LOS ANGELES — Have a high index of suspicion for gastric lymphoma in a patient who presents with severe abdominal pain, weight loss, and melena, Dr. Ijeoma A. Azodo advised in a poster session at the annual Digestive Disease Week.
“They will have other symptoms, such as early satiety, heartburn, and things that would warrant upper endoscopy,” Dr. Azodo of the Mayo Clinic in Rochester, Minn., said in an interview. She based her comments on results from an analysis of 711 hospitals participating in the gastric cancer patient care evaluation study of the National Cancer Data Base, which is an alliance between the American College of Surgeons' Committee on Cancer and the American Cancer Society.
The analysis was limited to clinical data on the management of patients with gastric cancer collected between January 2001 and December 2001. Of the 7,084 gastric malignancies in 2001, 688 (10%) were lymphomas. Patients with gastric lymphoma were predominantly white (73%), and more than half (57%) were male. The mean age at diagnosis was 69 years, and the three most common symptoms at presentation were severe abdominal pain (74%), weight loss (61%), and melena (47%).
Upper endoscopy with tissue biopsy was used in 86% of cases, and the procedure identified a gastric lymphoma in nearly all (97%). Abdominal and pelvic CT scans were also used for staging purposes, but newer technologies such as endoscopic ultrasonography and laparoscopy were infrequently used.
Dr. Azodo also reported that the most common gastric lymphoma sites were unspecified/diffuse/multiple (50%) and distal (16%), and that 31% of patients had a history of Helicobacter pylori infection while 22% had negative test results.
Large-cell diffuse lymphoma was present in 49% of patients, and marginal zone B-cell lymphoma was present in 36%.
Fewer than half of all gastric lymphoma patients with H. pylori exposure received an adequate regimen of therapy for its eradication.
Most patients (89%) were treated without surgery, but those who underwent surgery had a 30-day mortality of 19%. Postsurgical adjuvant therapy was used in 5% of patients. Radiation was the stand-alone treatment in 9% of patients, and chemotherapy was administered in 51% of patients.
Symptoms include severe abdominal pain, weight loss, melena, early satiety, and heartburn. DR. AZODO