The frequency of the transition of ulcers to cancer is, according to most authors, about 5-7% of all cases of stomach ulcers). Statistical data in this regard, as with other complications, range from 1-2 to 30%.
From a diagnostic point of view, it is important that only a stomach ulcer, more often of the antrum, pyloric and subcardial sections, passes into cancer, less often of a lesser curvature. More often, the transition to cancer is observed with a long-term peptic ulcer disease. The latter position should be accepted with some reservations, since the anamnesis does not always reflect the age of the ulcer.
Diagnosis of stomach ulcers turning into cancer is often very difficult. Also, the patient may have problems with employment . It is known that even during the operation it is not always possible to decide whether the patient has an ulcer, cancer or even syphilitic gum. Often this issue is resolved only after a histological examination of the tissue, by the presence of atypical proliferation of glands in the edges or in one edge of the ulcer. The criterion for passing an ulcer into a cancer should be a set of clinical data that make the assumption of a malignant neoplasm most likely. Each of the characteristics listed below is far from absolute, but many of them in various combinations have indisputable significance.
S. S. Yudin very figuratively pointed out some elements of the clinical picture of peptic ulcer disease, which should make a doctor think about the possibility of a transition to cancer. He emphasizes that the larger the ulcer, the deeper the niche, the older the patient, the lower the acidity, the more data for the presence or the possibility of cancerous degeneration. Indeed, the possibility of developing stomach cancer in a patient suffering from peptic ulcer disease is indicated primarily by the duration of the disease and the patient’s age, approaching the middle and elderly, a change in the nature of pain, sometimes their increase, a fairly rapidly progressive decline in the secretory function of the stomach and in some cases a significant an increase in the amount of associated hydrochloric acid; not disappearing, despite treatment, (occult blood in the feces as a constant or intermittent finding; rapidly growing symptoms of gastric motor insufficiency when the process is localized in the pyloric region; tpochromic anemia, neutrophilic leukocytosis, accelerated ROE, treatment failure, as well as X-ray data. in relation to the possibility of the transition of ulcers to cancer are stomach ulcers that do not heal for a long time and persistently, often callous, especially localized in the upper and lower third of the lesser curvature of the stomach.
X-ray examination on medical equipment determines (the large size of the ulcer and its increase, despite (the treatment performed, the unevenness of the contours of the niche, a pronounced inflammatory shaft (around the niche, dense, palpable and increasing, loss of radial delineation, wall stiffness).
There is a known relationship between the size of the ulcer and the frequency of its transition to cancer. Ulcers up to 2.5 cm in size turn into cancer in 20% of cases, more than 3 ohms – in 80%. This provision must be accepted with a proviso: if an ulcer develops or worsens against the background of dystrophy or malnutrition, this sign does not matter.
The width of the ulcer entrance also plays a role, and not its depth. Flat and wide niches are more suspicious than deep and narrow ones. An inflammatory shaft is also observed with a callous ulcer, but in this case, folds of the mucous membrane are usually (although not always) visible in it.
With an ulcer turning into cancer, the shaft around the niche not only increases, but also loses its exhaustion and folding. However, the presence of folds and their convergence do not exclude the possibility of a transition to cancer, which sometimes develops in parallel with the scarring of the ulcer. The loss of a peristaltic wave in the area of the ulcer can be observed with inflammatory infiltration of the stomach wall on the soil of the ulcer, as well as with cancer.
In patients with the degeneration of an ulcer into cancer achilia, approximately the following is found: in 50%, low acidity, in 9-10% normal and increased in 40%. The nature of the thrombocytogram is important for the diagnosis of cancer.