Question

All of the following are indications for surgery in gastric lymphomas, except:

• A. Bleeding
• B. Perforation
• C. Residual disease following chemotherapy
• D. Intractable pain

Hint:

Surgery in gastric lymphoma is reserved for complications like bleeding, perforation, or leftover tumor after chemotherapy, not for pain alone.

Answer 1

The Correct Option is D

Step 1: Recall how gastric lymphoma is managed.
Most gastric lymphomas, especially the MALT type, are treated first with chemotherapy, radiotherapy, or antibiotics against H. pylori rather than with an operation. Surgery is kept back for specific problems the tumor causes, not for routine treatment.

Step 2: Check bleeding as an indication.
A gastric lymphoma can erode through the stomach wall and bleed heavily. When bleeding cannot be controlled by medical measures or endoscopy, surgery is needed to stop it. So bleeding is a genuine indication.

Step 3: Check perforation as an indication.
Chemotherapy can shrink the tumor fast enough to leave a hole in the stomach wall, and the tumor itself can perforate before treatment. A perforation is a surgical emergency, so this is also a genuine indication.

Step 4: Check residual disease after chemotherapy.
If a mass of lymphoma tissue remains after a full course of chemotherapy, surgery may be used to remove what is left. This is a genuine indication too.

Step 5: Check intractable pain.
Pain from gastric lymphoma is usually controlled with analgesics and by treating the underlying disease with chemotherapy or radiotherapy. Pain on its own, without bleeding, perforation, or obstruction, is not a standard reason to operate.

Step 6: Final answer.
The one option that is not a recognized indication for surgery in gastric lymphoma is intractable pain.
\[ \boxed{\text{Intractable pain}} \]