Presentation

Most patients have their cancer diagnosed with stage I or stage II disease outside the lymph nodes. In general, patients have stomach pain, ulcers, or other localized symptoms, but rarely do they suffer from systemic complaints such as fatigue or fever.  Many patients have a history of autoimmune disease such as helicobacter gastritis, Hashimoto's thyroiditis, or Sjogren's syndrome.  It is most often diagnosed in people in their 60’s. But cases are sometimes found in people in their 20’s or 30’s.
 

Causes

The bacteria Helicobacter pylori has been shown to cause MALT in the digestive system in about 90% of cases.  Chromosome abnormalities t(1;14)(p22;q32) and t(11;18)(q21;q21) have also been noted in this form of NHL.
 

Treatment

Gastric (in the digestive system) - treatment of Helicobacter pylori infection may resolve cases of local gastric involvement.  After standard antibiotic regimens, 50% of patients show resolution of gastric MALT (when checked by endoscopy) after 3 months.   Other patients may resolve after 12 to 18 months of observation. Stage III or IV disease may be treated with surgery or CHOP chemotherapy with or without radiation.

Non-gastric - localized involvement can be treated with radiation or surgery.   When in the lymph nodes, bone marrow, or blood marginal zone behaves like other indolent / low-grade lymphomas.

As with all B-cell lymphomas, use of immunotherapy drugs is possible and there are a number of clinical trials running using newer monoclonal antibody drugs like Rituxan, Bexxar, and Zevalin to induce responses.  Ask your doctor or browse the trials page.

Care

I have been told of tenderness in the digestive system during or after treatment with gastric MALT.  You will want to talk to your doctor and possibly the staff nutritionist about what to eat during and after treatment.  A number of good books (example) exist for people with cancer but consultation with your medical team is recommended. 

Further Reading / In-Depth

Non-Hodgkin's Lymphomas, Peter M. Mauch (Editor), James O. Armitage (Editor), et al., 2004.

• Section IV: Pathology, Biology, Clinical Evaluation, and Treatment Section
  • Chapter 22: Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Type

Excellent but Technical: An Illustrated Guide to Skin Lymphomas, Cerroni, Gatter, Kerl, 2nd. Ed, 2005

• Chapter 10: Marginal Zone Lymphoma and Cutaneous Immunocytoma

Web Resources:

Books:

• Malt Lymphomas (Medical Intelligence Unit (Unnumbered: 2003) by Emanuele Zucca and Francesco Bertoni, February 2004
  
• Gastrointestinal Lymphoma: Future Perspectives (Recent Results in Cancer Research, 156) by Wolfgang Fischbach (Editor), Hardcover, Published February 2000 - technical 

Information Sources

• The Hematopathology of Lymphoma 
• MALT Lymphoma Genetics from Cancer Genetics Web
• Unusual Lymphoma Entities: Evaluation and Management by Vose, Fisher, and Lister, 1997 ASCO

Non-Hodgkin's Lymphoma Information Pages:

    Non-Hodgkin's Lymphomas
    Non-Hodgkin's Lymphoma: Diagnosis
    Non-Hodgkin's Lymphoma: Aggressive Lymphomas
    Non-Hodgkin's Lymphoma: Indolent Lymphomas
    Non-Hodgkin's Lymphoma: Treatment
    Non-Hodgkin's Lymphoma: Resources
    Bone Marrow and Stem Cell Transplants

Other Pages of Interest:

• Childhood Non-Hodgkin's Lymphoma Information
• The Lymphoma Information Network

This page is a work in progress - if you have more complete information, references, or other information please contact the author. The author is not in the medical field and does not warrant the correctness of the material on this page or the sites linked - please take online information and consult with your own medical team to make informed decisions.