Gastric Lymphoma

Background

Nonhodgkin's lymphoma accounts for about 5% of all gastric malignancies. While gastric lymphoma is relatively uncommon compared to adenocarcinoma, the stomach is the most common site of extranodal lymphoma. The peak incidence of this disease is in the 6th and 7th decades.

Presentation

When gastric lymphoma is symptomatic, its symptoms are similar to those of gastric adenocarcinoma. Gross bleeding is uncommon but occult hemorrhage and anemia may be present in up to 25% of cases. Diagnosis is generally made via upper endoscopy and biopsy.

When the diagnosis of gastric lymphoma is made, evidence of systemic disease should be sought. A careful examination of lymph nodes is made. In addition, CT scans of the chest and abdomen are generally acquired. Bone marrow biopsy is also sometimes performed.

Staging of primary gastric lymphoma is as follows:

• Stage I: disease confined to the stomach

• Stage II: disease involving the perigastric lymph nodes

• Stage III: disease spread to lymph nodes beyond perigastric nodes

• Stage IV: disease spread to other solid organs

Managemant

Approximately 75% of patients with primary gastric lymphoma will have resec-table disease at the time of diagnosis. Patients with stage I disease have disease which is generally curable with resection. Surgical therapy includes total gastrectomy with intraoperative staging. Data suggests that adjuvant radiotherapy improves locoregional disease control. In patients with stage II disease, 30% of those who undergo curative resection and adjuvant radiotherapy will have disease recurrence outside the treatment field. Thus, stage II disease is considered systemic disease and adjuvant chemotherapy is included in the treatment regimen.

In patients with stage III and IV disease, treatment primarily consists of chemoradiation. Surgery is performed in those patients who suffer complications of disease (i.e., bleeding, obstruction, or perforation) or who have persistent gastric disease following chemoradiation. If patients present with these complications, surgery is performed first followed by chemoradiation. Chemotherapy consists of cy-clophosphamide, doxorubicin, vincristine, and prednisone (CHOP).

Stage I disease is associated with a 5-year survival rate of approximately 90%. Stage II is associated with a 75% 5-year survival. Stage III disease is associated with a 50% 5-year survival while stage IV disease is associated with a 5-year survival rate of about 15%.

References

1. Nyhus LM, Baker RJ, Fischer JE. Mastery of Surgery. 3rd ed. Boston: Little Brown and Co., 1997.

2. Greenfield LJ, Mulholland M, Oldham KT et al. Surgery scientific principals and practice. 2nd ed. Philadelphia: Lippincott-Raven, 1997.

3. Sabiston DC, Lyerly HK Textbook of surgery. 15th ed. Philadelphia: W.B. Saunders Co., 1997.

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