Lymphoma gastrointestinal

Gastric adenocarcinoma is one of the leading causes of cancer morbidity and mortality worldwide. Gastric cancer comprises approximately 95% of all gastric tumors, and is the focus of this chapter. Other less common gastric tumors not discussed here include mucosa-associated lymphoid tissue (MALT) lymphoma, gastrointestinal stromal cell tumors, and carcinoid tumors. 

Carmustine is a bicyclohexylnitrosourea (BCNU, Fig. 3) with broad spectrum of antineoplastic activity (e.g., lymphomas, multiple myeloma, sarcomas, brain tumors, gastrointestinal tumors, melanomas). At doses of 80-200 mg/m2 it is given i.v. at 6 week s intervals. 

NHL, non-Hodgkin s lymphoma AEG, adenocarcinoma of the esophagogastreal junction SCC, squamous cell carcinoma GIST, gastrointestinal stromal tumor. 

Azathioprine s toxicity includes bone marrow suppression, gastrointestinal disturbances, and some increase in infection risk. As noted in Chapter 55, lymphomas may be increased with azathioprine use. Rarely, fever, rash, and hepatotoxicity signal acute allergic reactions. 

Vorinostat (Zolinza) is a histone deacetylase inhibitor that is approved for the treatment of cutaneous T-cell lymphoma in patients with progressive, persistent, or recurrent disease on or after two systemic therapies. The recommended dosing is 400 mg orally once daily. Adverse effects include pulmonary embolus, deep vein thrombosis, thrombocytopenia, anemia, and gastrointestinal disturbances. 

Isaacson, P. G., Gastrointestinal lymphomas and lymphoid hyperplasias. In Neoplastic Hematopathology (D. M. Knowles, ed.), pp. 1235—1261. Lippincott Williams Wilkins, Philadelphia, PA, 2001. 

Paraneoplastic autonomic neuropathy is primarily seen with SCLC [103]. Lymphoma, non-small cell lung cancer, and ovarian cancer are also associated with autonomic disturbances [104]. Autonomic dysfunction affects 23-30% of Hu antibody positive patients [36, 98] and is the predominant symptom at presentation in up to 9% of the patients [90]. The onset of symptoms is usually subacute. A prominent clinical manifestation in patients with paraneoplastic autonomic neuropathy is gastrointestinal dysmotility and intestinal pseudo-obstruction, which can occur as part of the PEM/SN syndrome or as the sole symptom of Hu antibody related PNS. Ortostatic hypotension and erectile dysfunction are other common features [37, 105, 106], Autonomic neuropathy is also commonly associated with the CRMP-5 antibody and have been detected in more than 30% of CRMP-5 antibody positive patients [30], Inflammation in autonomic ganglia and infiltration of B and T cells have been demonstrated at autopsy [107], and Hu antibodies have been shown to induce neuronal apoptosis in cultured myenteric neurons [105],... 

Neoplasia adenoma, carcinomas such as breast, gastrointestinal, skin, urogenital and others lymphoma and melanoma... 

Methotrexate Nausea and vomiting diarrhoea fever anaphylaxis hepatic necrosis Oral and gastrointestinal ulceration, perforation may occur bone marrow depression hepatic toxicity including cirrhosis renal toxicity pulmonary infiltrates and fibrosis osteoporosis conjunctivFtis alopecia depigmentation menstrual dysfunction encephalopathy infertility lymphoma teratogenesis... 

In 71 patients with cutaneous T cell lymphomas randomized to denileukin diftitox 9 or 18 pg/kg/day, flu-like and gastrointestinal symptoms were observed in 92%... 

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