Management of gastrointestinal lymphoma.

Abstract

Despite numerous effective chemotherapeutic regimens developed to treat non-Hodgkin’s lymphoma (NHL), it remains the sixth most common cause of cancerassociated deaths in the United States. Estimates from the American Cancer Society project that about 53,000 new cases of NHL will be diagnosed in the United States in 2002 and approximately half of those afflicted will die of their disease. The incidence of NHL has increased greatly since the early 1980s, in large part from increased HIV disease, though ubiquitous environmental and toxic exposures have also been implicated. NHL is more common in men (M/F ratio 1.5/1). The incidence of NHL in younger white men (ages 18 to 45) has stabilized since 1997 but might be increasing in both women and African Americans. Extranodal lymphoma, or lymphoma arising within solid organs, occurs in up to 40% of all cases. The gastrointestinal (GI) tract is the most frequently involved extranodal site, accounting for up to half of all extranodal cases. Lymphomas can involve any part of the GI tract from oral cavity to rectum. Surgical resection can play an important role in the diagnosis and treatment of NHL involving the GI tract. The surgeon should maintain a high index of suspicion for GI lymphomas and appreciate the critical role surgery might play in obtaining an accurate diagnosis and successfully managing these malignancies. This article reviews GI lymphomas with particular emphasis on the role of surgery as part of a multidisciplinary approach to the diagnosis and management of NHL.