Gastric lymphomas are divided into primary gastric lymphomas and secondary gastric lymphomas. The most common diagnosis is low-grade extra-nodal MALT non-Hodgkin's lymphoma. What are the causes of gastric lymphoma and what are the symptoms of this cancer? How is cancer treatment going and what is the prognosis?

Gastric lymphomasare the second most common neoplastic disease in the stomach (cancer is the most common cancer). At the same time, the stomach is the most common location of lymphomas among the organs of the entire human gastrointestinal tract.

Primary disease may be located in the stomach itself (primary gastric lymphomas) or in another organ, and the stomach may be secondary (secondary gastric lymphomas).

Tumors of the lymphatic tissue arise from two types of cells, B lymphocytes (approximately 85%) and T cells (approximately 15%). Depending on the type, they are characterized by a high or low degree of malignancy, which is why it is so important to determine the exact type of neoplasm before introducing the therapy.

The most commonly diagnosed gastric lymphomas are low-grade mucose associated lymphatic tissue (MALT-lymphoma=MALToma) lymphomas (MALT).

These neoplasms, in over 80% of cases, originate from the lymphoid tissue associated with the gastric mucosa, in which there are altered polyclonal B lymphocytes. Infection with the bacteriumHelicobacter pylori plays a key role in the development of the disease..

Gastric MALT lymphoma - frequency of occurrence

Lymphomas originally located in the stomach are rare, accounting for about 2% of all lymphomas and 15% of gastric cancers. Mainly adults are sick, especially after the age of 60. The literature reports that gastric MALT lymphoma is detected in 0.7 / 100,000 people / year.

Gastric MALT lymphoma - causes of the disease

It has been proven that one of the causes that significantly increases the risk of developing gastric MALT lymphoma is chronic infection with the bacteriumHelicobacter pylori .

It causes chronic gastritis with lymphocytic infiltration. Some patients with MALT lymphomas have a t (11, 18) translocation, as a result of whichthe AP12-MLT fusion gene is formed, as well as the t (1,14) translocation.

In contrast, enteropathy-associated T-cell lymphoma (EALT) lymphomas are often reported in patients suffering from gluten-dependent enteropathy, or celiac disease.

MALT gastric lymphoma - location

Gastric MALT lymphomas are most often located in the pre-pyloric part of the stomach, and can occasionally be observed in its body or fundus.

Gastric MALT lymphoma - clinical symptoms

The ailments reported by patients in the initial stage of the disease are not specific. Patients complain mainly of gastrointestinal complaints, lack of appetite, nausea, belching, as well as pain and discomfort located in the middle epigastrium.

Along with the advancement of the neoplastic disease, patients can observe:

  • Passing tarry stools that result from gastrointestinal bleeding. In this case, it is urgent to contact a general practitioner who will examine the patient and refer them for further diagnostics
  • easy fatigue, lack of energy, dizziness, which can often indicate anemia caused by chronic bleeding from a cancerous tumor;
  • low-grade fever, fever, night sweats and unintentional weight loss, but these are rare and are not the main reason why you see your GP.

Gastric MALT lymphoma - diagnosis and diagnosis

The test of choice used in the diagnosis of gastric lymphoma is gastroscopy. It involves examining the upper gastrointestinal tract with the help of specialized equipment, an endoscope.

During the examination, it is possible to collect sections of the macroscopically changed gastric mucosa for histopathological examination.

The most common visible ulceration, erosion or polyp are the fragments of which are removed with special forceps, but it is not uncommon to observe a situation where there are no macroscopic changes in the mucosa.

It is worth noting that according to the standards, at least 8 specimens from a lesion suspected of having cancer should be taken for examination. The obtained material is sent to the pathology laboratory, where a pathological specialist physician assesses the tissue structure under a microscope. It determines whether there is a neoplastic process in it, what type of disease it is, as well as its pathological stage.

During imaging checkups, such as computed tomography of the abdomen, it can be accidentally detectedthickening of the stomach wall, however, on the basis of the radiological image alone, it is not possible to make an unequivocal diagnosis.

Typically lymphomas are well demarcated from surrounding tissue and do not infiltrate them. In such cases, it is necessary to deepen the diagnosis with gastroscopy with the collection of biopsies for histopathological examination.

The purpose of the evaluation of the clinical stage of neoplastic disease is to perform imaging examinations, computed tomography of the abdominal cavity, chest and pelvis. They enable the assessment of the primary tumor, infiltration of surrounding tissues and the involvement of regional lymph nodes.

