Treatment of gastric lymphoma (MALT-lymphoma) abroad
MALT-lymphoma (mucosa-associated lymphoid tissue lymphoma) is a malignant tumour arising from the lymphoid tissue. The tumour is mainly located in the stomach ( in 55% of cases).
The illness is peculiar with a favourable prognosis. In most cases, a complete endoscopic remission is possible without any surgical intervention.
Causes of MALT-lymphoma
Infection of pathogenic microorganism bacteria called Helicobacter Pylori in the gastric mucosa is the main reason why MALT-lymphoma affects the person’s stomach. The bacterium is the causative agent of stomach and duodenum peptic ulcer. Meanwhile, of the 50% of people who have Helicobacter Pylori present in their stomachs, only a few develop MALT-lymphoma.
Other risk factors are:
- Long-term treatment with antidepressants, usually after organ transplantation or during the onset of an autoimmune diseases
- Viral hepatitis C
- Old age
Symptoms of MALT-lymphoma
Pain in the stomach is the first sign that you will need to pay attention to as it’s a clean sign for 70% of patients. Other possible stomach MALT-lymphoma symptoms are:
- Indigestion (belching, heartburn, heaviness in the stomach) - 32% of patients
- Weight loss - 30% of cases
- Vomiting - 20% of patients
- Gastric bleeding - 15% of patients
30% of patients suffer from anemia as a result of obvious or hidden bleedings. Constant blood loss leads to the decreased level of hemoglobin. Patients may also notice black stool colour which reveals the gastric nature of the bleedings.
Another cause of anemia is a violation of hematopoiesis. The amount of blood and other blood elements like platelets, leukocytes automatically decreases in the blood. Blood coagulability worsens and immunity weakens.
MALT-lymphoma of the stomach affects the bone marrow in the pathological process in only 13% of cases. If the primary tumour location is in the other place, this risk is significantly higher.
Diagnostics of MALT-lymphoma
MALT-lymphoma can be detected and diagnosed with the help of various instrumental and laboratory techniques:
- Computed tomography is done to visualise a tumour and evaluate the prevalence of the oncological process.
- Blood tests for AIDS and hepatitis C
- Complete blood count is done to detect anemia, thrombocytopenia, and leucopenia
- Red bone marrow biopsy is performed in the case of abnormally low level of leukocytes, platelets, erythrocytes in the blood
- Endoscopic examination of the stomach is performed together with biopsy, where tissue samples are taken from 8-12 suspicious areas of the mucosa
In German hospitals, chromosome anomalies are determined by the so called FISH method (fluorescence in situ hybridization). This is a necessary measure to obtain a prognosis for the stomach MALT-lymphoma and choose the best therapeutic tactic possible.
It is noteworthy, that diagnostics remains necessary even after the treatment course. Gastric mucosa biopsy is performed again to assess the therapy results. Though, it’s done no earlier than in a few months after the treatment is over. Procedures are vital since lymphoid infiltration can remain for some time even after the onset of complete remission.
Treatment of MALT-lymphoma abroad
Antibacterial treatment. MALT-lymphoma treatment includes mandatory eradication therapy aimed at destroying the causative agent of peptic ulcer called Helicobacter Pylori.
The results of such treatment are:
- Complete endoscopic remission in 62% of cases
- Partial remission in 12% of cases
- Stabilization (ceased tumour growth) in 4% of cases
- Progression (tumour keeps on growing) in 2% of cases
Such a therapy takes a couple months to complete. A patient is also prescribed antibiotics and proton pump inhibitors.
Distant radiation therapy is applied if MALT-lymphoma doesn’t disappear after the antibacterial treatment. It can either reduce the tumour size or completely destroy it. Radiation therapy is recommended at the early stages when a tumour is big and causes disturbing symptoms.The reduction of MALT-lymphoma size helps to significantly improve the patient’s life quality during the therapy period.
Monoclonal antibodies. The drug called Rituximab is prescribed to reduce the size of MALT-lymphoma if it reacts badly to eradication therapy with antibiotics.
Chemotherapy is used from the 3rd stage of MALT-lymphoma onwards. This tumour responds well to cytotoxic drugs and decreases in size after treatment.
Surgery is rarely used, as most patients can be cured without it. Surgical treatment is used if:
- MALT-lymphoma doesn’t respond to other treatment methods
- There are complications like constant bleedings
- A tumour causes complete obstruction of the gastrointestinal tract
In this case, resection of the stomach or gastrectomy (complete removal of the stomach) is performed. After the treatment of MALT-lymphoma, a constant control of the disease is still needed. A biopsy of the stomach is done every 6 months for the first two years. Then another biopsy has to be done once a year.
Prognosis for MALT-lymphoma
Prognosis is favourable for MALT-lymphoma as the tumour grows slowly and doesn’t spread to other organs and tissues within long years. Oncologic pathology is either cured in the majority of cases or it can stay in the long remission period without surgery.
Approximate five-year survival of the patients (not taking into account mortality from other causes not associated with MALT-lymphoma) exceeds 90%.
An unfavourable prognosis is peculiar for a tumour with a high degree of malignancy. Such a histological type of MALT-lymphoma is infrequent. But the five-year survival rate in this case is only 56%.