Lymphomas of the stomach mostly arise from the mucosa-associated lymphoid tissue (MALT) and represent the largest subgroup of all extranodal lymphomas. They have become a focus of interest in recent years due to their unique Helicobacter pylori (H. pylori) associated etiopathogenesis resulting in complete remission (CR) of MALT-type lymphoma in early stage in up to 80%, following cure of infection by antibiotic therapy only. Gold standard diagnostic procedures include gastro- duodenal endoscopy, tissue biopsy for histological work- up and gastric endosonography (EUS).
The outcome for patients with gastric lymphomas (GLs) is substantially more favorable than that with gastric cancer. As opposed to gastric cancer, lymphoma cells are highly sensitive towards chemotherapy (CTX) as well as irradiation (RTX) thus providing the option of a non-invasive, multimodal therapeutic approach pushing aside surgery from the first-line position. To date, both RTX and CTX have given excellent results in treating indolent as well as aggressive lymphomas, equalizing results from surgical therapy and exceeding them with respect to quality of patient life. Stage at diagnosis and the histology of the lymphoma are the most important factors predicting prognosis, which is reflected by 5-year overall survival rates between 90 and 100% for stage EI, but 50-80% for stage EII according to the Ann Arbor system and between 90% for indolent and 60% for aggressive lymphoma, respectively.
Lifelong follow up of patients in CR is recommended, because of relapses later than 10 years in other MALT locations, due to the homing properties of tumor cells and a slight increase in secondary malignancies. In the future, gastric MALT-type lymphoma may set an example for evolving molecular and cytogenetic factors into major markers predicting prognosis and selecting the mode of treatment.
KeywordsUrea Breath Test Gastric Lymphoma Perigastric Lymph Node Primary Gastric Lymphoma Homing Property
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