Gastric MALT lymphoma - gastroscopy

Endoscopic examination of the upper gastrointestinal tract may be performed on an outpatient basis. Before the examination, the patient should fasten for at least 6-8 hours, and on the morning of the examination day, take all medications that are taken continuously with a little water (except for hypoglycaemic drugs and blood clotting drugs - their use should be consulted with a doctor beforehand).

It is worth noting that before starting the test, the patient must give his consent in writing, its absence is an absolute contraindication to its performance. Gastroscopy begins with local anesthesia of the back of the throat with lidocaine solution, and in some cases sedatives may also be used.

During the examination, the patient should lie on his left side. The endoscope, i.e. specialized, flexible equipment for gastroscopy, terminated with a camera and its own light source, is placed in the patient's gastrointestinal tract. The monitor screen shows the image of the inner walls of the esophagus, stomach and duodenum and the structure of the mucosa lining them.

From lesions suspected of a disease process or cancer, the doctor may take samples with the use of special forceps and submit the collected material for histopathological examination. In addition, a fragment of the gastric mucosa can be collected for a trauma test for the presence of bacteriaHelicobacter pylori .

The gastroscopic examination is unpleasant, but in most cases it does not cause pain for the patient, it takes about 15-20 minutes. After the examination, the first meal can be taken after about 2 hours, otherwise the fluid or food may be choked, after which the local anesthesia should stop working.

Gastric MALT lymphoma - treatment

The most common treatment for gastric MALT lymphoma is pharmacotherapy, including eradication of Helicobacter pylori infection,radiotherapy, as well as immuno- or chemotherapy.

EradicationHelicobacter pylori

Successful eradication of infection is often the first and only method of therapy, as it may lead to clinical and histological resolution of gastric lymphoma. It was observed that the lesions regressed after the infection had healed in about 60% of patients.

Eradication of bacteriaHelicobacter pyloriinvolves the simultaneous application of a combination of several drugs, usually a proton pump inhibitor (e.g. omeprazole, pantoprazole, esomeprazole), antibiotics (including clarithromycin, metronidazole, amoxicillin and tetracyclines) as well as bismuth.

The pattern of therapy used depends on the percentage of strainsH. pyloriresistant to given drugs in specific latitudes.

There are 3 main and most commonly used therapy regimens:

  • Quadruple therapy, based on the simultaneous administration for 10 days of a proton pump inhibitor, a preparation containing potassium-bismuth citrate, metronidazole and tetracycline. It is chosen by doctors in countries with a high percentage of H. pylori bacteria resistant to clarithromycin.
  • Sequential therapy consisting in administering a proton pump inhibitor and amoxicillin to the patient for 5 days, and a proton pump inhibitor, as well as metronidazole and clarithromycin on the following days.
  • Concurrent treatment consisting in administering a proton pump inhibitor to the patient for 10 days and 3 antibiotics, amoxicillin, clarithromycin and metronidazole.
  • Triple therapy consisting of the administration of a proton pump inhibitor clarithromycin and one of the two antibiotics metronidazole or amoxicillin for 7 days.

To assess the effectiveness of eradication of H. pylori bacteria, gastroscopy should be performed with the collection of gastric mucosa sections (in order to perform a urease test), approximately every 6 months.

Radiotherapy

Radiotherapy is used to treat gastric lymphoma in patients not infected with Helicobacter pylori, and also as a supplement to therapy after unsuccessful eradication of the infection and as an adjunct after gastric resection.

Read also: What do you know about radiotherapy? Facts and myths worth knowing

Immuno- and chemotherapy

The type of chemotherapy administered depends on the histological type of the lymphoma. Surgical treatment is not used routinely. Surgical procedures are most often performed in situations where the patient's life is immediately threatened, e.g. during massive bleeding from a neoplastic lesion in the stomach or perforation of the gastrointestinal tract. Byno response and no effects of non-surgical treatment, gastric resection and complementary radiotherapy are recommended.

Gastric MALT lymphoma - follow-up

Patients undergoing treatment of gastric MALT lymphoma should remain under close medical supervision and undergo the recommended examinations, especially gastroscopy. For the first 2 years after the completion of therapy, tests during which gastric mucosa samples will be taken for histopathological examination and the assessment of bacterial infectionHelicobacter pylorishould be performed every six months, then less frequently, on average every 1 to 1.5 years.

Gastric MALT lymphoma - prognosis

Gastric MALT lymphoma is a neoplastic disease with a relatively good prognosis, 10-year survival depends on the degree of disease remission and amounts to 50-80%.

Category:

Oncology