Malt lymphoma of the stomach is a “young” and relatively rare disease of a malignant nature. It is often disguised as chronic gastritis or peptic ulcer. Timely detection and proper treatment of the pathology in most cases allows achieving stable remission.
- general information
- Causes of malt lymphoma of the stomach
- Symptoms
- Classification
- Diagnostics
- Treatment of malt lymphoma of the stomach
- Recovery process after treatment
- Diet
- Metastasis
- Complications and relapse
- Forecast
- Prevention
general information
The diagnosis of malt lymphoma of the stomach was introduced into practice relatively recently. Previously, this pathology was considered “pseudolymphoma,” until in 1983 scientists proved the origin of the entire tumor from one malignant cell. The term MALT stands for mucosal associated marginal zone lymphoma. They can appear in any extranodal (primary focus outside the lymph nodes) organs and structures of the body, most often affecting the digestive system (30-40%). The stomach accounts for 60-75%.
This pathology belongs to non-Hodgkin lymphoma. Women get sick somewhat more often than men. In most cases, the disease develops after 50-60 years. Usually the process occurs locally (one focus) in the antrum of the stomach (the body or cardia is less commonly affected). More often the disease is diagnosed in the initial stages (about 70%).
General recommendations for the patient
Immediately after diagnosis, the patient should switch to a special diet. During chemotherapy for gastric lymphoma, it is imperative to exclude any fatty, salty and hot foods from your diet.
Those who have undergone chemotherapy should add the following products to the menu :
- various cereals;
- cottage cheese, kefir, low-fat yoghurts;
- fish and seafood;
- natural juices;
- boiled vegetables.
However, the situation is complicated by the fact that almost all patients lose their appetite, due to which the body is deprived of nutrients, so steamed dishes are best served in crushed or liquid form - this will make it easier for the patient to eat. The diet should not contain foods that have an aggressive effect on the damaged gastric mucosa. A course of chemotherapy and radiation therapy greatly deplete the body, so to normalize the condition, it is advisable to take vitamin complexes and drugs that improve intestinal microflora.
Obviously, traditional medicine recipes will not be superfluous. To reduce painful sensations, you can drink infusions of chamomile or sea buckthorn; a decoction of oatmeal . We must remember that even the most harmless remedy can be used only after consultation with a doctor.
To summarize, it should be said that lymphoid infiltration of the stomach is not a diagnosis that you should panic when you hear it. Timely diagnosis and well-chosen treatment make it possible to achieve stable remission in most patients .
Causes of malt lymphoma of the stomach
Malt lymphoma appears as a result of long-term chronic inflammation occurring in the stomach. In response to the constant presence of infectious agents, extranodal lymphatic tissue located in the mucous membranes of the digestive tract proliferates. The production of B lymphocytes increases, which then undergo multiple mutations. As a result of gene damage, cells acquire atypical properties, and tumor growth begins.
More than 90% of all malt lymphomas occur due to the negative influence of Helicobacter pylori. In other cases, the disease develops due to the systematic action of other infectious or other agents on the gastric mucosa.
Symptoms
At the initial stage, the clinical picture of gastric lymphomas is absent or corresponds to that of chronic gastritis or peptic ulcer. Mostly, dyspeptic disorders are observed (heartburn, belching, nausea, vomiting, sometimes with streaks of blood) and periodic painful sensations in the epigastrium, aching in nature, independent of food intake.
Against the background of concomitant pathology, there may be complaints of bloating, poor bowel function, constipation, loss of appetite, etc. If lymphoma progresses, symptoms of a “tumor nature” appear (asthenic syndrome, severe pain).
Etiological factors of the disease
The term lymphoma refers to a neoplasm that grows from lymphoid tissue. Normally, the gastric walls are devoid of lymphatic follicles, however, under the influence of unfavorable factors, the active formation and growth of the latter begins.
Doctors tend to believe that most often the prerequisites for the appearance of a lymphoid tumor are created by chronic gastritis . This theory is confirmed by the fact that chronic gastritis, caused by the gram-negative bacterium Helicobacter pylori, is registered in almost 90% of cases in people with gastric lymphoma.
In addition to bacteria, the process of proliferation of lymphoid tissue in the stomach is also influenced by other negative factors leading to lymphoma:
- weakening of the body's immune function;
- pathologies of autoimmune origin;
- bad genetics;
- history of internal organ transplantation;
- long stay or residence in an area with increased background radiation;
- regular consumption of foods with large amounts of pesticides and carcinogens;
- long-term therapy with drugs that suppress the immune system.
