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Lymphoma
Define lymphoma and its classification
Enlist risk factors and causes of Hodgkin and non Hodgkin lymphoma Discuss the clinical manifestation of Hodgkin and non Hodgkin lymphoma Describe the pathophysiology and diagnostic findings of Hodgkin and non Hodgkin lymphoma Explain the medical and nursing management of Identify the complications of Hodgkin and Hodgkin lymphoma LYMPHOMA:-The lymphomas are neoplasms of cells of lymphoid origin These tumors usually start in lymph nodes but can involve lymphoid tissue in the spleen, Gl tract (e.g., the wall of the
stomach), liver, or bone marrow .
• They are often classified according to the degree of cell differ- entiation and the origin of the predominant malignant cell. Lymphomas are broadly classified into two categories: • HODGKIN LYMPHOMA:(Type of cancer that affects the immune system, specifically the lymphatic system.) • NON HODGKIN LYMPHOMA :(a type of cancer that affects the immune system, specifically the lymphatic system.) HODGKIN LYMPHOMA:Hodgkin lymphoma is a malignant neoplasm characterized by the presence of distinctive cells called Reed- Sternberg cells,its subtypes include : I. Nodular sclerosis: This is the most common form of Hodgkin lymphoma, It is seen most often in the young; among these patients, the lymph node contains elements of fibrous (sclerotic)[This type of Hodgkin lymphphoma is highly curable. II. Mixed cellularity: This is the second most common form of Hodgkin lymphoma, This subtype is more common in older adults and in males; it is frequently seen in patients with HIV infection III. Lymphocyte-depleted. This form of Hodgkin lymphoma is rare; it is characterized by involved lymph node(s) with few normal lymphocytes but numerous Reed-Stember cells.Lymphocyte-rich: This type of Hodgkin lymphoma is also an uncommon form of the disease; the lymph node(s) has numerous normal lymphocytes and Reed-Sternberg cells IV. Nodular lymphocytes predominant Hodgkin lymphoma (NLPHL): This is the lone type of Hodgkin lymphoma . In NLPHL there are few Reed-Sternberg cells; rather, there is a predominance of lymphocyte cells called "popcom" cells. Furthermore, there is minimal involvement of the lymph nodes as compared to the other subtypes . NLPHL is seen more often in males than females NLPHL is slow growing and highly curable, CAUSES AND RISK FACTOR OF HODGKIN LYMPHOMA The cause of Hodgkin lymphoma is unknown. However, Risk factors have been identified Age, History of viral infections, Human immune deficiency virus [HIV], or human herpesvirus 8 [HHV8]), Family history, Exposed to cytotoxic agent Long-term immunosuppressive therapy (e.g.organ transplant recipients) Veterans exposed to the herbicide Agent Pathophysiology of Hodgkin lymphoma It initiates in a single node.
The disease spreads by contiguous extension along the lymphatiy system.
The malignant cell of Hodgkin lymphoma is the Reed Sternberg cell( These cells arise from the B lymphocyte).
