Intestinal lymphoma refers to lymphoma that develops in the gastrointestinal tract. Lymphoma is a type of cancer that originates from lymphocytes, a type of white blood cell. Intestinal lymphoma can cause a variety of symptoms, including abdominal pain and discomfort. However, the degree of pain and discomfort can vary depending on the location, type, and stage of the lymphoma.
What is Intestinal Lymphoma?
Lymphoma is a cancer of the lymphatic system, which is part of the body’s immune system. There are two main types of lymphoma:
- Hodgkin lymphoma – Named after Dr. Thomas Hodgkin, who first described it in 1832. This type of lymphoma spreads in an orderly manner from one group of lymph nodes to the next.
- Non-Hodgkin lymphoma – A diverse group of blood cancers that include any kind of lymphoma except Hodgkin’s. There are over 60 subtypes of non-Hodgkin lymphoma.
Intestinal lymphoma develops when lymphocytes in the gastrointestinal tract become cancerous and grow out of control. It most commonly affects the:
- Stomach
- Small intestine
- Colon
- Rectum
The most common subtypes of intestinal lymphoma are:
- Diffuse large B-cell lymphoma – An aggressive form that can develop anywhere in the body, including the GI tract.
- Mantle cell lymphoma – Usually affects the lymph nodes, spleen, and bone marrow, but can spread to the GI tract.
- Follicular lymphoma – Often occurs in the lymph nodes, but sometimes develops in the GI tract.
- Mucosa-associated lymphoid tissue (MALT) lymphoma – A slow-growing lymphoma that develops from cells in the mucous membranes of the GI tract.
What Causes Intestinal Lymphoma?
The exact causes of intestinal lymphoma are unknown. However, some factors are believed to increase the risk, including:
- Chronic immune stimulation – Long-standing inflammation in the GI tract may stimulate lymphocyte growth.
- Bacterial infection – Helicobacter pylori infection of the stomach and Campylobacter jejuni infection of the small intestine have been associated with MALT lymphoma.
- Congenital or acquired immunodeficiency – People with weakened immune systems have a higher risk of lymphoma.
- Autoimmune diseases – Conditions like celiac disease and inflammatory bowel disease may increase lymphoma risk.
In many cases, intestinal lymphoma arises spontaneously without any known trigger.
Signs and Symptoms
The signs and symptoms of intestinal lymphoma depend on the location and extent of the disease, but may include:
Stomach Lymphoma
- Abdominal pain or discomfort
- Feeling overly full during or after eating
- Nausea and vomiting
- Heartburn
- Loss of appetite and unintentional weight loss
- Indigestion
- Fatigue
Small Intestine Lymphoma
- Abdominal pain, cramps, or swelling
- Unintentional weight loss
- Nausea and vomiting
- Changes in bowel habits – diarrhea or constipation
- Bloating or gas
- Feeling of fullness after eating just a small amount
- Fatigue
- Fever
- Night sweats
Colon and Rectum Lymphoma
- Persistent abdominal discomfort
- Constipation
- Diarrhea
- Feeling of needing to pass stool even when bowels are empty
- Rectal bleeding
- Unexplained weight loss
- Constant fatigue
- Fever and night sweats
However, in early stages, intestinal lymphoma may not cause any obvious symptoms.
Is Intestinal Lymphoma Painful?
Intestinal lymphoma can certainly cause abdominal pain and discomfort. However, the degree of pain can vary considerably based on factors like:
Location of the Lymphoma
Lymphoma located in the inner lining of the intestine often causes little pain. Submucosal lymphoma that invades deeper intestinal layers is more likely to provoke pain. Lymphoma blocking intestinal passages results in cramping pain.
Rate of Growth
Slow-growing lymphoma typically produces milder pain that develops gradually over time. Aggressive high-grade lymphoma is more likely to cause severe pain that comes on quickly.
Extent of Disease
Early intestinal lymphoma confined to a small region tends to cause minimal pain. Widespread lymphoma infiltrating long segments of bowel is more apt to cause substantial pain.
