Lymphoma, the most common type of blood cancer usually develops in the lymph nodes, which is an important part of the immune system and lymphatic system. The development of lymphoma is related to the abnormal growth and reproduction of white blood cells called lymphocytes. Because lymph nodes are spread throughout the body, the disease can appear anywhere, but most commonly in the neck, armpits and abdomen. Lymphoma also attacks in the intestine.
Intestinal lymphoma is very rare. Lymphomas are classified as either Hodgkin or non-Hodgkin lymphoma according to its characteristics, but intestinal lymphoma is usually non-Hodgkin lymphoma originated in the B or T-cells. Since it is an uncommon cancer, there is no specific optimal treatment. Patients are usually treated with standard therapies for lymphoma.
Intestinal Lymphoma Development, Risk Factors
According to the study “Primary gastrointestinal lymphoma,” published in 2011, the gastrointestinal tract is the most common extranodal site for the development of the disease. Gastrointestinal lymphoma is usually non-Hodgkin with the most frequent sites of occurrence in the stomach, small intestine and ileocecal region. Usually intestinal lymphoma is secondary, which means it was spread from a lymphoma that originated somewhere else.
Diffuse large B-cell lymphoma is the most usual type of intestinal lymphoma.
Several risk factors influence the development of the disease.
Men are more likely than women to develop it; the average age of diagnosis is 60 years. Smoking and drinking alcohol are risk factors but other diseases contribute to intestinal lymphoma such as celiac disease, previous colon cancer, Crohn’s disease, familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer, Peutz-Jeghers syndrome, MUTYH-associated polyposis and cystic fibrosis (CF).
A high fiber diet may decrease risk.
Intestinal Lymphoma Symptoms, Diagnosis
Symptoms associated with intestinal lymphoma include abdominal pain and cramps, unexplained weight loss, malabsorption of the food ingested, rectal bleeding and severe constipation or bowel obstruction. In addition, mood alterations including irritability, anxiety and depression, as well as fatigue and insomnia can occur.
Early and correct diagnosis is sometimes difficult because symptoms are not exclusive of intestinal lymphoma and may be signs of other conditions.
When intestinal lymphoma is suspected, the physician will begin the diagnosis track by performing a complete physical examination and asking for medical and family history. Biopsy, the most common exam required to diagnose lymphoma, is used to analyze tissue to determine the type, extent and stage of the disease. Other exams that could be needed include lab, blood and imaging tests.
Treatment and Prognosis of Intestinal Lymphoma
Many factors such as age, gender, medical history, or extent and stage of the disease impact treatment choices. CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone), is usually the first chemotherapy choice but sometimes it is used after other therapies. The biological therapy Rituximab is often used either alone or as a complement to other therapies.
Surgery may be an option. The most common surgery is a segmental bowel resection or a right hemicolectomy. Palliative surgery is used as an alternative treatment for patients with advanced disease and obstruction problems. Radiation therapy may be recommended to complement chemotherapy or alone.
Because diagnosis is not easy and the intestinal lymphoma can be aggressive, prognosis is not usually particularly positive.
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