Malignant lymphoma and MALT lymphoma

[June419]

My mother had an endoscopy perfomed on Dec. 27 after completing a PREV PAC regimen for H pylori.  She appears to be feeling a bit better; her appetite has increased somewhat and she says she is feeling much stronger with very little dizziness which she had been having on a daily basis. She had lost about 15 pounds over the course of 4 months because of severe nausea and I guess the h pylori. She had been on two emergency room visits after which we were sent home after a variety of blood tests and were told that her anemia had improved greatly since the antibiotics and that her liver funciton was okay.  Her Dr. finally ordered the endoscopy because she was still complaining of feeling full.   At any rate, two days ago, the Dr's office who did the endoscopy called and informed us that the biopsy results were in and we needed to pick up a 'work order' to take to the local hospital for further testing.  This frightened me and I bluntly asked if they suspected cancer. The person who called lightheartedly told me not to worry.  When I picked up the order yesterday, in big letters the order said 'MALIGNANT LYMPHOMA."  I am reeling.  What a way to see this! My mother had a CT scan while we were at the hospital yesterday. We are not due to talk to the Dr. until the 12th and I am going crazy after seeing those words.  My question is this:  Would an endoscopic exam/biospsy which revealed a 'malignant lymphoma' most likely fall into the category of a MALT lymphoma?  I am convinced she IS improving and I have read that sometimes, as the h pylori is eradicated, the problem goes away.  I am, of course, praying that it is MALT that hasn't spread and that she can have another course of antibiotics and this will all be okay.  I know you can't tell me for sure, but is it ridiculous to hope that this is "just" MALT lymphoma?
Thank you for your time and help.
June

[Kevin Pho, MD]

As you suspect, it would be impossible to comment on the diagnosis and severity of the lymphoma.

MALT lymphoma is the most common GI-associated lymphoma.  There is a clear association with H Pylori - and it is imperative that the H Pylori be eradicated.  Re-testing for this bacteria can be considered if the symptoms continue.  Appropriate eradication can regress the lymphoma by as much as 50 to 80 percent.

Chemotherapy is warranted if the disease is refractory or severe.  This should be discussed in conjunction with your GI physician and an oncologist.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[help pls]

BEFORE YOUR MOM HAD HER FIRST ENDOSCOPY, WHAT SYMPTOMS WAS SHE HAVING? DID THE FIRST BIOPSY SHOW THE MALT LYMPHOMA? IF IT DIDN'T, THEN I'M WONDERING IF THE MEDICATION FOR H. PYLORI CAUSE HER MALT LYMPHOMA?

[June419]

Thanks for responding but I'm really confused!! Medication to treat h pylori can CAUSE MALT lymphoma?  This was her first endoscopy and her first biopsy results.  The Dr hasn't spoken to us yet and the only reason I know the diagnosis is because they were callous enough to write "Diagnosis: Malignant Lymphoma" on the work order that they sent us to lab with.  That's why I'm so afraid--I don't even KNOW if it IS Malt Lymphoma. I'm hoping it is because that sounds so much more treatable than a 'regular' malignant lymphoma.  Mom's symptoms before her endoscopy were: mild but not severe abdominal pain with no pain if the Dr. prodded her belly, back pain (much more so than her abdominal pain) lack of appetite which led to a weight loss of about 15 pounds in four months, fatigue, a constant feeling of fullness and she tested positive for h pylori.   Before the antibiotic series, she was nauseous a lot but this pretty much went away after the PrevPac as did most of the belly pain and she says she feels much stronger.  The endoscopy revealed three 'masses' that the Dr said looked really weird and not like any ulcers OR cancers he'd ever seen before.  Since MALT lymphoma sounds kind of rare, I'm hoping maybe this is WHY he hadn't seen it before.  At any rate, we don't get to talk to him about the results until Friday and after seeing those ugly words MALIGNANT LYMPHOMA, I am going crazy. If you know anything about this disease, please leave me a message.  Again, thanks so much for responding.

[help pls]

THANKS FOR RESPONDING. I WAS DIAGNOSED WITH H. PYLORI ON DEC 12, AFTER MY 7 DAY TREATMENT (WITH HORRIBLE SIDE EFFECTS). I STILL HAVE THE DIZZINESS AND LOOSE STOOLS AND I'VE BEEN OFF THE MEDS FOR 2 WEEKS NOW. I'M WAITING TO DO THE BREATH TEST TO SEE IF I STILL HAVE THE H. PYLORI BACTERIA... I FEEL WORSE NOW THAN BEFORE I WAS DIAGNOSED. THE MEDICATION WAS REALLY STRONG AND LIKE I SAID BEFORE....HORRIBLE SIDE EFFECTS!!!! I HOPE ALL GOES WELL FOR YOUR MOM. PLEASE KEEP ME INFORM AS TO WHAT HER DOCTOR SAYS ABOUT THE RESULTS. I'M NOT REALLY SURE ABOUT THE MEDS CAUSING MALT LYMPHOMA, MAYBE THAT IS A QUESTION YOU CAN ASK HER GI DOCTOR.

[kimbacat]

June,

did the script for the testing have the letters "R/O" before the words malignant lymphoma?  that stands for rule out.  in other words, the pathologist might have seen something questionable on the biopsy and the gi is running further tests to clarify and rule out anything nasty.

it's tough to keep from worrying.  but until you have all the info, worry is a waste of energy and time.  

when you see the doc, tell him/her how upsetting it was to see that on the script.  s/he needs to know that it not the way to handle information.

take care, best wishes

[June419]

Kimbacat,
  The paper said DX. That means diagnosis, right?  And the receptionist that I handed it to actually said she was sorry and wished us luck as we were leaving.  The ironic thing is--had I not seen this paper, I would have felt very hopeful for this has been the best three days she has had in two months. Her appetite has increased as has her energy. However, the dark cloud of waiting for him to just solidify what was on the paper is awful.  I do plan on discussing the way they have handled this. To me, it's inexcusable for ANYONE to see something as horrifying as the words malignant lymphoma and have no explanation/course of action for another week.  Worrying IS a waste of energy--that's why I've spent hours online researching what it could be and that's why I'm actually praying that if it has to be some form of lymphoma, it be MALT because that seems to be the one with the highest cure rate. Thanks for responding, Kimbacat and pls hlp.