Skip to main content

Health condition · Clinically reviewed

MALT lymphoma, the rare cancer that antibiotics can cure.

A slow-growing lymphoma most often found in the stomach and linked to H. pylori infection. Treating the infection often treats the cancer.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BSH, ESMO and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including H. pylori eradication, radiotherapy and rituximab-based regimens.

Key facts

MALT lymphoma at a glance.

The essentials, in plain English - what it is, where it arises, and how it’s treated in the UK today.

  • What it is

    A rare, usually indolent (slow-growing) marginal zone B-cell non-Hodgkin lymphoma arising in mucosa-associated lymphoid tissue.

  • Most common site

    The stomach - gastric MALT lymphoma accounts for the majority of cases and is strongly linked to Helicobacter pylori infection.

  • Other sites

    Salivary gland (often Sjögren-associated), thyroid (Hashimoto-associated), ocular adnexa, lung, skin and small intestine.

  • A rare cure

    Gastric MALT lymphoma is one of the few cancers that can be cured by treating an infection - antibiotics for H. pylori alone.

  • Key test

    Endoscopy with biopsy, histology and H. pylori testing - the eradication result guides everything that follows.

  • Prognosis

    Generally excellent - indolent behaviour and high response rates to first-line treatment in most patients.

Why this guide matters

A stepped plan built around H. pylori status.

MALT lymphoma is rare, usually indolent, and unusually treatable. The three points below shape everything else on this page.

  • H. pylori testing comes first

    Whether the infection is present decides the entire treatment pathway - eradication alone can be curative for localised gastric disease.

  • Radiotherapy is highly effective

    When eradication isn’t suitable or doesn’t work, localised low-dose radiotherapy achieves excellent control with limited side effects.

  • Advanced disease still responds well

    Rituximab-based systemic therapy gives good outcomes even when disease has spread beyond the original site.

How the diagnosis is made

From endoscopy to a clear plan.

The steps a UK gastroenterology and haematology team will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Endoscopy and biopsy

    Gastroscopy with multiple biopsies is the starting point for suspected gastric MALT lymphoma - see gastroscopy.

  2. 02

    Assessing

    Histology and immunohistochemistry

    CD20 positivity supports B-cell lymphoma; cyclin D1 negativity helps exclude mantle cell lymphoma as a mimic.

  3. 03

    Assessing

    H. pylori testing

    Urea breath test or biopsy-based testing - essential, since a positive result determines first-line treatment - see H. pylori test.

  4. 04

    Confirming

    Staging CT and PET-CT

    CT of chest, abdomen and pelvis plus PET-CT maps disease extent beyond the stomach or original site.

  5. 05

    Confirming

    Endoscopic ultrasound

    Assesses depth of gastric wall invasion - important for treatment planning and eradication-response prediction.

  6. 06

    Confirming

    t(11;18) translocation testing

    Specialist molecular testing that predicts resistance to H. pylori eradication and guides the next step if positive.

  7. 07

    Deciding

    Haematology-oncology MDT

    A joint gastroenterology and haematology multidisciplinary team confirms staging and agrees the treatment pathway.

Typical timeline: a first endoscopy to a confirmed diagnosis and plan within a few weeks.

Symptoms

What MALT lymphoma actually looks like.

Gastric disease often looks like ordinary dyspepsia. Extragastric disease shows up as a mass or swelling wherever it arises.

  • Dyspepsia

    Persistent indigestion and upper abdominal discomfort - the most common presenting complaint in gastric disease. See dyspepsia.

  • Epigastric pain

    A dull or gnawing ache in the upper abdomen, sometimes worse with food, sometimes relieved by it.

  • Weight loss

    Unintentional weight loss can accompany more established or advanced gastric disease.

  • GI bleeding

    Occasionally, ulceration over the lymphoma causes bleeding - seen as dark stools or, rarely, vomited blood.

  • Incidental finding

    Many cases are picked up unexpectedly during endoscopy performed for routine dyspepsia investigation.

  • Site-specific mass or swelling

    Extragastric MALT lymphoma presents as a swelling or mass at its site - salivary gland, thyroid, orbit, lung, skin or small bowel.

  • Salivary and thyroid associations

    Salivary gland disease often arises against Sjögren’s syndrome; thyroid disease often arises against Hashimoto’s thyroiditis.

  • Red flag - alarm GI symptoms

    Progressive dysphagia, persistent vomiting, GI bleeding or unexplained weight loss warrant prompt endoscopic assessment.

Treatment

How MALT lymphoma is treated in the UK.

H. pylori eradication first for localised gastric disease, radiotherapy when that isn’t enough, and rituximab-based therapy for advanced disease.

  • H. pylori eradication therapy

    Triple therapy antibiotics plus a proton pump inhibitor - first-line and often curative alone for localised, H. pylori-positive gastric disease.

  • Localised radiotherapy

    Low-dose, highly effective radiotherapy for disease that persists after eradication, is H. pylori-negative, or carries the t(11;18) translocation.

  • Rituximab plus chemotherapy

    Anti-CD20 rituximab combined with chlorambucil or a CVP-type regimen for advanced or disseminated disease - see rituximab clinic.

  • Watch and wait

    Active monitoring without immediate treatment, reserved for selected patients with asymptomatic, indolent, low-volume disease.

