Symptoms and diagnosis of MALT lymphoma

Some people don’t have any symptoms when they are diagnosed with MALT lymphoma and the lymphoma is found through a test for something else.

For people with symptoms, they will depend on where the MALT lymphoma is in the body:

Gastric MALT lymphoma affects the stomach area.

The main symptoms are:

• frequent indigestion or heartburn
• feeling or being sick
• sore stomach
• unusual weight loss
• blood in your stools.

People with gastric MALT lymphoma might also feel fatigued (extremely tired) or have anaemia (low red blood cells) caused by bleeding in the stomach.

Symptoms of non-gastric MALT lymphoma depend on where the lymphoma is:

• In the eyes MALT lymphoma can cause double vision, lumps or rashes on the eyelids, or cause the eyeball to bulge.
• In the lungs it can cause coughing, chest pain or feeling short of breath.
• In the bowels it can cause changes in your poo and how often you poo, stomach pain, bloating, losing weight without trying.
• In the thyroid gland it can cause trouble swallowing, husky voice, a lump at the front of the neck, fatigue.
• In the skin it can cause unusual patches on the skin.

Some people may have a mixture of these symptoms if the MALT lymphoma is in more than one place.

If you are experiencing any of the symptoms above, it’s a good idea to make an appointment with your GP.

Having any of these symptoms does not mean you have cancer, but it’s important to see a doctor to make sure.

Doctors will use a range of tests to confirm whether you have MALT lymphoma. Some of the tests you might have include:

A biopsy is when a small sample of tissue is taken from the affected part of the body and examined in a laboratory.

The sample can be taken in several different ways depending on where the suspected lymphoma is. One of the main methods of doing a biopsy is through an endoscopy.

This is when a small, thin tube with a camera on the end is passed into your body through your nose, mouth or anus (bottom). The camera gives doctors a view of what is going on inside your body.

Doctors can also use the tube to take a small sample of tissue. There are various types of endoscopy:

• gastroscopy: a tube is passed through your mouth and down your throat to look into your stomach
• colonoscopy: a tube is passed through your anus into your bowels
• bronchoscopy: a tube is passed through your mouth or nose into your lungs

Having an endoscopy is not usually painful, but some people find it uncomfortable. You will usually be offered a relaxant to help make the procedure as comfortable as possible.

Ask your hospital team what to expect. They will be able to answer any questions or concerns.

You are likely to have some blood tests. These aim to:

• check the number of healthy blood cells and abnormal lymphocytes in your blood
• check for any bacterial infections in your body, such as H. pylori
• check for the presence of hepatitis C virus
• check your general health and how well your liver and kidneys are working.

A blood test is a relatively quick procedure where a doctor inserts a small needle into your vein and takes a small amount of blood. Part of this sample will then be sent to a laboratory for a full blood count (FBC). This measures the levels of red blood cells, white blood cells, and platelets in your blood, as well as the number of abnormal cells.

You might have several blood tests to look at your full blood count over a period of time.

Some of your sample may be sent to a laboratory for the other blood tests listed above.

If doctors think you might have gastric MALT lymphoma, you may have a breath test to test for the presence of H. pylori in your system.

• You will be given a tablet or tasteless drink containing urea - a chemical that H. pylori breaks down into carbon dioxide.
• Around half an hour later, you will breathe into a tube that tests the levels of carbon dioxide in your system.
• If the level of carbon dioxide in your body is higher than it was before you had the tablet or drink, it shows that you have H. pylori present.

Doctors might also ask for a stool sample (a small sample of poo) to test for the H. pylori infection.

Other tests could include taking biopsies from other parts of your body, and having scans. Scans take images of bones and organs, giving doctors a better picture of what is going on inside your body.

There are various types of scans you might have - some look at specific areas in your body, and some look at your body as a whole.

The most common scans used to help diagnose MALT lymphoma include:

• CT scan
• ultrasound scan
• MRI scan
• X-ray.

Some people may also have a PET scan. We have more information about scans.

You might have a bone marrow biopsy to check whether MALT lymphoma cells have developed in your bone marrow, the spongy tissue inside some of your bones where blood cells are made.

It’s rare for MALT lymphoma cells to collect in your bone marrow, so only a few people will be offered a bone marrow biopsy.

Your team will talk you through what they are looking for during each test and answer any questions you have.

As well as helping to confirm a diagnosis, the results from your tests help doctors stage the lymphoma.

The stage of MALT lymphoma describes where it is in the body. Knowing the stage helps doctors identify your risk level and plan the best treatment for you.

Lymphoma is staged using numbers 1-4.

• Stage 1 and 2 are classed as early stage lymphoma. It affects one or two areas of the body on one side of the diaphragm – the sheet of muscle that separates your chest from your stomach area.
• Stage 3 and 4 are classed as advanced lymphoma, which affects areas on both sides of the diaphragm.

MALT lymphoma is usually diagnosed early, at stage 1 or 2.

Lymphoma is also described as either low grade or high grade, depending on how quickly it is growing. MALT lymphoma is usually low grade, meaning it develops slowly.

Sometimes low grade lymphomas can start to grow more quickly and progress to a high grade lymphoma. This process is called transformation. If the MALT lymphoma is transforming, you may notice swellings or lumps in your body, or symptoms called B symptoms:

• drenching night sweats (that soak through your nightclothes or bedding)
• a high temperature (a fever)
• unexplained weight loss (losing weight without trying).

Transformation is rare. Less than 10 percent of people (1 out of 10) with MALT lymphoma progress to a high grade type of lymphoma. But if you notice any new symptoms like the ones listed above, speak to your hospital team or GP.