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The Gastric Cancer Problem* Medical Arts and Sciences: A Scientific oJ urnal of the College of Medical Evangelists Volume 2 | Number 2 Article 3 4-1948 The aG stric Cancer Problem Clarence E. Nelson College of Medical Evangelists Follow this and additional works at: http://scholarsrepository.llu.edu/medartssciences Part of the Digestive System Diseases Commons Recommended Citation Nelson, Clarence E. (1948) "The asG tric Cancer Problem," Medical Arts and Sciences: A Scientific oJ urnal of the College of Medical Evangelists: Vol. 2: No. 2, Article 3. Available at: http://scholarsrepository.llu.edu/medartssciences/vol2/iss2/3 This Article is brought to you for free and open access by the Loma Linda University Publications at TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. It has been accepted for inclusion in Medical Arts and Sciences: A Scientific ourJ nal of the College of Medical Evangelists by an authorized administrator of TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. For more information, please contact [email protected]. MEDICAL ART. S AND SCIENCES VOLUME 2 APRIL, 1948 NUMBER 2 THE GASTRIC CANCER PROBLEM* CLARENCE E. NELSON, M.D.t The importance of gastric carcinoma as the ing to Collins, Gover, and Dom. Kirschner cause of death in the United States can be stated that 50 per cent of cancer deaths among appreciated when we consider that during men in Germany were due to cancer of the World War II, according to the former Sur­ stomach. It has been found that cancer of geon General Thomas Parran, as many people the stomach is higher in the Italians who came died from cancer of the digestive tract as were over from Italy to work in the mills in Connec­ lost in the armed forces of the United States ticut than it is in the general population of as the result of enemy action. It is estimated that State. However, in the second and third that of the people living in the United States generation Italians, the death rate from cancer today, between 4,000,000 and 5,000,000 will of the stomach is about the same as in the rest die of cancer of the stomach. Gastric carci­ of the population. noma causes more deaths than any other Genetics seems to have an influence upon cancer. Because of the difficulties in early diag­ the incidence of gastric carcinoma. The nosis, only 2 to 6 per cent of all patients that genetic influence is probably organ specific. have gastric carcinoma are alive at the end There are exceptional families known for of five years. Walters and co-workers at the their high incidence of cancer of the stomach. Mayo Clinic found that about 25 per cent are The family of Napoleon is perhaps the most suitable for curative surgery, and of these famous; as Napoleon, his father, his grand­ about 25 per cent are alive and well at the father, all three of his sisters, and one of his end of five years, and 20 per cent are alive at four brothers are said to have died from gas­ the end of ten years. tric carcinoma. It is a disease of later life, the average age Most forms of cancer found in human be­ of patients being 55 years. There is a prepon· ings are also known to occur in animals. Can­ derance in the male of nearly two to one. The cer of the esophagus and of the stomach, how­ death rate from cancer in certain countries is ever, are outstanding exceptions and are higher than in other countries. It is much among the rarest types of tumors in animals. higher in Holland than it is in England. It is Welles et al. described 8 cancers of the fore­ higher in the Northern States of the United stomach, which corresponds to the mouth, States than it is in the Southern States, accord- pharynx, and esophagus, and 3 adenocarci­ nomas of the pars glandularis, which corre­ M:J:'ri~::,e Cancer Conference of the Seq Diego Couaty sponds to the stomach, in 142,000 mice dying f From the Department of SwiJery, CoUege of Medk.al Eva118elilb. of natural causes, many of old age. This ex- Copyright, 1948, by Review and Herald Publilhin1 Aaociation 51 52 Nelson-Gastric Cancer Problem tremely low incidence of carcinoma of the these animals he had been able to subject stomach in animals is remarkable considering them to irritants that humans commonly use, that if they had been human beings the inci­ such as tobacco, alcohol, condiments, hot bev­ dence of carcinoma of the stomach would have erages, and other types of irritants, undoubt­ been about 30,000 instead of I I. edly the incidence of carcinoma would have McCarrison, while a medical officer in the been much higher. Indian Army Medical Service, spent about Although nutritional deficiencies have an nine