Gastrointestinal Lymphoma

Gastrointestinal (GI) lymphoma is cancer that starts in your GI tract. This is the part of your digestive system that goes from your mouth to your anus (butthole).

Most lymphoma cases start in your lymph nodes — the bean-shaped tissue that filters lymph and contains white blood cells called lymphocytes. But your GI tract is the second most common place for lymphoma to start.

Still, this condition is rare overall. Only 1% to 4% of cancers that start in your GI tract are lymphomas. The treatment and outlook depend on lots of factors your healthcare provider will discuss with you.

Types of this condition

Experts classify gastrointestinal lymphomas based on where they form. The most common sites for GI lymphoma to start (from most to least common) are your:

• Stomach (gastric lymphoma)
• Intestines (intestinal lymphoma)
• Esophagus (esophageal lymphoma)

Another way to group them is by cell type. Most GI lymphomas are a subtype of non-Hodgkin lymphoma called B-cell lymphoma. This means that the cancer cells start from healthy B cells (a type of lymphocyte) in your immune system. Most of these B-cell lymphomas are MALT lymphoma or diffuse large B cell lymphoma (DLBCL). But there are many more subtypes that can start in your GI tract.

Keeping track of all the types can feel confusing. The important thing to know is that the cancer’s location — and the type of cells affected — are all important to your diagnosis. These details help your healthcare provider choose treatments and determine your outlook (prognosis).

Symptoms of gastrointestinal lymphoma

Symptoms depend on where the tumor is in your GI tract. They include:

• Belly pain (most common)
• Bloating
• Bloody poop
• Constipation
• Diarrhea
• Nausea and vomiting
• Painful swallowing
• Unexplained weight loss

Gastrointestinal lymphoma causes

GI lymphoma happens when normal lymphocytes change (mutate) into cancer cells. Experts don’t know why this happens. But they’ve found that infections and long-term inflammation in your GI tract play a role.

Risk factors include:

• H. pylori infection (biggest risk factor)
• Autoimmune diseases
• Epstein-Barr virus
• Hepatitis B
• HIV
• Medicines that keep your immune system from being as active

Risk factors

Most people with GI lymphoma are males over 50 years old. But adults of all ages can develop it. Females get diagnosed, too.

Complications of this condition

Although it’s rare, a tumor can grow so big that it causes a blockage in your GI tract (bowel obstruction). It can damage the tissue and cause a hole (gastrointestinal perforation). These complications can be life-threatening.

How doctors diagnose this condition

Diagnosis can take a while because symptoms of GI lymphoma are like symptoms of other non-cancer conditions. Your healthcare provider will likely rule these out first. Once they learn you have GI lymphoma, they’ll zero in on the type. They’ll stage it to see how advanced it is.

As part of your diagnosis, you may need:

• Blood tests: Your blood cell counts may be atypical if you have GI lymphoma. You may have high levels of an enzyme called LDH.
• Imaging tests: You may need a CT-scan, MRI, PET-scan or ultrasound so your provider can see the tumor’s location and size. Imaging can also show if the cancer has spread.
• Endoscopy tests: These tests use special scopes to check for tumors. During an upper endoscopy, your provider can use tools inside the scope to remove tissue from the tumor. They’ll test it for lymphoma cells (biopsy). Other endoscopy tests you may need include balloon enteroscopy and capsule endoscopy.

How is it treated?

Treatment varies, depending on the type of GI lymphoma, its stage and your overall health. Options include:

• Antibiotics: This medicine can clear H. pylori infections. Some gastric lymphomas go away with this treatment alone.
• Chemotherapy: This treatment uses drugs to destroy cancer cells. Many GI lymphomas respond well to a chemo regimen called CHOP. Others respond better to R-CHOP, which adds a drug to the mix that helps your immune system fight cancer.
• Radiation therapy: This treatment uses powerful X-rays to destroy tumors. Sometimes, people with GI lymphoma get chemo along with radiation.
• Surgery: A surgeon may remove tumors that are in one area (localized). Surgery is only an option to relieve symptoms and complications of the lymphoma. It’s not good at preventing the lymphoma from returning.
• Palliative care: This treatment reduces your symptoms, so you feel better. It may involve any of the treatments above. It may also mean changing your routine. For example, some people need tube feedings or to receive nutrients through an IV to reduce stress on their GI tracts. These treatments may be short- or long-term.

If GI lymphoma is related to taking medicines that make your immune system less active, stopping them may help. This gives your immune system time to power up, so it can fight cancer better.

When should I see my healthcare provider?

Contact your healthcare provider if you have belly pain, bloating or other signs of GI lymphoma that don’t improve within two weeks. Remember, many conditions share these symptoms. It’s important not to assume you have cancer. But you’ll need to see a healthcare provider to be sure.

Seek emergency care if you have signs of a perforation or blockage. Things to look out for include:

• Blood in stool
• Fever
• Inability to poop
• Sudden severe belly pain

What can I expect if I have this condition?

Some GI lymphomas are slow-growing and curable. But others lead to a shorter life expectancy. Generally, things linked with a better outlook include:

• Early-stage disease
• Good overall health
• Normal LDH levels on blood tests
• Younger age at diagnosis (under 70)

But your experience depends on lots of things, including where the lymphoma is in your body. For example, esophageal and gastric lymphomas tend to have better outcomes than intestinal lymphomas. Cell differences matter, too. Lymphomas linked to B-lymphocytes tend to be less aggressive than lymphomas with T-lymphocytes. But even specific subtypes of B cell lymphomas are more serious than others.

Given the variety, it’s important to talk with your healthcare provider about what you should expect. Every diagnosis and outcome is unique.