Typical clinical picture
The symptomatic manifestations of gastric lymphoma are very similar to the external signs of malignant lesions and other diseases of the gastrointestinal tract. The first symptom that makes it possible to suspect the presence of a lymphoid neoplasm is enlarged cervical or inguinal lymph nodes. Subsequently, the symptoms become more extensive:
- A person complains of a dull and aching pain in the epigastric region, which noticeably intensifies after eating.
- Even after eating a small portion of food, satiety occurs quickly.
- Poor appetite, unconscious reduction in the amount of calories consumed, aversion to certain foods.
- A rapid decrease in body mass index, up to the appearance of anorexic thinness.
- Systematic attacks of nausea and vomiting, aggravated by minor overeating.
- When a tumor grows near a network of blood vessels, bleeding occurs.
- Increased sweating, especially during sleep.
Gastric lymphoma often occurs against the background of such serious complications as:
- perforation of the stomach wall, when a through wound is formed in the area of the lymphoid tumor;
- the occurrence of severe gastric bleeding;
- pathological narrowing of the lumen of the antrum of the digestive organ.
Classification
Among all non-Hodgkin primary lymphomas that arise in the stomach, malt lymphomas are the most frequently reported. Their classification was developed by a special group of researchers and doctors. The following stages of the disease are distinguished:
- Stage I - pathology is limited to the stomach: 1 - tumor within the mucous membrane or with penetration into the submucosal layer;
- 2 - lymphoma affects the muscular, subserous and/or outer layer;
- 1 - paragastric lymph nodes are affected;
The last two stages were combined because they imply the same prognosis. Malt lymphomas also vary in their degree of malignancy and their aggressiveness.
Diagnostics
Diagnostic measures begin with a standard interview and examination of the patient. When diagnosing malt lymphoma, endoscopic examination with the collection of histological material from different parts of the stomach is of primary importance. The resulting biopsy is studied using the following methods:
- morphological assessment;
- immunohistochemical analysis;
- molecular genetic research using FISH or PCR.
The presence of an active Helicobacter pylori infection must be confirmed using immunohistochemical, serological, antigen stool or urease breath tests.
In addition, the complex of examinations for gastric lymphoma includes:
- blood test with determination of general and biochemical parameters (leukocyte formula, b2-microglobulin, lactadehydrogenase, etc.)
- fluoroscopy of the gastrointestinal tract;
- endoscopic ultrasound of the stomach and nearby lymph nodes;
- CT scan of the abdomen, pelvis and lungs;
- collection of aspiration material from the bone marrow.
The differential diagnosis of malt-lymphomas of the stomach with other lymphomas is particularly difficult for the doctor. It is also sometimes difficult to distinguish this malignant tumor from chronic diseases of the organ, since the neoplasm often occurs against the background of a peptic ulcer or gastritis.
Often, during gastroscopy, lymphomas look like mucosal ulcers or areas of hyperplastic tissue. Therefore, it is so important to always collect histological material from several points (at least 6-8) to correctly diagnose the patient.
Forecast
When malt lymphoma is diagnosed, the prognosis is ambiguous. It depends on many features of the disease, the correct choice of course of therapy and the capabilities of the patient’s body.
If treatment was started at the first or second stage, the prognosis is most often favorable. With the help of drugs and chemotherapy, a survival rate of more than 90% can be achieved within five years.
When the pathology is at stage 3 or 4, the chance of recovery decreases. Patients should undergo regular medical examination, including endoscopic examination.
Treatment of malt lymphoma of the stomach
Since gastric marginal zone lymphoma is approximately 90% associated with Helicobacter pylori infection, treatment begins with antibacterial therapy aimed at eliminating this pathogen. Even in those patients whose disease was caused by other infections, sometimes there is a positive effect from taking drugs against Helicobacter.
Many clinical studies conducted for gastric lymphomas have proven the effectiveness of eradication treatment in 80% of patients with the first stage and confirmed infection with Helicobacter pylori. In the second stage of the disease, antibacterial therapy was successful in 40% of patients. Thus, this method is the first-line treatment for gastric marginal zone lymphoma.
After a full course of eradication therapy, after 1 year, a comprehensive examination of the patient is carried out to assess the effectiveness of the treatment. An endoscopic examination of the stomach with a biopsy is required. If resistance (resistance) of microorganisms to the treatment is confirmed, a second line of therapy is prescribed—irradiation.
Marginal zone lymphoma is very sensitive to radiation. To achieve a therapeutic effect, a total total dose of 30 to 35 Gy is prescribed. An important point is that ionizing radiation should only affect the stomach and paragastric lymph nodes. In order to protect neighboring organs (liver, pancreas, kidneys), high-precision irradiation is used, or the total load is reduced to 25 Gy.