  • Site-specific extragastric care

    Radiotherapy for localised extragastric MALT lymphoma; systemic therapy such as rituximab-based regimens when disease is disseminated.

  • Surveillance endoscopy

    Repeat endoscopy after eradication confirms histological response and rules out relapse - continued periodically thereafter.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your gastroenterologist or haematologist knows your case and history and can tell you which parts apply to you. If in doubt, get seen.

  • British Society for Haematology (BSH). Guideline for the diagnosis and management of marginal zone lymphomas.

  • European Society for Medical Oncology (ESMO). Gastric marginal zone lymphoma of MALT type: clinical practice guideline.

  • Lymphoma Action. Information on MALT lymphoma for patients.

  • NICE. Referral guidelines for suspected upper gastrointestinal cancer.

Red flags

When MALT lymphoma needs urgent attention.

Most MALT lymphoma follows a calm, planned pathway. These are the situations that call for prompt specialist reassessment.

  • GI bleeding

    Melaena or haematemesis in the context of known or suspected gastric MALT lymphoma needs urgent gastroenterology assessment.

  • Progressive dysphagia

    New difficulty swallowing alongside dyspepsia is an alarm symptom warranting prompt endoscopy.

  • Deep gastric wall invasion

    Endoscopic ultrasound showing invasion beyond the submucosa lowers the chance of response to eradication alone and changes management.

  • t(11;18)-positive disease

    This translocation predicts resistance to H. pylori eradication - radiotherapy or systemic therapy is planned earlier.

  • Failed eradication response

    Persistent lymphoma on repeat endoscopy after adequate H. pylori treatment needs specialist reassessment, usually for radiotherapy.

  • Disseminated or transformed disease

    Multi-site involvement, or transformation to a more aggressive large B-cell lymphoma, needs urgent haematology-oncology review.

  • Unexplained weight loss

    Significant unintentional weight loss alongside gastric symptoms is a standard trigger for urgent upper GI referral.

  • New extragastric mass

    A new salivary, thyroid, orbital, skin or lung mass in a patient with a lymphoma history should be assessed without delay.

Living with it

A rare lymphoma, with an unusually good outlook.

Four things that make the biggest difference through diagnosis and follow-up - knowing your H. pylori status, being patient with eradication, keeping surveillance appointments, and trusting the outlook.

A quiet reminder

This is one of the more treatable lymphomas.

A confirmed diagnosis can feel frightening, but the stepped pathway - antibiotics first, radiotherapy or systemic therapy if needed - has an excellent track record.

  1. 01 Testing

    H. pylori status is central

    Knowing whether H. pylori is present - and confirming it has been cleared - shapes the entire treatment journey.

  2. 02 Patience

    Eradication takes time to work

    Full histological response can take several months to appear on repeat endoscopy - early reassurance is normal.

  3. 03 Follow-up

    Surveillance matters

    Regular repeat endoscopy after treatment confirms remission and catches any early recurrence.

  4. 04 Outlook

    Prognosis is usually excellent

    MALT lymphoma is typically indolent - most people do very well with appropriate, stepped treatment.

Frequently asked

Everything we get asked about MALT lymphoma.

Quick answers on H. pylori, eradication therapy, radiotherapy and outlook.

  • What is MALT lymphoma?

    MALT lymphoma (mucosa-associated lymphoid tissue lymphoma) is a type of marginal zone B-cell non-Hodgkin lymphoma - usually indolent, or slow-growing. It most commonly arises in the stomach, though it can also develop in the salivary glands, thyroid, ocular adnexa, lung, skin or small intestine.

  • Why is the stomach the most common site?

    Chronic Helicobacter pylori infection drives ongoing immune stimulation in the stomach lining, which over years can lead to the abnormal lymphoid proliferation seen in gastric MALT lymphoma. This is why testing for and treating H. pylori is the first step in management.

  • Can antibiotics really cure a cancer?

    For localised, H. pylori-positive gastric MALT lymphoma, yes - eradicating the infection with triple therapy antibiotics and a proton pump inhibitor achieves complete remission in the majority of patients. It is one of the few examples in oncology where treating an infection alone can cure the cancer.

  • What happens if H. pylori eradication does not work?

    If the lymphoma persists, if the patient is H. pylori-negative, or if the t(11;18) translocation is present, localised low-dose radiotherapy is highly effective. Advanced or disseminated disease is treated with rituximab, often combined with chemotherapy such as chlorambucil or a CVP-type regimen.

  • How is MALT lymphoma diagnosed?

    Diagnosis usually starts with endoscopy and biopsy, with histology and immunohistochemistry (including CD20 and cyclin D1) confirming the subtype. H. pylori testing, staging CT and PET-CT, endoscopic ultrasound, and sometimes t(11;18) translocation testing complete the picture, all discussed at a specialist MDT.

  • What is the outlook for MALT lymphoma?

    The outlook is generally excellent. Most gastric MALT lymphoma is indolent and responds well to first-line treatment, whether that is H. pylori eradication, radiotherapy, or systemic therapy. Regular surveillance endoscopy confirms and maintains remission over time.

Related content

Keep reading.

Pulse Healthcare concierge

Send us your enquiry

A concierge service for UK private healthcare. We match you with the best vetted clinics and consultants in our network - they then contact you directly.

So we can match you to the right clinician close to you.

We reply to every enquiry within 24 hours (Mon–Fri). Confidential - your details are never shared outside our vetted consultant network.