Malignant Diseases of the Stomach Gastric Lymphoma Treatment

u TO

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m Stages and Treatment Options

The following treatment options are available for gastric lymphoma:

► H. pylori eradication

► Surgical resection

► Irradiation

► Chemotherapy

The use of these treatment modalities depends on the tumor grade and the extent of disease (Table 3.22).

Table 3.22 Staging of primary gastric lymphomas

Affected organs and lymph nodes

EI1 Unifocal or multifocal gastric involvement without lymph node involvement and without organ infiltration by contiguous spread. Lymphoma is confined to the mucosa and submucosa.

EI2 Like EI1, but transcending the submucosa and infiltrating the muscularis or serosa or invading an organ by contiguous spread.

EII1 Unifocal or multifocal gastric involvement plus involvement of regional lymph nodes (compartments 1-2).

EII2 Unifocal or multifocal gastric and lymph node involvement going beyond the regional lymph nodes (compartments 1 -2) plus further organ involvement by contiguous spread or other localized organ involvement below the diaphragm.

EIII Unifocal or multifocal gastric or lymph node involvement above or below the diaphragm plus further localized organ involvement, which may be above the diaphragm.

EIV Unifocal or multifocal gastric involvement with or without involvement of adjacent lymph nodes and diffuse or disseminated involvement of one or more extragastric organs.

E = primary extranodal disease

Treatment of Low-Grade Non-Hodgkin Lymphoma

H. pylori eradication should be considered as a solitary treatment only in patients with low-grade unifocal or multifocal gastric lymphoma without lymph node involvement and without organ infiltration by contiguous spread. This is an organ-conserving strategy, and the response should be regularly assessed by endoscopy. If the treatment is unsuccessful, surgical resection is indicated.

In cases with involvement of regional or nonregional infradi-aphragmatic lymph nodes, treatment consists of surgery or irradiation.

With extensive spread (infradiaphragmatic and supradia-phragmatic lymph nodes, involvement of additional organs), chemotherapy is indicated.

Treatment of High-Grade Non-Hodgkin Lymphoma

High-grade non-Hodgkin lymphoma is an indication for chemotherapy, which may be combined with surgical resection (early stage) or irradiation (early and advanced stages).

MALT lymphomas of the

Fig. 3.113a-d stomach

MALT lymphomas of the

Fig. 3.113a-d stomach

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