Gastric lymphoma - Gastrointestinal oncology

Gastric lymphoma

Definition

A primary lymphoma of the stomach which accounts for 3% of malignant gastric tumours.

Aetiology/pathophysiology

Gastric lymphoma is a non-Hodgkin B cell lymphoma. Tumours arising in the mucosa associated lymphoid tissue (MALT) result from H. pyloriinfection in over 90% of cases.

Clinical features

Patients present similarly to gastric adenocarcinoma with nonspecific weight loss, anaemia and malaise and associated epigastric tenderness. Symptoms may be mild despite a large tumour mass.

Microscopy

Lymphoma cells range from small cells to large immunoblastic cells.

Investigations

Endoscopy and biopsy is diagnostic.

Management

Lymphoma often responds to H. pylori eradication therapy. As there is potential for recurrence frequent upper gastrointestinal endoscopy and multiple biopsies are recommended for all patients following eradication therapy. Patients who do not respond to, or who relapse following eradication therapy are treated with single agent chemotherapy (e.g. cyclophosphamide or chlorambucil) or radiation therapy. Patients with advanced or aggressive disease and those who fail to respond or recur after single agent chemotherapy are treated with multiagent chemotherapy, such as CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone). Surgery is now rarely indicated.

Prognosis

Postoperative 5-year survival of 80–90%.