They may have more than one nucleus and often have an owl like appearance
The presence of Reed-Stemberg cells is the patho logic diagnostic criteria of Hodgkin lymphoma Clinical manifestation of Hodgkin lymphoma Hodgkin lymphoma usually begins as an enlargement of one or more lymph nodes on one side of the neck Supraclavicular and mediastinal nodes Compress trachea Dyspnea Compression of organs by the tumor, such as cough and pulmonary effusion (from pulmonary infiltrates) Jaundice (from hepatic involvement or bile duct obstruction) Abdominal pain (from splenomegaly or retroperitoneal adenopathy Bone pain (from skeletal involvement). Pruritus Fatigue, decreased appetite, Impaired cellular immunity increased susceptibility to infections Particularly herpes zoster Diagnostic evaluationof Hodgkin lymphoma
Excisional lymph node biopsy
Physical examination of all palpable lymp nodes chain Chest x ray CT scan of the chest,abdomen,and. Pelvis Pet positron Emission tomography Laboratory tests Serum electrolytes Blood urea nitrogen ESR Immunohistochemistry HIV testing Hepatitis B and C testing Multiple gated acquisition (MUGA)Scan ECG Complications of Hodgkin lymphoma Cardiovascular disease Hypothyroidism Infertility in both males and females Other organ dysfunction Premature menopause Neurological disorder Pulmonary disorder Nursing management of Hodgkin lymphoma Patients need to be informed that Hodg- kin lymphoma is often curable. The nurse should encourage patients to reduce factors that increase the risk of developing second cancers, such as use of tobacco and alcohol and expo- sure to environmental carcinogens and excessive sunlight. Screening for late effects of treatment, such as chemotherapy In addition, the nurse should provide education about relevant self-care strategies and disease Management Medical management of Hodgkin lymphoma the goal in the treatment of Hodgkin lymphoma is cureable. Patients with early disease (stage 1-2) may receive one of the following combination chemotherapy regimens: ABVD ( Adriamycin), bleomycin, vinblastine, and dacarbazine Radiation therapy may or may not be included as part of the treatment regimen. The standard treatment for patients with advanced disease (stages III to IV) and those with B symptoms is also ABVD chemotherapy, Other combinations of chemotherapy may be used; however, these options have more toxic effects When a patient has a suspected relapse of disease, a biopsy and a PET scan are performed to confirm the diagnosis and stage of disease. Immunotherapeutic agents, such as a monoclonal antibody (MoAb) (eg., everolimus, brentuximab) Non Hodgkin lymphomaThe NHLs are a heterogeneous group of cancers that originate from the neoplastic growth of lymphoid tissue. the cells may vary morphologically. NHL involve malignant B cell lymphocytes with the remaining 15% involving T cell lymphocytes or natural killer cells It occur more commonly in males
Etiology Although no common etiologic factor has been identified Immune deficiencies or autoimmune disorders; Organ transplant recipient; History of viral infections , HIV, Exposed to herbicides, pesticides, solvents, dyes, and defoliating agents Clinical manifestation of NHL Painless swelling in one or more lymph NHL in the neck, axillary region, or groin. Mediastinum can cause cough, shortness of breath, and chest pain Cardio- vascular Respiratory distress. Acute kidney injury Bowel obstruction. Splenomegaly can cause abdominal pain, nausea, early satiety, and weight loss. Diagnostic evaluation of NHL Lymph node biopsy Flow cytometry FISH fluorescence situ hybridization Laboratory studies PCR CT SCAN PET SCAN ECG Medical Management of NHL The goal of treatment for NHL is to obtain remission of disease by killing as many of the malignant cells as possible Treatment for NHL is based upon the specific subtype of lymphoma and the stage of disease. If the disease is indolent and localized, the treatment of choice may be radiation therapy alone. For aggressive subtypes of NHL, combination chemotherapy is typically indicated. A MoAb may be given along with the chemotherapy . Radiation therapy may or may not be added to the treatment regimen. In some cases, a MoAb may be conjugated with a radioactive isotope and used for treatment CNS involvement is common with some aggressive forms of NHL, in this situation, cranial radiation or intrathecal chemotherapy is used in addition to systemic chemotherapy. Complications of NHL Tumor Lysis syndrome Reactivation of hepatitis B Progressive multifocal leukoencephalopathy Respiratory compromise Nursing management of NHL When caring for patients with lymphoma, it is extremely important for the nurse to know the specific disease type, stage of disease, treatment history, and current treatment plan. Most of the care for patients with Hodgkin lymphoma or NHL takes place in the outpatient setting, unless complications occur Patients need to be educated to minimize the risks of infection, to recognize signs of possible infection, and to contact their primary provider if such signs develop survivors should be screened regularly for the development of second malignancies. Survivors of both Hodgkin lymphoma and NHL may be faced with managing persistent fatigue, depression, anxiety, and cardiac and pul monary toxicity Survivors should be encouraged to have regular follow-up appointments and be screened for the signs and symptoms of possible secondary malignancies. Additionally, patients should be evaluated for cardiovascular and fertility concerns with each patient visit. Pt should maintaining a normal body weight, and engaging in a minimum of 150 minutes of exercise per week Difference between HL and NHL REFERENCE ;
• Brunner and suddarth: Textbook of medical surgical
