Primary Gastric Lymphomas

Gastric lymphomas include those that arise primarily from the stomach (primary gastric lymphoma) and those that arise from systemic lymphomas with a gastric component. Systemic lymphomas commonly involve the gastrointestinal tract. The most common site is the stomach, followed by the small intestine, ileocecal area. and the colon.

Primary gastric lymphomas account for less than 15% of gastric cancers. They usually occur in the 6th decade of life and, as with gastric adenocarcino-mas, there is a male predominance. They are difficult to distinguish clinically from gastric adenocarcinomas and definitive diagnosis can only be made through biopsy at the time of endoscopy or abdominal surgery. Histologically, these tumors can be well-differentiated superficial processes (mucosa-associated lymphoid tissue or MALT) or high-grade large cell lymphomas. Helicobacter pylori is particularly associated with the development of MALT lymphomas. For lymphomas without nodal involvement, the 5-year survival rate is 80% and with nodal involvement this drops to 50%.

For primary gastric lymphomas, surgery is considered as the treatment of choice where feasible. Radiotherapy is often advocated as an adjunct to surgery for those with advanced disease, and combination chemotherapy and radiotherapy is sometimes used in those with unresectable disease. Eradication of H. pylori infection results in regression of low-grade MALT lymphomas. Thus, in these cases, a trial of Helicobacter therapy is warranted.

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