Lymphoma Of The Stomach

Lymphoma of the stomach Background The second most common primary cancer of the stomach But constitute only 2-5% of the total number 95% being adenocarcinomas

Lymphoma of the stomach Background Almost all are non-Hodgkin's lymphoma (NHL) And generally classified as B cell mucosa-associated lymphoid tissue (MALT) lymphoma

About 20% of patients manifest a second primary cancer in another organ

Lymphoma of the stomach Background Also classified as: low grade or high-grade base on nuclear pattern Macroscopically: * infiltrative * ulcerative * nodular * polypoid and * combines

Lymphoma of the stomach Background There are many different non-Hodgkin's lymphoma (NHL) ► Low-grade NHL ► High-grade NHL ► Cutaneous T cell lymphoma

Lymphoma of the stomach Low-grade NHL May be * Large or small * Grouped together (follicular type) * Spread out (diffuse type)  

Lymphoma of the stomach Low-grade NHL Types  * Mantle cell lymphoma  * Splenic marginal zone lymphoma   * MALT lymphoma   * Lymphoplasmacytic NHL (also called Waldenstrom's macroglobulinaemia) 

Lymphoma of the stomach High grade NHL * Diffuse large B cell   * Diffuse mixed cell lymphoma   * Burkitt’s lymphoma   * Anaplastic large cell lymphoma  

Lymphoma of the stomach High grade NHL

Lymphoma of the stomach Transforming from low grade to high grade Over time, low grade lymphomas may change into a more aggressive high grade type lymphoma If it does, it may be several years after you were first diagnosed with the low grade lymphoma ►► higher grade type ►poorer prognostic

Lymphoma of the stomach Clinical presentation History Strikingly similar to that of adenocarcinoma of the stomach making the diagnosis very difficult

Lymphoma of the stomach Clinical presentation History Age Patients with primary gastric lymphoma are usually in their mid-fifties Sex With a male-to-female predominance of 1.7 to 1 Less than 20% asymptomatically

of

patients

present

Lymphoma of the stomach Clinical presentation History Pain: The major symptom, occurring in over 80% of patients, and it may be associated with: * anorexia * early satiety * nausea and * vomiting

Lymphoma of the stomach Clinical presentation History Vague symptoms Such as: * Weakness * Malaise are also relatively common

Lymphoma of the stomach Clinical presentation History Remember In case of diffuse lymphoma * night sweats * weight loss * fever Can be present in up to 40%

Lymphoma of the stomach Clinical presentation History Remember: 42% of Patients presented with emergency complication of gastrointestinal lymphoma: * Bleeding * Perforation * Obstruction * Fistula

Lymphoma of the stomach Clinical presentation History Gastric lymphoma may also occurs following: ► surgical treatment for peptic ulcer ► treatment of Hodgkin's disease ► Chrohn’s disease or ► Immunosupression for renal transplantation

Lymphoma of the stomach Physical Examination Patients with primary gastric lymphoma sometimes present with abdominal findings suggestive of a mass in the left upper quadrant

Most commonly there are no abdominal findings unless there is a complication of the tumor

Lymphoma of the stomach Physical Examination Splenomegaly is occasionally found in patients with direct extension of the lymphoma to the spleen Massive splenomegaly may indicate diffuse lymphoma

Lymphoma of the stomach Physical Examination Other findings that suggest diffuse or abdominal lymphoma include: * palpable peripheral adenopathy or * large retroperitoneal mass

Lymphoma of the stomach Diagnosis Upper Gastrointestinal Radiology (series) Ultrasonography scan (USS) CT scan Gastrointestinal endoscopy

Lymphoma of the stomach Treatment Medical (Helicobacter pylori) ► According to the stage Surgery Chemotherapy Radiation therapy