Loading
A lymphoma that starts in the stomach or bowel is staged by how deep it goes into the wall and how far along the lymph node chain it has travelled, not only by how many node regions are involved. The depth is measured by endoscopic ultrasound, and it decides whether antibiotics alone are worth trying.
Gastrointestinal lymphoma has its own staging vocabulary because the ordinary node-counting system does not capture what matters. The Lugano staging system for gastrointestinal lymphoma, which predates and is separate from the Lugano classification of 2014, runs: stage I, confined to the gut wall; stage II, extending into the abdomen, subdivided by whether the involved nodes are local (II-1) or distant (II-2); stage IIE, penetrating the serosa to involve adjacent organs; stage IV, disseminated or with supradiaphragmatic nodes. A parallel system, the Paris staging system, maps the same disease onto TNM-style depth categories (T1 mucosa and submucosa, T2 muscularis propria, T3 serosa, T4 adjacent structures).
Why the depth matters. In gastric marginal zone lymphoma of mucosa-associated lymphoid tissue, antibiotic eradication of Helicobacter pylori is the whole of the first treatment, and it works best in disease confined to the mucosa and submucosa. Endoscopic ultrasound measures that depth directly, and in a prospective series it assessed the depth of infiltration correctly in 91.5 per cent of cases against the resected specimen, while being less reliable about how far the tumour spread across the surface.
What the staging does not decide. Surgery has no routine role in gastric lymphoma at any stage, which is the main thing that separates it from gastric adenocarcinoma, and a stage that would mean an operation in a carcinoma does not mean one here.
Leukaemias, myeloma and MDS live in the marrow and blood; lymphomas grow in lymph nodes and spleen. The node stations are the disease map, not a route of spread, and staging counts them.
In lymphoma the node stations are the disease itself; staging (Ann Arbor / Lugano) counts how many regions and sides of the diaphragm are involved.
Same organ: High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double-hit lymphoma), Mediastinal grey zone lymphoma, Primary effusion lymphoma, Plasmablastic lymphoma, T-cell/histiocyte-rich large B-cell lymphoma, EBV-positive diffuse large B-cell lymphoma, Primary large B-cell lymphoma of the testis, Gastric MALT lymphoma, Ocular adnexal MALT lymphoma, Extranodal NK/T-cell lymphoma, Adult T-cell leukaemia/lymphoma, ALK-positive anaplastic large cell lymphoma, ALK-negative anaplastic large cell lymphoma, Breast implant-associated anaplastic large cell lymphoma, Primary cutaneous anaplastic large cell lymphoma, Lymphomatoid papulosis, Mycosis fungoides, Enteropathy-associated T-cell lymphoma, Monomorphic epitheliotropic intestinal T-cell lymphoma, Splenic marginal zone lymphoma, Nodal marginal zone lymphoma, Primary cutaneous marginal zone lymphoma, Primary cutaneous follicle centre lymphoma, Sezary syndrome, Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma), Hepatosplenic T-cell lymphoma, Intravascular large B-cell lymphoma, Lymphomatoid granulomatosis, T-cell prolymphocytic leukaemia, Splenic B-cell lymphoma/leukaemia with prominent nucleoli (formerly B-cell prolymphocytic leukaemia and hairy cell leukaemia variant), T-cell large granular lymphocytic leukaemia, Mixed-phenotype acute leukaemia, Myeloid leukaemia of Down syndrome, Burkitt leukaemia, Marginal zone lymphoma, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome), Primary mediastinal (thymic) large B-cell lymphoma, Leukaemia (all types), Acute myeloid leukaemia, Acute lymphoblastic leukaemia, Chronic lymphocytic leukaemia, Chronic myeloid leukaemia (CML), Diffuse large B-cell lymphoma, Follicular