A 68-Year-Old Man Is Evaluated Because of Worsening Chronic Epigastric

Multiple Choice

A 68-year-old man is evaluated because of worsening chronic epigastric pain. He now has fatigue and early satiety. He has iron deficiency anemia. Results of upper gastrointestinal endoscopy reveal diffuse gastritis, along with mucosal thickening in the gastric antrum associated with a mass lesion. Abundant Helicobacter pylon organisms are noted on biopsy, and histologic evaluation of the mass lesion shows it to be a gastric lymphoma of mucosa-associated lymphoid tissue (MALT) type. What is the most appropriate next step in the management of this patients illness?

A) Combination chemotherapy with 5-fluorouracil, doxorubicin, and mitomycin C (FAM)
B) Combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)
C) Four cycles of CHOP followed by involved-field radiation therapy
D) Eradication of Helicobacter pylori
E) Total gastrectomy followed by radiation therapy