, located on the periphery of the tumor, stubborn palpation, in some cases, stretched or flattened. Sometimes the affected area may be smooth, but is more often at "malignant relief" as a result of irregularities tumors and pitting on the surface in some places formed small and shapeless clumps of contrast in the form of uneven spots small size. Such relief might be typical of malignant neoplasms.
Going into the lumen of the stomach, the tumor cause a filling defectin which the cast of the stomach seems to be incomplete, but because of the location in his oral incremental soft tissue formations contrast shadow of the stomach is reduced according to position, size and shape of the tumor. Filling defect arising from the cancer has usually wrong, as if eaten, fuzzy outlines.
Well defects are found filling with tumors located in small and large curvature, as well as tumors of the code and pericardialny part of the stomach, keeping a knockout in a special position of the patient with some inclination in cranial direction.
Filling defect is a symptom arising from the growth of any pathological tissues, and should therefore be excluded, all influences that may cause this symptom and thus to simulate the presence of a tumor. These factors can be attributed extravehicular tumors, as well as the remains of food in the stomach and gas in the colon, which put pressure on the walls of the stomach and cause the same picture as the tumor jutting out into the lumen of the stomach. In addition, the regional filling defect in rare cases may be masked spasm. In case of difficulties connected with the possibility of simulating factors have to resort to a re-examination to determine the level of resistance to change, especially when the impact of gases and food residues.
At the boundaries of the tumor healthy tissue between light filling defect and dark contrasting mass formed pointed or wedge-shaped ledges, representing pathognomonic for filling defect indication (Fig. 90).
When cancer prone to rapid decay, we often observe the formation of craters, resembling a niche in kallusnoi plague, which often represents a differential diagnostic difficulties, not always amenable to final resolution. It usually happens in small izyaslavovicha tumors. If you have large filling defects phenomenon of disintegration recognized quite easily and can easily be attributed to the tumor.

Fig. 90. Stomach cancer (x-ray).
Filling defect in the body when exophytic tumors.

Diffuse-infiltra form of cancer is different in that are not caused by normal filling defect, and is accompanied by a more or less widespread narrowing of the lumen, to a certain extent a uniform. In most cases this Scherr, located mostly in the lower divisions. In such cases, the infiltration distributed circular (Fig. 91). With regular research neoplastic infiltration is not so easily delineated from healthy tissue, as in other forms of cancer.

Fig. 91. Stomach cancer, skirr.
The PolyGram - absence of peristalsis of the body of the stomach.

