Carcinoma of the Stomach and Oesophagus and Anaemia

In spite of the enormous interest in the problem of carcinoma of the stomach and oesophagus, our understanding of these diseases remains unsatisfactory. We know that there are wide geographical differences in the incidence of these tumours but no precise aetiological factors have been discovered. This paper will consider some of the interrelationships between cancer of these organs, epithelial changes and some forms of anaemia. It has been known for many years that patients with pernicious anaemia have an increased incidence of gastric carcinoma and in some series this has been shown to be around 12% (1, 2). In pernicious anaemia the gastric mucosa is characterized by an atrophic gastritis or gastric atrophy involving the whole of the body mucosa but sparing the antral mucosa (3). This is illustrated in fig. 1. These patients have complete achlorhydria and the specialized acid and pepsin producing cells of the body mucosa are replaced by an unspecialized epithelium which may have many of the characteristics of intestinal epithelium (4). In contrast to other forms of gastritis there is a high incidence (80-95%) of antibodies to parietal cells and to intrinsic factor (40-50%). In studies on 70 proven cases of gastric carcinoma, there was an overall incidence of pernicious anaemia of 10% (5). Four cases had had pernicious anaemia for many years before developing cancer. In four more, pernicious anaemia was detected on the basis of antibody studies at the time of diagnosis of the carcinoma (table 1). The criteria upon which pernicious anaemia was diagnosed in these cases are shown. This series illustrates that gastric cancer can develop at any time irrespective of the duration of the gastritis. In pernicious anaemia, the severe gastric atrophy affects the body mucosa (fig. 1). Yet when cancer develops it may be in either body or antrum. This suggests that some factor other than the gastritis may be