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ما المعالجة المختارة لرجل عمره 40 سنة ويعاني من لمفوما معدة مثبتة بالخزعة ؟


ما المعالجة المختارة لرجل عمره 40 سنة ويعاني من لمفوما معدة مثبتة بالخزعة ؟

المعلومة

ما المعالجة المختارة لرجل عمره 40 سنة ويعاني من لمفوما معدة مثبتة بالخزعة ؟
1- استئصال المعدة التام
2- علاج شعاعي
3- علاج كيماوي
4- استئصال موضعي واسع

المرجع

schwartz principles of surgery

by


الأفضل في علاج لمفوما المعدة MALT lymphoma هو العلاج الشعاعي...

Fouad's picture
Fouad
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Quote:
- علاج كيماوي

I GUESS I WILL START WITH THIS Exclamation

Miss Cuz's picture
Miss Cuz
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The question need to be more specified. When you say Lymphoma you have to mention the stage and whether it is MALT lymphoma or not.
This is important because early stage MALT lymphoma would require only eradication of H.Pyolri bacteria and nothing else.

ABIM's picture
ABIM


حلو

شكراً قصي وabim

بعتقد بالمراحل المتقدمة حأستخدم الشعاعي فقط

DR-MAK


ذكر أن 60% من حالات لمفوما المعدة تتراجع بالقضاء على hp.

هل هذا صحيح؟

Buzz_LightYear

Quote:
هل هذا صحيح؟

Yes , but in early cases only (invloving the mucosa but not all the gastric wall)

ABIM's picture
ABIM

Quote:
Yes , but in early cases only (invloving the mucosa but not all the gastric wall)

i was to say that but not sure...thanx...

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Fouad
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2- علاج شعاعي

علاء خطيب
طالب دراسات عليا

wowShocked Shocked
i've read in some where thats seems likeEmbarrased Embarrased Embarrased
>
>
.but thanx alot all!!!
good CORRECT informationEye-wink
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Miss Cuz
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- استئصال موضعي واسع

طبعا على افتراض انو ما في نقائل

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a.m.a
طبيب مقيم


Embarrased Embarrased WELL its seems like there is a misunderstanding !!

الان رجاءً ما هو الجواب النهائي؟؟؟؟

Miss Cuz's picture
Miss Cuz
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Quote:
استئصال موضعي واسع

طبعا على افتراض انو ما في نقائل

Dear ..be careful, this concept you are talking about is true for SOLID tumors (like adenocarconoma ) but not lymphoma.

ABIM's picture
ABIM

Quote:
Dear ..be careful, this concept you are talking about is true for SOLID tumors (like adenocarconoma ) but not lymphoma.

صح مظبوط Embarrased

شكرا عالتنبيه دكتور

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a.m.a
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the management of choice is RADIATION....i won't change my mind...
Fouad's picture
Fouad
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the management of choice is RADIATION....i won't change my mind...

Quote:

Well ... I guess you have to start thinking about it more (

Lets see the literature and the studies and see what you think. After all it is not what inside my or your mind.It is what the studies have shown .. right!!!!

ABIM's picture
ABIM

The treatment of MALT lymphomas:

1. Eradication of H. Pylori

THEN, if fails

2. Radiation therapy

THEN, if fails

3. One agent chemotherapy

THEN, if fails

4. Multiagent chemotherapy

THEN, if fails

5. Combination between the above treatments

THEN, if fails

6. UNCLEAR!

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KMG
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Really the main issue is to make sure we are talking about the same thing. Lymphoma of the stomach can be different types . and you can't group all treatments in one statement .
see

EXTRANODAL MARGINAL ZONE B-CELL (MALT) LYMPHOMA — This tumor, previously called MALT-type lymphoma or MALT lymphoma is now called extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue in the WHO classification system. The vast majority of low-grade B-cell lymphomas of the stomach are derived from mucosa-associated lymphoid tissue, and are therefore of the MALT type. Approximately 40 to 50 percent present with indolent or low-grade histology, of which 70 to 80 percent are confined to the stomach (stage IE) ].
Eradication of H pylori — The association of MALT lymphomas with H. pylori has been dramatically demonstrated by regression of gastric MALT lymphomas following treatment aimed at eradicating H. pylori . Complete histologic regression has been demonstrated in 50 to 80 percent of carefully selected patients
Patients with localized (stage IE) mucosal disease are candidates for anti-H. pylori therapy. It is estimated that less than 10 percent of patients with gastric lymphoma are in this category, as the majority have aggressive histology (ie, diffuse large B-cell lymphoma, see below), extensive mural involvement, or advanced stage (stages IIE to IV).

Patients with extensive mucosal involvement or more advanced stage (stages IIE to IV) should be offered the same treatment options as those with high-grade histology

Patients whose tumor fails to respond to eradication of H. pylori are often found to have a high-grade component, which may have been missed at the time of the original biopsy
Treatment failures — Fortunately, patients who do not respond to, or who relapse following, anti-H. pylori therapy still have a high rate of cure.In general, the standard of care for localized gastric extranodal MZL which fails antibiotic therapy or is H. pylori negative is radiation therapy, with >90 percent long-term disease-free survival.

Multiagent chemotherapy, such as CVP or CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), with rituximab, is reserved for patients failing or recurring after other less aggressive therapies, those with advanced stage disease (ie, stage III or IV disease), and those with diffuse large B-cell lymphoma (ble

Combination chemotherapy is the treatment of choice for patients with advanced (stage IIIE and IV) disease. Response rates are comparable to those observed for extraintestinal NHLs, but the overall prognosis is poor, with 5-year and 10-year survival rates of approximately 50 and 20 percent, respectively [46]. As in the adjuvant setting, CHOP is the preferred regimen outside of a clinical trial.

The role of radiation and surgery in advanced disease is uncertain. Radiation therapy provides effective palliation for extensive, unresectable disease, but is unlikely to have an impact on overall survival. Palliative surgical resection in patients with extensive or advanced disease prior to chemotherapy may prevent subsequent bleeding or perforation, but this approach remains controversial [43,47,48].

DIFFUSE LARGE B-CELL LYMPHOMA OF THE STOMACH

Diffuse large B-cell lymphoma (DLBCL) is the name currently given to the entity previously called "high-grade" gastric MALT lymphoma. It is the most common histology for primary gastric lymphomas, representing approximately 50 percent of cases. Compared to patients with low-grade lymphomas, these patients tend to have more systemic symptoms and a more advanced stage at diagnosis. It was concluded that chemotherapy alone should be considered the treatment of choice in this setting.

MANTLE CELL LYMPHOMA
Mantle cell lymphoma involving the gastrointestinal tract usually presents in older patients, often involving multiple sites throughout the gastrointestinal tract (lymphomatous polyposis). (. Although systemic chemotherapy is the treatment of choice, mantle cell lymphoma is presently considered to be an incurable disease, with a median survival of 3 to 5 years. ).

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ABIM
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