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Symptoms of Extranodal Lymphoma in the Abdomen

written by: Eric Haines • edited by: Emma Lloyd • updated: 5/23/2011

Lymphoma is a cancer that originates in the cells of the immune system. Lymphoma of the gastrointestinal tract is a rare disease with an incidence of 1.6 per 100,000. Approximately 50% of all lymphoma patients experience extranodal lymphoma in abdomen symptoms.

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    Lymphoma is a cancer that originates in the cells of the immune system. While the majority of lymphoma sufferers are over the age of 60 years, this disease is known to affect both adults and children. It is estimated that close to 75,000 people will be diagnosed with lymphoma and over 21,000 people will die from lymphoma in 2010.

    There are two basic categories of lymphomas. The Hodgkin lymphoma subtype which is characterized the presence of Reed-Sternberg cells, a lymphoid cell (usually a clonal B cell) that is very large in nature with an abundant pale cytoplasm and two or more oval nuclei. The diagnosis of Hodgkin lymphoma is much rarer compared to its counterpart, non-Hodgkin lymphoma. The first sign of Hodgkin disease is often an enlarged lymph node; followed by the spreading to nearby lymph nodes and later to the lungs, liver or bone marrow. Symptoms of this condition include:

    • Painless swelling of the lymph nodes in the neck, armpits or groin
    • Fever and chills
    • Night sweats
    • Weight loss and loss of appetite
    • Itchy skin

    The other subtype of lymphoma is known as non-Hodgkin lymphomas. This subtype is much more abundant that Hodgkin lymphoma and consists of a diverse group of cancers of immune system cells. Non-Hodgkin lymphomas are further divided into cancers that are slow-growing or less aggressive and those that have aggressive, fast-growing properties. Non-Hodgkin lymphoma can cause many symptoms including:

    • Swollen, painless lymph nodes in the neck, armpits or groin
    • Unexplained weight loss
    • Fever
    • Soaking night sweats
    • Coughing, trouble breathing or chest pain
    • Weakness and tiredness that don't go away

    Compared to Hodgkin disease, this subtype is more likely to be characterized by extranodal lymphoma in abdomen symptoms such as abdominal pain and swelling, as well as a feeling of fullness or loss of appetite.

    Both these two subtypes of lymphomas behave and respond to treatment differently. They can both occur in children and adults and their prognosis and treatment depend on both the stage and the type of cancer.

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    Lymphoma and the Abdomen

    Lymphoma of the gastrointestinal tract comprises a group of rare diseases with a British incidence of 1.6 per 100 thousand patients per year. Abdominal lymphoma is predominantly associated with non-Hodgkin lymphomas. This subtype of lymphoma represents about 1% of all gastrointestinal-related tumors. Its incidence is only in 0.4% of colorectal tumors, 2.5% of stomach cancers and approximately 20% of small intestinal cancers. Approximately 40% of lymphoma patients present with extranodal lymphoma. Extranodality has been observed in the vast majority of the body’s organs and tissues. It is most commonly found in the spleen, liver, gastrointestinal tract, pancreas and the abdomen.

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    Symptoms

    With approximately half of all lymphoma patients experience extranodality, it is important to understand the extranodal lymphoma in abdomen symptoms. When the afflicted lymph nodes are deep within the abdomen, it can press against a variety of organs. This can cause a loss of appetite, weight loss, diarrhea, sensation of being bloated, constipation and abdominal pain. Moreover, if the pressure occurs on the intestinal system, an individual may experience a loss of appetite and/or vomiting. It is also important to note that if the lymphoma involves lymphatic tissue within the abdomen, fluid can accumulate and lead to swelling near the intestines and potentially leading to the enhancement of extranodal lymphoma in abdomen symptoms.

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    Extranodal Disease and Non-Hodgkin’s Lymphoma

    Extranodal lymphoma in abdomen symptoms is more commonly found in non-Hodgkin's lymphoma (NHL) than with Hodgkin's lymphoma. In fact, extranodal lymphoma of the gastrointestinal tract occurs in up to 30% of patients. It is also more likely to be present in and intermediate- to high-grade tumors. While the stomach (60-75% incidence) is the area of the gastrointestinal tract most commonly affected by extranodal disease, it can also be present in the small bowel, pharynx, large bowel, and esophagus. Moreover, 20-30% of all extranodal stomach lymphomas involve the abdominal lymph node.

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    Extranodal Disease and MALT lymphoma

    Mucosa-associated lymphoid tissue (MALT) lymphoma is less common than non-Hodgkin's lymphoma. However, they are more likely to affect extranodal sites. Extranodal MALT lymphoma is most commonly found in the stomach and is closely associated with chronic stomach inflammation, such as that cause by Helicobacter pylori gastritis. Extranodal lymphoma in abdomen symptoms involvement is generally associated with a poor prognosis. The transformation of MALT lymphomas to a more aggressive cancer constitutes to 40–70% of all gastric lymphomas. This transformation is most likely the result of a long-standing H. pylori infection. Patients generally present with gastric symptoms such as: abdominal pain (70% of cases), weight loss (40%) and dyspepsia (30%). Moreover, bleeding and gastric perforation are less common symptoms.

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    References

    Abdominal Manifestations of Extranodal Lymphoma: Spectrum of Imaging Findings. Lee et al. AJR 2008.

    Primary extranodal lymphomas of stomach: clinical presentation, diagnostic pitfalls and management. Psyrri A Ann Oncol (2008).

    Lymphoma Foundation Canada - http://www.lymphoma.ca/en/symptoms-of-lymphoma.htm

    National Institute of Health - http://www.nlm.nih.gov/medlineplus/hodgkindisease.html