If a patient with gastric marginal region lymphoma has not responded to antibacterial treatment and radiation therapy and for disseminated processes, chemotherapy is prescribed. The medications used include:
- chimeric monoclonal antibody to CD-20 B-lymphocyte receptors (rituximab);
- anthracycline-containing regimens;
- purine analogues of nucleosides (cladribine, fludarabine);
- regimens with mitoxantrone and prednisolone;
- alkylating agents used for non-Hodgkin's lymphomas (chlorambucil, cyclophosphamide).
For each patient with gastric lymphoma, a different treatment regimen is selected. According to indications, surgical intervention is possible, which is the method of choice for the treatment of this pathology. Gastric resection is often performed.
Just a few years ago, surgery was considered a priority for eliminating gastric marginal zone lymphomas. However, the high probability of postoperative complications and death limit the possibility of surgical interventions.
Malt lymphoma: what is it, symptoms, causes, treatment, prevention
Experts identify many types of lymphomas. They differ not only in the degree of malignancy, but also in localization and further prognosis. One form of the disease is malt lymphoma, which most often affects the gastric mucosa.
General information about the disease
Malt lymphoma belongs to a class of malignant diseases in which the pathological process affects the cells of the lymphatic system. The pathology is also called maltoma.
Inflammation is most often found in the stomach area, but can also be localized in other parts of the body. Based on research results, it has been established that the disease is diagnosed more often in elderly patients, mainly in women. Among all non-Hodgkin's lymphomas, maltoma ranks third.
But, despite many studies, specialists were unable to obtain complete information about the disease and its molecular genetic features.
The danger of the disease is that the pathological process can quickly spread to neighboring and distant organs. Diagnosis in the initial stages is difficult, since there are practically no signs of pathology.
Classification
Malt lymphoma is divided depending on the location of the pathological process. The disease is also classified according to the stage of development of the disease.
Stage 1
Inflammation affects only one area or organ. Located outside the nodes of the lymphatic system.
Signs of pathology are practically absent, which greatly complicates the diagnosis.
Stage 2
The pathological process affects only one organ or area, the lymph nodes on one side of the diaphragm.
Symptoms of the disease become more intense, which forces patients to consult a specialist.
Stage 3
The pathological process affects tissues located on both sides of the diaphragm. It can also spread to distant lymph nodes and the spleen.
Stage 4
It is the most dangerous stage of disease development. Signs of pathology are clearly expressed, patients complain of pain.
It is difficult to cure the disease at stage 4. To achieve remission, complex treatment is used.
Localization
Maltoma most often affects the stomach tissue. This localization of inflammation is observed in more than half of the cases of lymphoma.
But the pathological process can affect the thyroid gland, liver tissue, lungs, conjunctival area, respiratory tract and chest. Symptoms appear depending on the location of the inflammation.
Causes
The exact causes of maltoma have not been established. It is believed that the main cause of the development of the pathological process in the stomach area is bacteria of the Helicobacter pylori type.
Experts have also identified a number of unfavorable factors that influence the occurrence of the disease. These include exposure to chemicals and toxic substances, smoking, drinking alcohol, and infectious diseases. Maltoma can be caused by stomach diseases such as ulcers and gastritis.
Genetic predisposition is of particular importance. Many patients had close relatives who also suffered from similar diseases.
Clinical picture
The intensity of symptoms depends on the stage of development of the pathology. In addition, signs appear in accordance with the localization of the pathological process.
Most often, patients complain of pain in the stomach, spleen, liver or upper respiratory tract. Usually they are aching in nature.
Common symptoms also include vomiting, belching, increased body temperature, and increased sweating, mainly at night. There is a rapid onset of a feeling of fullness when eating.
As the pathological process spreads, gastric bleeding may occur, and patients experience psycho-emotional exhaustion.
Lymph nodes enlarge in the armpits, groin and neck. Pain may occur during palpation examination. The affected lymph nodes are elastic and mobile in the initial stages.
It is noted that in the last stages of development of maltoma, in which the lesion affects the tissues of the stomach, the disease is similar in its symptoms to cancerous damage to the organ.
There are practically no signs that indicate the presence of a neoplasm. As a result, patients turn to a specialist late.
Diagnostic methods
If the development of maltoma is suspected, the doctor conducts an examination and studies the patient’s medical history. In order to establish an accurate diagnosis and determine the course of therapy, instrumental and laboratory research methods are prescribed.
A blood test allows you to get a complete picture of the pathology. The study is prescribed to determine changes in the composition and presence of tumor markers.
The patient is also prescribed MRI, CT, and ultrasound. The techniques allow us to establish the localization and extent of spread of the pathological process.
A biopsy is also used to obtain images of changed tissue. The biopath is sent for cytological examination, which makes it possible to determine the presence of cancer cells.
