J.Jpn. Surg. Soc.. 62(1): 91-101, 1961
STATISTICAL STUDIES ON ANEMIA IN GASTRIC GARCINOMA CASES, ESPECIALLY ON ITS RELATION TO THE CANCER PROGRESS
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Prof. M. Muto's Surgical Clinic, Tohoku University, Sendai Etsuro KOMA |
The writer studied the relation of the grade (erythrocyte count and the hemoglobin concentration) as well as the type (hemoglobin index) of the anemia to the size , gross appearance of the tumor and the resectability rate of the lesion, and also to the gastric acidity and the evidence of gastric hemorrhage in the patient, and especially to the extent of cancer progress judged from various findings at operation. The study is based on 1628 gastric carcinoma cases operated in our surgical clinic during the last 18 years.
The results obtained are summarized as follows:
1. Anemia was observed in 1161 (71.3 per cent) out of the 1628 cases, its severity being slight in 49.8 per cent, moderate in 12.6 per cent and marked in 9.0 per cent.
2. The anemia was normochromic in 61.6 per cent of the mentioned 1161 cases, hypochromic in 24.4 per cent and hyperchromic in 14.0 per cent.
The rate of the hyperchromic cases was almost equal through the various severities of anemia, while that of the normochromic cases was small in advanced anemias and the hypochromic cases were found in the highest rate in the markedly anemic cases.
3. When the cases were classified, according to the extent of cancer progress, into four groups: stage Ia, the earliest cases, Ib, the comparatively early cases, II, moderately advanced cases, and III, far advanced cases, anemia was observed even in the Ia cases (in which the lesion was limited in the wall of the stomach) in comparatively high rate (64.4 per cent). The rate of occurrence of the anemia was 63.9 per cent in the lb cases, 73.8 per cent in the II cases and 75.5 per cent in the III cases, slightly increasing with the progress of the lesion.
4. According to the size of the tumor, anemia was observed in the highest rate (77.3 per cent) in the large tumor cases, the rate of occurrence in other groups being 69.9 per cent in the medium tumor ceses, 67.7 per cent in the small tumor cases and 47.0 per cent in the smallest tumor cases. Thus, it was found that the anemia in gastric carcinoma cases was more marked in those with larger tumors.
5. There was no significant correlation between the grade as well as the type of anemia and the gross appearance (Borrmann) of the tumor.
6. In cases with the history of evident gastric hemorrhage such as hematemesis and melena, anemia was observed in as high rate as 95.0 per cent, 70.8 per cent of which were moderate or marked in severity. Among cases in which the bleeding was perceptible only with the positive reaction for the occult blood in feces, 68.1 per cent were anemic, the moderate or marked anemia being found in 17.7 per cent of them. On the other hand, only 48.5 per cent of the cases without positive blood reaction were anemic, the rate of the advanced anemia was as small as 10.6 per cent.
Though the causes of anemia in gastric carcinoma cases may be complex, bleeding from the tumor was thus proved to be a comparatively important factor. This must be kept in mind in diagnosis of gastric carcinoma.
7. Anemia was perceptible in 71.3 per cent of the achlorhydric cases and in 72.8 per cent of the hypochlorhydric cases, being higher in rate as compared with the normo or hyperchlorhydric ones (61.4 per cent and 68.0 per cent, respectively). The rate of occurrence of the moderate or more marked anemia was 21.3 per cent and 21.7 per cent in the achlorhydric and hypochlorhydric cases, thus being much higher than in the normo- or hyperchlorhydric cases (15.0 and 18.0 per cent respectively) .
8. Resectability rate of the lesion was 74.8 per cent in cases without anemia, 67.8 per cent in cases with slight anemia, 65.9 per cent in ceses with moderate anemia and 66.4 per cent in cases with marked anemia. Thus the resectability rate was found to decrease with the progress of anemia.
9. As mentioned above, the anemia in gastric carcinoma cases was more marked in those with the more progressed lesion. However, the fact that 64.4 per cent of the least advanced cases showed the obvious anemia may indicate that the anemia occurs in a comparatively early stage in cancer progress.
(Author's abstract)
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