Lymphoma

Primary Lymphoma of the Colon
Primary lymphoma of the colon is a rare tumor of the gastrointestinal (GI) tract malignancies. There are several types of lymphoma that may arise in the gastrointestinal tract but the major two appearing in more than 90% of cases are diffuse large B-cell non-Hodgkin’s Lymphoma (NHL) and mucosa-associated lymphoid tumor (MALT) NHL.  The stomach is the most common location of GI lymphomas, followed by the small intestine and then the colon.

What are the risk factors for Colorectal Lymphoma?
Etiological factors involved in the development of primary colorectal lymphoma are unknown.  However, high frequency has been observed in conditions of immunosuppression such as inflammatory bowel disease (ulcerative colitis or Crohn’s disease), HIV infection and conditions following organ transplant.  The mean age at diagnosis is 55 years.  Men are affected twice as often as women.

What are the symptoms of Colorectal Lymphoma?
Most symptoms do not occur until more advanced stage of the tumor.  Symptoms include a palpable mass, change in bowel habits, anemia, bleeding, abdominal pain or bloating, fatigue and weight loss.

How is colorectal lymphoma diagnosed?
Diagnostic tests may include colonoscopy, barium enema and/or CAT scan of the abdomen and pelvis.  The lack of specific complaints makes the diagnosis hard to establish.  Unfortunately, for some patients, a surgical procedure is the only diagnostic tool.  Due to a delay in diagnosis in up to 65% of patients, operative procedure is either urgent or emergent.

How is colorectal lymphoma treated?
In the absence of disseminated disease, surgical resection is generally performed.  If the tumor is unresectable, then a biopsy is done.  It is believed that surgery may provide important prognostic information, including tumor extent and stage.  Surgery may also prevent complications such as perforation and may offer a chance for cure with or without chemotherapy.  Multi-agent chemotherapy remains the basis of treatment for most lymphomas in advanced stage patients.