Protocols - Hemorio

6 – GASTRIC MALT LYMPHOMA
DIAGNOSIS
Essential tests:
- physical exam;
- performance status;
- presence of B-symptoms;
- full hemogram;
- LDH, uric acid, β2-microglobulin;
- renal and hepatic function;
- serology (HBV, HCV, HIV 1 and 2, HTLV I and II, syphilis and wounds);
- PA and profile simple chest X-ray;
- chest / abdomen CT;
- histopathology of gastric biopsy;
- immunohistochemistry: CD5-, CD10-, CD20+, CD23-/+, cyclin D1- and bcl-2 negative;
- coloration for H. pylori at the histopathology of gastric biopsy;
- bone marrow biopsy.
Desirable tests:
- endoscopic ultrasound in order to determine the perigastric lymph node attack;
- EDA with multiple biopsies.
STAGING
Lugano Staging TNM
Ann
Arbor
Tumoral Extension
T1N0M0 IE mucosa, submucosa
stage I confined to TGI T2N0M0 IE proper muscle
T3N0M0 IE serosa
stage II extension to abdomen
T1-3N1M0
T1-3N2M0
IIE
IIE
perigastric lymph nodes
more distant lymph nodes
stage IIE penetration of serosa T4N0M0 IE invasion of adjacent structures
stage IV
extranodal disease or attack of
both sides of diaphragm
T1-4N3M0
T1-4-N0-3M1
IIIE
IVE
lymph nodes on both sides of
diaphragm / metastasis
TREATMENT:
- Stage IE H. pylori positive: antibiotic therapy for H. pylori. Re-staging in 3 months;
- Stage IE H. pylori negative or stage IIE: antibiotic therapy for H. pylori or radiotherapy 30-33 Gy
(preferred).
- Re-staging in 3 months for the subjects treated only with ATB;
- Stage III or IV. Indications of treatment: symptomatic, TGI hemorrhage, bulky, disease progression or
preference of the subject. In case of indication, consider: T induction QT (isolated agent or
polychemotherapy) or RT located on specific situations. Monitor with EDA.
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