Treatment methods
When maltoma is diagnosed, treatment is primarily aimed at eliminating bacteria such as Helicobacter pylori. According to studies, it has been established that the probability of remission after therapy is about 80%.
If treatment was started at the first stage of development of the pathology, only in 5% of cases is there a recurrence of the pathological process.
When malt lymphoma is detected, patients are prescribed antibacterial drugs. Nifuratel, Amoxicillin, Tetrazikin or Rifaximin are popular. If the drugs do not bring a positive effect, surgical intervention is prescribed.
But the operation is used only in 5% of cases. Typically, patients are prescribed complex treatment, which includes the use of radiation or chemotherapy.
Radiation therapy
The impact on the affected tissue is carried out by radioactive radiation. The technique allows you to slow down or completely stop the growth of the tumor and eliminate the occurrence of complications.
According to research results, it has been established that radiation therapy brings positive results in 90% of cases. The disadvantage of the method is the high risk of side effects, since radioactive radiation also has a negative effect on healthy tissue.
Chemotherapy
The use of chemotherapy drugs can improve the prognosis. The duration of the course of therapy is determined by the attending physician and depends on the stage of development of the pathology. Medicines are selected by a specialist taking into account research results.
According to experts, most often malt lymphoma at stages 1 and 2 can be treated with chemotherapy without difficulty.
Chemotherapy drugs, when the disease is at stage 3 or 4, help slow down the process of mutation of tissue cells in half of the cases.
Possible complications
Lack of therapy causes complications to develop. Patients experience stomach bleeding and severe pain.
As the pathological process spreads, disruption of the functioning of many organs and systems is observed. Metastatic lesions may also develop over time.
The most dangerous consequence is death. Death occurs as a result of complications.
Forecast
When malt lymphoma is diagnosed, the prognosis is ambiguous. It depends on many features of the disease, the correct choice of course of therapy and the capabilities of the patient’s body.
If treatment was started at the first or second stage, the prognosis is most often favorable. With the help of drugs and chemotherapy, a survival rate of more than 90% can be achieved within five years.
When the pathology is at stage 3 or 4, the chance of recovery decreases. Patients should undergo regular medical examination, including endoscopic examination.
Prevention
There are no special measures to prevent malt lymphoma, since the exact causes of the disease have not been established. Experts recommend following general rules:
- properly . The diet should include vegetables and fruits, as they contain many vitamins. You also need to reduce the amount of fatty, salty and fried foods.
- Lead a healthy lifestyle . Patients should give up bad habits such as smoking and drinking alcohol.
- Treat infectious diseases in a timely manner. According to scientists, they are the causes of the development of pathology.
- Get checked regularly . Timely diagnosis improves the prognosis.
Compliance with preventive measures will reduce the risk of developing maltoma and complications associated with the disease.
Malt lymphoma is a type of malignant lesion. The pathological process most often affects the tissues of the stomach, but can also affect internal organs.
The danger of the disease is that in the initial stages it is difficult to diagnose the pathology. This is due to the absence of obvious signs. Treatment is carried out in accordance with the stage of development and characteristics of the disease.
Both drugs and other therapies are used to destroy cancer cells. But even after completing the course, patients should visit their doctor regularly to reduce the risk of relapse.
Source: //onkologia.ru/onkogematologiya/malt-limfoma/
Metastasis
Gastric marginal zone lymphoma rarely gives distant metastases. Metastatic seedings to regional lymph nodes are most often observed. Much less often the process spreads to distant lymph nodes.
When a tumor extends beyond the serosa of the stomach, nearby tissues and organs can be affected. Most often, lymphoma metastasizes to the liver, pancreas and kidneys. Often, patients with stage 4 of the process experience bone marrow damage.
Complications and relapse
After treatment for gastric lymphoma, the risk of complications and relapse will depend on which methods were used. After long-term use of antibiotics, drug resistance, allergic reactions, intestinal dysbiosis, intoxication of the whole body or individual organs may appear. When using chemotherapy drugs, the toxic damage will be several times stronger, taking into account the regimens and doses used. There may be a decrease in the number of blood cells, suppressed immunity, damage to peripheral nerves, etc.
If during irradiation of the stomach neighboring organs and tissues are exposed to rays, typical post-radiation complications will be observed. After surgery, early and late undesirable consequences may occur. In the postoperative period the following cannot be excluded:
- bleeding;
- suture infection;
- failure of the gastric stump;
- state of shock;
- peritonitis;
- thromboembolism;
- pneumonia;
- myocardial infarction and other complications associated with surgery for lymphoma or anesthesia.
When visiting a specialized clinic, where modern equipment is used and qualified doctors work, the risk of complications and recurrence of gastric lymphoma is significantly reduced.