Individual Factors
People have differing pain thresholds. Some tolerate mild lymphoma pain well, while others find the same degree of pain debilitating. Emotional state, stress levels, and coping abilities also affect the perception of pain.
Type of Lymphoma
Some lymphoma subtypes are more prone to provoke pain than others when arising in the intestines:
| Lymphoma Subtype | Pain Potential |
|---|---|
| Diffuse large B-cell lymphoma | High |
| Burkitt lymphoma | High |
| Mantle cell lymphoma | Moderate |
| Follicular lymphoma | Low to moderate |
| Small lymphocytic lymphoma | Low |
| Marginal zone lymphoma | Low |
So in summary, fast growing and aggressive lymphomas often cause significant pain, while indolent forms may be associated with little to no pain.
Patterns of Pain
Intestinal lymphoma can cause various patterns of abdominal pain:
Cramping Pain
Obstruction of the intestinal lumen causes bouts of intense crampy pain that come and go. This is often accompanied by constipation or diarrhea.
Achy/Dull Pain
Infiltration and thickening of the bowel wall by lymphoma produces a constant, dull ache. This worsens after eating in some cases.
Tenderness
Direct pressure on the abdomen over areas of lymphoma involvement elicits focal tenderness and discomfort.
Night Pain
Some patients experience worsening of intestinal lymphoma pain at night. The reasons are unclear but may relate to intestinal peristalsis or diurnal hormonal fluctuations.
Intermittent Pain
The pain may come and go unpredictably. Periods of severe pain can alternate with pain-free intervals. Remission induction chemotherapy often helps stabilize the pattern.
Diagnosis
If intestinal lymphoma is suspected based on symptoms, the following tests help confirm diagnosis:
- Blood tests – To check for signs of inflammation and look for abnormal white blood cell counts.
- Fecal occult blood test – Checks stool samples for hidden blood that may indicate intestinal bleeding.
- Endoscopy and biopsy – A tiny tissue sample is taken from the intestine by endoscope and analyzed.
- Imaging tests – CT scan, PET scan, or MRI to visualize areas of intestinal wall thickening and lymph node enlargement.
- Capsule endoscopy – The patient swallows a tiny camera capsule to take pictures of the entire small intestine.
These tests allow accurate staging of the intestinal lymphoma, which determines the optimal treatment approach.
Treatment
Treatment options for intestinal lymphoma include:
Chemotherapy
Drugs that kill cancerous lymphocytes are used in various combinations. Common chemo regimens are R-CHOP and bendamustine with rituximab. High-dose chemo may be beneficial in some intestinal lymphomas.
Radiation
Focused radiation beams are directed at affected areas of the bowel and surrounding lymph nodes. This helps control localized disease.
Surgery
Rarely needed but may be used to relieve a bowel obstruction or remove an isolated lymphoma polyp or mass.
Biologic drugs
Monoclonal antibodies and immune modulators help boost the body’s attack on lymphoma cells. Examples are rituximab and lenalidomide.
CAR T-cell therapy
The patient’s own T-cells are genetically engineered in the lab to better target lymphoma cells. This novel immunotherapy induces long remissions in some lymphoma cases.
Stem cell transplant
High dose chemotherapy followed by transplantation of the patient’s blood stem cells can produce durable remissions for eligible candidates.
With current treatments, 5-year survival rates for many subtypes of intestinal lymphoma are 60-80%. Ongoing advances promise to further improve prognosis.
Conclusion
In summary, the degree of abdominal pain caused by intestinal lymphoma depends on many factors:
- Location of disease
- Rate of lymphoma growth
- Extent of bowel involvement
- Individual pain tolerance
- Lymphoma subtype
Aggressive lymphomas and extensive intestinal infiltration often produce significant pain. Indolent forms and disease confined to the inner bowel lining may cause little pain. Accurate diagnosis using endoscopy and imaging allows optimal treatment planning. With contemporary chemoimmunotherapy approaches, lymphoma remission and pain relief are achievable for most patients. Ongoing research aims to further improve the outlook for intestinal lymphoma.