CLINICAL CONSIDERATION OF GASTRIC ULCER AND CARCINOMA

It is a debated question among pathologists whether a high or a relatively low percentage of gastric ulcers undergo carcinomatous transformation. McCarty¹ said that 68 per cent of resected ulcers are associated with carcinoma; Wilensky and Thalhimer² found that 1 or 2 per cent of ulcers develop into carcinoma. In this presentation I shall deal with the clinical aspects of the problem and not enter into the histopathologic debate. One must decide whether medical treatment is ever justifiable or whether the patient should be subjected at once to subtotal gastrectomy. In view of the difference of opinion among pathologists, one is justified in basing a clinical descision on the number of ulcers, diagnosed clinically and roentgenologically, that subsequently manifest carcinomatous changes. One must, of course, make a differential diagnosis between ulcer and carcinoma, and this is frequently difficult when the latter is in an early stage. Friedenwald and