Gastric lymphoma

From 1976 to 1988, 35 patients were treated for Stage IE and Stage IIE primary gastric lymphoma (non-Hodgkin's). Pain and weight loss were the predominant symptoms, physical findings were usually absent and 20 per cent of the patients were anemic. The results of gastrointestinal contrast studies suggested a malignant condition in 75 per cent, but findings were not specific for lymphoma. Endoscopic findings suggested a malignant process in 85 per cent, but the yield for biopsy was only 60 per cent. Of 28 patients undergoing operative exploration, 75 per cent were resectable. Nine patients received postresectional adjuvant therapy. Five had chemotherapy; three, radiotherapy, and one patient, a combination of the two. Primary nonsurgical treatment consisted of chemotherapy in 11, radiotherapy in two and combined therapy in one instance. Three of five recurrences were successfully treated. The five year survival rate was 65 per cent without significant differences between surgical and nonsurgical regimens. Those with tumors smaller than 7 centimeters had a five year survival rate of 100 per cent versus 50 per cent for larger neoplasms. Patients more than 60 years of age appeared to have a more favorable course after surgical therapy compared with those who had nonsurgical treatment. We concluded that endoscopy is a most useful, although limited diagnostic study and since no treatment program is obviously superior, the choice of therapy can be individualized accordingly.