Primary Lymphoma of the Gastrointestinal Tract

Only a small percentage of patients in whom a malignant lymphoma develops present with evidence of gastrointestinal involvement. A number of authors have indicated that long-term survival can be obtained by surgery alone in selected cases with well localized disease (1-5). This study was initiated to review the experience at The Ontario Cancer Institute incorporating The Princess Margaret Hospital to try to evaluate the indications for and value of radiation therapy in the management of primary lymphoma of the gastrointestinal tract. Material The case reports of patients over the age of sixteen years who have been seen at The Princess Margaret Hospital during the period from 1950 to 1965 with proved gastrointestinal tract involvement have been reviewed. During this period the total number of patients with a diagnosis of malignant lymphoma is 1,555. Of all those who presented with abdominal symptoms, gastrointestinal involvement could be proved by laparotomy or radiological methods in only 83. Those in whom there was evidence of involvement of the mesentery only were not included in this study. Distribution by Age, Sex, and Site Of the 83 patients included in the study, 38 were females and 45 were males. There was an approximately equal distribution of patients in each ten-year period between the ages of thirty-five and seventy-five years (Fig. 1). The major or only involvement of the gastrointestinal tract by pathological diagnosis is shown in Figure 2. The frequency of involvement of the stomach (40 cases) and small intestine (25 cases) is in sharp contrast to the distribution in children in whom involvement of the stomach is extremely uncommon (6). Staging of Disease The whole group of patients has been divided into two subgroups. These have been classified very simply as (a) an early or (b) a late group. All the lymphomas, Hodgkin's disease, lymphosarcoma, and reticulum-cell sarcoma have been lumped together, although some individual comparisons between disease entities have been made. Early cases are those in which the lymphoma involved the gastrointestinal tract alone or had spread to regional nodes only. A bowel perforation did not change the classification. Also, those patients who had systemic symptoms of fever, weight loss, or anemia which were compatible with the local disease process were kept under the early classification. In a preliminary review of the survival figures there was no apparent difference between those with and without microscopic evidence of regional node involvement. Consequently it seemed logical, because of the small numbers, to group those cases together and class them all as early. All the remaining patients were placed in the late group. This obviously encompasses an enormously varied group of patients. It includes those who had clinical evidence of intra-abdominal disease beyond the gastrointestinal tract and mesentery as well as those with widespread metastases.