lymphoma, Hodgkin lymphoma, Mantle cell lymphoma, Multiple myeloma, Non-Hodgkin lymphoma (all types), Myelodysplastic syndromes / neoplasms (MDS), Myeloproliferative neoplasms (PV, ET, myelofibrosis), Polycythaemia vera (PV), Essential thrombocythaemia (ET), Waldenström macroglobulinaemia, Hairy cell leukaemia, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Blastic plasmacytoid dendritic cell neoplasm (BPDCN), Burkitt lymphoma, HIV-associated (AIDS-related) lymphomas, Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms, Systemic mastocytosis, Erdheim-Chester disease, Rosai-Dorfman disease and other histiocytic neoplasms, Langerhans cell histiocytosis (LCH), Post-transplant lymphoproliferative disorder (PTLD), FLT3-mutated acute myeloid leukaemia, IDH1- and IDH2-mutated acute myeloid leukaemia, NPM1-mutated and KMT2A-rearranged acute myeloid leukaemia, Secondary and therapy-related acute myeloid leukaemia, Acute promyelocytic leukaemia, Acute myeloid leukaemia in older or unfit patients, Smouldering multiple myeloma, Newly diagnosed multiple myeloma, transplant-eligible, Newly diagnosed multiple myeloma, transplant-ineligible, Relapsed or refractory multiple myeloma, Plasma cell leukaemia, Lower-risk myelodysplastic syndromes, Higher-risk myelodysplastic syndromes, Chronic lymphocytic leukaemia, first treatment, Relapsed or refractory chronic lymphocytic leukaemia, Richter transformation of chronic lymphocytic leukaemia, Chronic myeloid leukaemia, chronic phase, Chronic myeloid leukaemia, accelerated and blast phase, Primary myelofibrosis, Standard-risk B-cell acute lymphoblastic leukaemia in children, High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL), Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL), Philadelphia chromosome-like acute lymphoblastic leukaemia (Ph-like or BCR::ABL1-like ALL), Infant acute lymphoblastic leukaemia (KMT2A-rearranged, under one year), Relapsed and refractory acute lymphoblastic leukaemia in children, Acute myeloid leukaemia in children, Erdheim-Chester disease, Rosai-Dorfman-Destombes disease, Single-system Langerhans cell histiocytosis (bone, skin or one other organ), Multisystem Langerhans cell histiocytosis (with or without risk-organ involvement), Indolent and smouldering systemic mastocytosis, Advanced systemic mastocytosis (aggressive SM, SM with an associated haematological neoplasm, mast cell leukaemia), Early-stage classical Hodgkin lymphoma (stage I to II), Advanced-stage classical Hodgkin lymphoma (stage III to IV), Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma), Relapsed and refractory classical Hodgkin lymphoma
Showing the organ this term concerns: Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma).
Shares Gastric MALT lymphoma, Marginal zone lymphoma, Non-Hodgkin lymphoma (all types) and the tags heme, lymphoma.
Shares Enteropathy-associated T-cell lymphoma, Monomorphic epitheliotropic intestinal T-cell lymphoma, Non-Hodgkin lymphoma (all types) and the tags heme, lymphoma.
Shares Enteropathy-associated T-cell lymphoma, Gastric MALT lymphoma, Monomorphic epitheliotropic intestinal T-cell lymphoma, Non-Hodgkin lymphoma (all types) and the tags heme, lymphoma.
Shares Gastric MALT lymphoma, Nodal and extranodal lymphoma, Lugano classification / Ann Arbor staging, Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) and the tags heme, lymphoma.
Shares Gastric MALT lymphoma, Marginal zone lymphoma, Non-Hodgkin lymphoma (all types) and the tags heme, lymphoma.
Shares Non-Hodgkin lymphoma (all types) and the tags heme, lymphoma.
Shares Non-Hodgkin lymphoma (all types) and the tags heme, lymphoma.
Shares Nodal and extranodal lymphoma, Monomorphic epitheliotropic intestinal T-cell lymphoma, Lugano classification / Ann Arbor staging, Non-Hodgkin lymphoma (all types) and the tags heme, lymphoma.