Primary gastrointestinal lymphoma

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 7, 2017
StartDiseasesPrimary gastrointestinal lymphoma

Primary gastrointestinal lymphoma is known by many different names. This condition has also been called non-Hodgkin gastric lymphoma and primary Hodgkin’s lymphoma of the stomach. While these names sound very different, they are all the same condition. There are two basic subdivisions of the condition, known as diffuse large B-cell lymphoma of the stomach and mucosa-associated lymphoid tissue gastric lymphoma. Both of these conditions create different symptoms and are caused by different cells in the body.

Contents

Definition & Facts

Primary gastric lymphoma is an umbrella term for a type of cancer that develops in the stomach. Mucosa-associated lymphoid tissue gastric lymphoma is scientifically linked to an infection of the Helicobacter pylori bacterium that is found in the stomach. While primary gastric lymphoma is well researched, available medical literature exhibits a clear controversy when it comes to defining the cancer, classifying it, and the staging of this cancer.

In general, the term lymphoma refers to a form of cancer that originates in the lymphatic system, which protects the body from disease, infection, and outside hazards. At first, this cancer functions as part of the immune system, which allows it to access a large network of lymphatic vessels, which provides easy access to the bloodstream.

This makes it easier for this type of cancer to spread through the body. The reason the condition is referred to as primary gastric lymphoma is because it has generally metastasized by the time it has been diagnosed. Most lymphomas are caused by an error, or omission, during the production of lymphocytes. All it takes is a single lymphocyte to result in a malignancy that grows out of control.

Symptoms & Complaints

Not all patients with primary gastric lymphoma exhibit symptoms of the cancer. If they do have symptoms, they are usually non-specific, vague, and attributed to common ailments. Many patients who are diagnosed are not suspecting this type of diagnosis because they do not have symptoms they would attribute to a serious condition like this.

The most common symptom that is experienced is abdominal cramping and mild pain, which they usually attribute to common digestive issues. As the lymphoma progresses, patients may experience tenderness in the stomach, nausea, unintended weigh loss from vomiting, indigestion, and an overall feeling of being unwell.

Patients with advanced lymphoma may experience bleeding in the stomach and a palpable mass in the abdomen. Over time, jaundice, weakness, difficulty swallowing, and a fullness in the stomach. Full examination may reveal an enlarged liver (hepatomegaly), a tear in the stomach wall, and noticeable lymph node enlargement.

Causes

Even though extensive research has been done, the overall cause of primary gastric lymphoma has not been found. There is a strong link between the H. Pylori infection and the development of mucosa-associated lymphoid tissue gastric lymphoma. The puzzle is that lymphoid tissue associated with primary gastric lymphoma is not usually located in the stomach. The tissue only becomes present when H. pylori infection causes chronic inflammation in this region.

Even though the infection contributes, not everyone who suffers from this infection will develop lymphoma. Some patients who develop lymphoma are found to have abnormalities in their chromosomes inside the malignancy. Other forms of primary gastric lymphoma do not have a documented cause. 

Diagnosis & Tests

Currently, there is no screening process for lymphoma because it is not a common condition. Testing is only completed when someone visits their doctor with complaints of symptoms related to the condition. Since the symptoms are vague until later stages, doctors usually reassure patients that they are suffering from a stomach virus such as gastroenteritis, or offer them antibiotics to treat an infection.

If the symptoms persist for a long duration of time, the doctor will begin investigating for digestive conditions. The doctor will look for swelling around the lymph nodes, take a full history to determine risk factors, and rule out other medical conditions. Lab tests usually reveal a high white cell count, and an ultrasound can locate any mass in the stomach, which is then biopsied to determine whether it is malignant. 

Treatment & Therapy

Primary gastric lymphoma is treated with antibiotics to cure any existing infection, followed by chemotherapy. This is because chemotherapy weakens the immune system and would allow an infection to spread uncontrolled. At times, chemotherapy and radiation therapies are used in combination to shrink the cancer.

If there are tumors present, surgery may be done to remove them before beginning the first course of chemotherapy or radiation therapy. This allows the treatment to be more effective, and be used for a shorter duration of time because there is less malignant tissue to eradicate.

In some cases, a portion of the stomach may need to be removed, especially if the tumor has progressed deep into the wall of the stomach muscle. Removing these tumors also decreases the chance of the stomach wall becoming perforated, and it reduces the chance of developing bleeding in the stomach.

In later stages of the disease, surgery is almost always guaranteed. This is because removing the malignancy increases the chance of survival and reduces symptoms. This increases the patient's ability to eat and allows them a greater ability to receive the nutrients needed to aid the immune system.

Prevention & Prophylaxis

While some cases of primary gastric lymphoma may be predicted due to genetic predisposition, or through genetic testing, others are classified as spontaneous. Seeking prompt treatment for symptoms of H. Pylori, especially in people between the ages of 60 and 70 years of age, is important.

It is also noted that men are more likely to develop this type of cancer than women, and in the last decade there have been increased reports of children and teenagers developing the cancer. The only reliable preventable measures that can be taken are to receive regular checkups, have laboratory tests completed on a regular basis, and monitoring one's own health closely.