years among three remote tribes of north­ important bearing on the cause of carcinoma ern India. During that time he performed of the stomach, clinical surveys indicate that nearly 4,000 operations, many being for these irritants are significant exciting factors. hernia, goiter, cataract, etc., but he did not see Lintott compared a large group in Holland a single case of cancer, appendicitis, or colitis with a similar group in England. The inci­ during that whole time. He was so impressed dence of gastric cancer in Holland was about by the absence of many other diseases which twice that of England. The diet of the Hol­ are so prevalent in other parts of India that he landers contained large amounts of bread, made a careful study for possible reasons. He cheese, vegetables, and a smaller amount of concluded that it was because of their diet, meat. However, in Holland the food was taken inasmuch as they lived on natural foods at a higher temperature; and the consump­ direct from the soil, thus retaining their pro­ tion of spices, alcoholic beverages! and tobacco tective elements. He later set up a laboratory was higher. in southern India, where he put animals-­ Hurst has stated that approximately 75 per including pigeons, guinea pigs, rabbits, and cent of gastric carcinomas develop on a pre­ monkeyS-On diets which were common in existing gastritis. Among the causes of chronic various parts of India as well as on a diet made gastritis he gives the following: alcohol, espe­ up of foods commonly used in England. His cially strong spirits on an empty stomach; control animals numbering a total of I, I 98 strong tea and coffee; tobacco; condiments; were put on the diet, mainly lacto-vegetarian, mechanical and thermal injuries; infections of these healthy tribes of northern India. Dur­ due to oral sepsis; and certain drugs, particu­ ing a period of two years they were watched, larly bromides, digitalis, mercury, and salicyl­ and at the end of that time they were autop­ ates. sied and carefully examined, and he found no Ivy and Peacock are of the opinion that the evidence of any disease whatsoever except a use of excessively hot foods is prob.ably a factor few tapeworm cysts. On the other hand, a in the development of gastritis and gastric group of 2,443 animals which were put on im­ carcinoma. The oral mucous membrane will proper diets common among the people of tolerate food 15 per cent hotter than will the other parts of India and in England showed skin; this explains why tea cups have handles. all kinds of diseases, including two cases of A patient whom I saw recently with carcinoma carcinoma of the stomach. Thus if the 142,000 of the stomach would tend to' bear this out. animals autopsied by Welles et al. had been This man, aged 40, an oil-well driller, states on the improper diets that McCarrison gave that for several years he drank up to 20 cups his animals, and their response had been the of hot coffee a day. Widmark has demonstrated same, the incidence of cancer of the stomach a substance from roasted coffee which pr<>­ would have been 3,300 instead of I I. On the duces cancer in the skin of miCe. other hand, if in addition to the diet given Vitamin A deficiency is known to have an Medical Arts and Sciences 53 adverse effect on the integrity of the mucous of the general population of gastrk,. cancer membrane of the digestive tract. Passey, Lees, age have achlorhydria. Approximate\y &5~: ~o. and Knox have demonstrated that papilloma­ 75 per cent of gastric cancer patients .hav.e · tosis of the preventriculus of mice can be achlorhydria: It is in the group that has· fr.ee brought about by feeding them a diet deficient hydrochloric acid that there is the great~st in vitamin A. Studies of the metabolism of danger of not making adequate study. Our. cancer patients which have been carried out most promising field in the early detection of at the Memorial Hospital in New York reveal cancer of the stomach lies in the frequeqt e~­ several abnormalities, particularly that of vita­ amination (at least 3 times a year) of patie.nts min A deficiency and hypoproteinemia. How­ with achlorhydria and pernicic;>Us , anemia. ever, Peacock and Kirby have shown that large This should include X-rays as well as .gastro­ doses of vitamin A do not protect against the scopic examinations where X-ray findings al"e development of gastric papillomatosis when negative or are suspicious. All patients w:ith carcinogenic hydrocarbons are fed to animals. pernicious anemia should be watched: qtre­ Schindler • is also of the opinion that fully for the presence of gastric polyps.
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