Hodgkin’s lymphoma of the stomach
Non-Hodgkin ‘s lymphomas develop in various organs, which creates special problems in their diagnosis and treatment. Organ damage can also occur due to the spread of a tumor of the lymph nodes during relapse. In this case, we can talk about the generalized spread of the disease. If the patient has previously received a course of intensive chemotherapy, then the treatment is usually palliative.
The issues of treatment of patients with extra- nodal NHL, not aggravated by other diseases, are discussed below.
Lymphoma can develop anywhere in the gastrointestinal tract, but the stomach and small intestine are most commonly affected. The etiology and pathogenesis of the development of these lymphomas are not fully understood. Lymphoma that develops in the intestine is characterized by the migration of lymphocytes. Cells that are in the center of lymphoid nodules in the small intestine ( Peyer’s patches) produce immunoglobulin.
They migrate into the bloodstream and then return to the lamina propria of the small intestine, where they differentiate into plasma cells. A similar mechanism of “settlement” is also characteristic of the lymphocytes of the lining of the stomach and colon, as well as for cells producing other classes of immunoglobulins.
Lymphoma of the stomach is one of the rare tumors and accounts for 0.5% of all tumors of this organ. Usually the tumor is characteristic of middle-aged and elderly people, but it can also develop in young people. The development of a tumor is often preceded by a mucosal lesion, accompanied by the destruction of the glandular tissue, the so-called lymphoepithelial lesion.
The lesion may be diffuse and limited to the wall of the stomach for several years . Some tumors are large cells and spread early to nearby lymph nodes.
The table below shows the two most common staging systems .
The clinical picture of the disease resembles that of gastric adenocarcinoma . The main symptoms are nausea, anorexia, and discomfort in the upper abdomen. Sometimes the disease is accompanied by hematemesis or chronic anemia associated with iron deficiency.
On x-ray of the stomach , either a large ulcer or a neoplasm resembling adenocarcinoma can be seen. Endoscopy usually reveals a malignant ulcer, but sometimes it looks like a benign gastric ulcer. Analysis of biopsy specimens can be misleading, as small lymphocytes are sometimes present in the sample, which are very difficult to distinguish from areas of inflammation that infiltrate the tissue.
The relationship between the development of non-aggressive gastric lymphoma and an infectious disease caused by Helicobacter was noted. pylori .
Treatment of non-Hodgkin ‘s lymphoma of the stomach
past, gastric lymphoma was treated surgically. Since there are no randomized trials, it is difficult to make any recommendations on the use of non-surgical treatments.
If a non-aggressive lymphoma is diagnosed on biopsy and the patient is infected with H. pylori , the infection is usually treated with antibiotics and proton pump inhibitors. In 60% of patients, treatment is effective. Remission of the disease can last for several years. In the event of a relapse or if the primary treatment has proved ineffective, many doctors prescribe a course of chemotherapy to patients, leaving surgical treatment as a backup method.
If the patient ‘s condition allows , then combined chemotherapy is usually prescribed. When prescribing a course of chemotherapy to patients with an unresectable tumor or with relapses, there may be a risk of perforation of the stomach wall. Primary treatment should be carried out under close supervision.
In cases of aggressive stage I tumors not associated with H. pylori infection , the primary treatment is often surgical. The efficacy of chemotherapy and surgery has not been compared. For localized aggressive tumors and for all tumors in stage II or later, recurrence is common. Tumor recurrences can develop outside the abdominal cavity (in 50% of cases in stage II and III of the disease).
Patients with mildly aggressive stage II tumors are treated with radiation to the stomach and upper abdomen, but chemotherapy is increasingly preferred. In cases of highly aggressive stage III tumors, combination chemotherapy is usually given. For patients in stage II2 or III, chemotherapy is the most appropriate treatment. The latter is also indicated for the treatment of patients with stage IV.