Gastric MALT Lymphoma - Treatment Options and Prognosis

What is gastric MALT lymphoma and how is it treated?

Gastric MALT lymphoma is a type of non-Hodgkin Lymphoma (NHL) affecting the stomach. To learn more about the symptoms and tests for this lymphoma, see the article about MALT Lymphoma.

The following treatments can be used for gastric MALT lymphomas:

• Treatment of Helicobacter pylori infection (antibiotics)
• Radiation therapy
• Surgery
• Chemotherapy

In some cases, getting rid of an existing stomach infection may be all that is necessary, while more intensive treatment is often required to adequately treat the MALT lymphoma. For patients who have early stage H. pylori-positive gastric MALT lymphoma, initial H. pylori eradication therapy followed by surveillance can be the first step before any radiotherapy. About 20 to 30 percent of patients do not respond to eradication therapy or demonstrate relapse during follow-up, however. 

Antibiotics

Many if not most cases of MALT lymphoma of the stomach are strongly associated with infection with H pylori.  H. pylori is a bacterium which is known to causes gastritis and stomach ulcers. Just as the bacterium may harm the protective lining of the stomach and intestines to cause ulcers, it's thought that it may also lead to inflammation in the stomach which, in turn, can lead to cancer. Since roughly half of the world's population has been infected with these bacteria, such infections clearly do not seem to cause problems for everyone, and there are probably other factors such as heredity and lifestyle needed, in conjunction with H pylori infection, to cause problems.

In patients with MALT lymphoma who also test positive for H pylori, antibiotics for H pylori may actually completely control the cancer. In roughly 3 out of 4 patients with early disease, H pylori treatment may result in a complete resolution of the tumor. The disease remains controlled in many patients. Those with a complete response may be receive continued follow-up, or surveillance, with endoscopies. Despite complete remission, some people will continue to have a positive PCR test for H. pylori.

It's been found that some people who test negative for H. pylori infection respond to treatment with antibiotics with complete remission, so it could be argued that nearly anyone with a gastric MALT lymphoma should be treated with antibiotics to eradicate H. pylori.

Radiation Therapy

Radiation is the preferred treatment for MALT lymphoma when H pylori is absent, or when anti H pylori treatment fails. Relatively low doses of radiation are given, and these doses nearly always control the lymphoma. Radiotherapy treatment, alone, can achieve complete responses in more than 95% of the patients, and most patients remain controlled in the long term.

Surgery

Surgery is an effective treatment of MALT lymphomas of the stomach and results in long term control in most patients. The risks of surgery are higher than those of radiation, and therefore surgery is less commonly used for treatment. Like radiotherapy, surgery is usually sufficient to control and cure MALT lymphomas that are limited to the stomach.

Chemotherapy

Chemotherapy is generally used for early stage gastric MALT lymphomas when local treatments fail to control disease, or when the disease recurs. For advanced stage stomach cancers, chemotherapy is the treatment of choice. Different combination treatments are effective in these slow-growing lymphomas.

Immunotherapy

Rituxan (rituximab) is a monoclonal antibody that is effective in many forms of lymphoma including gastric MALT lymphoma. Just as our bodies make antibodies to fight off bacteria and viruses, Rituxan is essentially a "man made antibody" that works to fight off cancer cells.  Just as our own antibodies recognize abnormal markers on the surface of bacteria, this medication recognizes a particular marker on the surface of certain cells that have become cancerous.

Thankfully, gastric MALT lymphoma is a very treatable cancer with an excellent prognosis. That said, to can be terrifying to be diagnosed with any cancer. In addition, treatments can be associated with side effects, especially fatigue.  Reach out to your family and friends, and allow people to help you. You can also check out these tips that people have found helpful for coping with lymphoma.