Changing the shape of the stomach with the defeat cancer may depend on a number of reasons. Sometimes, large tumors filling defect causes a sharp strain of shade stomach, letting the last bizarre form. In such cases requires differentiation with extensive perigastric, which is accompanied by clear contours and continuing peristalsis.
Widespread infiltration, accompanied by the formation of fibrous tissue, can cause significant wrinkling of the stomach and lead to reduction of its volume.
All forms of stomach cancer are accompanied by a series of functional symptoms. The most important of them is to stop peristalsis in place occurring tumors. The question of the presence or absence of peristalsis in normal practice rentgenograficheskie, but not always possible with sufficient clarity to observe this phenomenon behind the screen. The big help in this renders the study of peristalsis on the PolyGram and rentgenonegativee, making it possible to clearly detect the absence of peristaltic waves on the location of the tumor infiltration. Despite the fact that the study of the relief mucous significantly expanded the possibilities of recognition of the primary forms of malignant neoplasms of the stomach, some cases are still difficulties, which can be overcome by resorting to the printing industry and rentgenonegativee.
No signs of peristalsis after pharmacological effects of stimulants, especially in the application of printing and rentgenonegativee, always points to the existing tumor infiltration.
Difficulties arise when detecting cancer of the code and pericardialny the stomach. To improved diagnosis in such cases can also promote the study of peristalsis of this Department is mainly using the method of printing, the situation upside down with the tilt table to such an extent that the body of the stomach becomes his lower pole. Then the pressure contrast liquid on the wall of the arch causes contraction of the muscles and on the PolyGram appear multiple waves that reflect either peristalsis of the code, or tonic contraction of its walls. And in that and in other case, the appearance on the PolyGram multiple waves characterizes the contractile activity of muscles, which are absent in the case of presence of tumor infiltration or observed at neporozhnego wall of the vault.
Symptom thickening of the wall of the body of the stomach cannot be considered reliable for determining tumor infiltration, as is often apparent thickening of the wall of the vault can be simulated projection perversions. Specification detection of the tumor set in such cases can contribute proposed functional test given the variability of forms of the code you inhale and exhale when forced breathing at the time of the research, the status of the surveyed lying with tilt in cranial direction. In the absence of tumor infiltration observed flattening and pulling the width of the code with a deep breath and roundness of her shapes when exhaling. Such functional test we called "respiratory symptom variability of the code, which gets its value when there is suspicion on the thickening of the walls.
Cancer cardiac parts have to differentiate defeat nadkataloh esophagus. Under fluoroscopy barium suspension long delays in the esophagus, causing a significant expansion of its up in the extreme, long flowing cases to a very large degree, like an extension for achalasia esophago-gastric junction. Weight goes down to the stomach narrow ragged band that wraps around a bumpy, "eaten"
the contours of the tumor, identifying a number of large or small filling defects. Without contrasting studies are often able to see the shadow education on the background of a gas bubble. In the study with contrast suspension seen as the latter sometimes fontano-figuratively sprayed, moving from bottlenecks wide. This symptom splashing, although it is not pathognomonic, as occurs and when the kinks, not associated with new growth points to the rigidity gaping rings and can be quite an early indication of the presence of a cancerous cell infiltration in the absence of visible filling defect. In some cases assisted by the injection of air or ingestion bicarbonate of soda with tartaric acid. Then on the background of increased air bubble clearly reveals the blackout caused by a tumor, becoming a contrast to the surrounding its gas.
In the last years to resolve difficulties arising in the solution of the question about the presence of cancer parasitylogo Department, is used the method of paleographie. The essence is that is created gazokontrolja environment in the peritoneal cavity by imposing pneumoperitoneum, combined with the introduction of air into the stomach through a tube (Fig. 92). Next is tomography. On such a combined vasocontriction background on the tomograms are clearly revealed the shadow of the tumor and its correlation with aperture and neighboring organs. Paleography is very effective and by tumors of other localizations (Porcher), especially when the infiltration of walls without the Express filling defect.

Fig. 92. Paleography stomach. The tumor pericardialny region.
Explanation in the text.

Occurring in patients with disorders of the locomotor functions can be manifested both in the delay evacuation, and to accelerate it. Exophytic forms of cancer delay evacuation occurs mainly when a tumor in the area of antral and gatekeeper. Often formed jumorazmy channel through which contrast suspension is narrow, winding lane, stroking rough, rutted outlines areas that delimit the mileage of a contrast agent. Very often when this localization between cavity cancer of the stomach and duodenum a gap, which is considered one of the characteristic signs of cancer.
When Schirra often seen rapid evacuation due to infiltration gatekeeper, with the result that he loses its normal functional "game" and gaping. Contrast dye moves quickly into the small intestine, and can be observed simultaneously filled stomach, duodenum and small intestine.
As with the plague, but much less common in cancer of the stomach meet local and regional circular spasms on the opposite curvature, which is an indicator of irritation muscles of the stomach.
Often the stomach is undergoing significant changes in respect of smaduamei, which greatly disturbed due to the presence of extensive growths surrounding tissues. Especially it concerns palpation of smaduamei in the field of filling defect or infiltration.
Capturing the adjacent organs, malignant process in cases of decay can cause messages between the stomach and neighboring organs, forming a fistula, fistulas stomach. Most often occur fistula between the stomach and colon. In such cases, x-ray examination can be seen as a contrast suspended from the stomach quickly and directly fills the colon, easily identifiable by the typical picture of Australia.
The radiological examination currently found most tumors of the stomach, and although still not to say that all tumor available x-rays in any form, number of radiologically unrecognizable tumors of the stomach progressive decreases. This contributes not only to improve the methodology, but also the development of x-ray symptoms of "small forms" cancer taking into account of functional disorders, which might identify visible anatomical changes.