Lymphoma

lymphoma

1. SUDESHNA BANERJEE DUTTA
S.R.S.V.M B.SC NURSING
COLLEGE
LYMPHOMA

2. LYMPHOMA
❖Lymphoma is the cancer of lymph node.
❖Lymphoma is the type of cancer that begins in the
immune system cell called lymphocytes.
❖There will be production of one or more abnormal
cells in one or more of the lymph nodes.

3. ETIOLOGY
Immune suppression
Infections
Epstein barrvirus-EBV:-Burkittlymphoma
H. pylori:-gastric lymphoma
**Symptoms often develop quickly, over just a few days or weeks. Burkitt
lymphoma usually causes lots of lymph nodes to enlarge in many
different partsof the body, and often involves your abdomen (tummy)
and bowel. Other organs like your spleen and liver may be affected.
The lymphoma may also be in the bone marrow and can spread to your
central nervous system (CNS; brain and spinal cord).

4. BURKITTLYMPHOMA

5. ➢Abnormal lymphocytes collect in one or more
lymph nodes or in lymph tissuessuch as spleen,
tonsils & eventually they forms mass of cells
called tumors.

6. ETIOLOGY cont…
Previous cancer treatments: Chemotherapy
& radiotherapy treatment given for a previous
cancer can increase the risk of someone
developing lymphoma. This is thought to be due
to damage caused by these treatments to genes
(DNA) of lymphocytes.
Advanced age
Smoking

7. CLASSIFICATION
The major types of lymphoma are:-
➢Hodgkin’s disease
➢Non-Hodgkin’s disease

8. HODGKIN’SLYMPHOMA
▪A neoplastictransformation of lymphocytes
particularly in lymph nodes.
Characterized by:-
1.Presence of Reed Sternberg cells on histology.
2.Spreading in an orderly fashion.
(e.g. Hodgkin's lymphoma that starts in cervical
lymph nodes, may spread first to the
supraclavicularnodes then to the axillarylymph
nodes.

10. Reed Sternberg cells: They are mature
B-cells that have become malignant,
usually large & carry more than 1
nucleus.

11. ETIOLOGY
1. Certain viruses:
➢Epstein-Barr virus (EBV)
2. Weak immune system :
➢Inherited condition
➢Certain drugs used after organ transplant
3. Age: Hodgkin’s lymphoma is most common among teens
and adults aged 15 to 20 years and adults aged 55 years
and older.
4.Family history

12. SIGN& SYMPTOMS
Enlarged, painful, Rubbery, non-erythematous,
lymph nodes are the hallmark of the disease.
Other symptoms:-
Night sweats
Frequent weight loss (‘B’ SYMPTOMS)
Fever
Pruritis(itchy skin)

13. Cervical, supraclavicular& axillary
lymphadenopathyare the most common initial
signs.
Hepatospleenomegaly
Extralymphaticsites may get involved such as
liver, bone marrow, lungs & CNS but,
extralymphaticinvolvement is more common with
Non Hodgkin’s lymphoma.
Pleural & pericardial effusion

14. STAGES OF HODGKIN’S & NON-
HODGKIN’SLYMPHOMA
STAGEIInvolvement of a single lymph node or a single
extra lymphatic organ or site
STAGE II Involvement of >2 lymphnode regions or
lymphatic structures on the same side (upper or
lower) of diaphragm
STAGE IIIInvolvement of lymph nodes on both (upper or
lower) sides of diaphragm which may include
extra lymphatic organ or tissue
STAGE IV Diffuse or disseminated involvement of >1 extra
lymphatic organ or tissue

16. DIAGNOSTIC EVALUATION
An excisionallymph node biopsy is the essential first step in
diagnosis. A biopsy is the only sure way to diagnose Hodgkin
lymphoma.
The biopsy can be:
❖Excisionalbiopsy (the whole lesion is removed & tested)
❖Incisionalbiopsy(a piece of tissue is taken from a lesion
& tested)
❖After that the most important step is to determine the
extent of the disease because the stage will determine
the nature of the therapy, that is, radiation vs.
chemotherapy

17. ➢Chest x-ray : X-ray pictures may show swollen lymph nodes
or other signs of disease in the chest .
➢CT: Chest, abdomen and pelvis ( CT is sensitive enough to
detect any abnormal nodes)
➢MRI
➢PET scan
➢LP(lumbar puncture) for CSF cytology if any CNS signs
➢A bone marrow biopsy is used when ‘B’ symptoms are
present

18. TREATMENT
➢Therapy is entirely based on the stage.
➢Localized disease ( stage I and II ) is managed with
radiation.
➢All patients with evidence of ‘’B’’ symptoms as well as
stage III and IV are managed with chemotherapy.
➢The most effective combination chemotherapeutic regimen
for Hodgkin lymphoma is
A : Adriamycin
B: Bleomycin
V: Vinblastin
D: Dacarbazine.

19. ABVD is superior to
M: Meclorethamine
O: Oncovin
P: Prednisoloneand Procarbazinebecause ,
ABVD has fewer side effects such as:
▪Permanent sterility
▪Secondary cancer formation
▪Aplasticanemia
▪Peripheral neuropathy

20. NONHODGKIN’SLYMPHOMA
(NHL)
The neoplastictransformation of either B or T cell.
NHL causes the accumulation of neoplasticcells
in the lymph nodes as well as more often diffusely
in extralymphaticorgans and the bloodstream.
Absent reed-Sternberg cells.

21. RISKFACTORS
Infections:
➢Epstein-Barr virus (EBV): Linked to Burkitt
lymphoma.
➢Helicobacter pylori: Associated with gastric
lymphoma
Age:
Most people with non-Hodgkin lymphoma are older
than 60

22. CLINICALPRESENTATION
Clinical presentation is the same as Hodgkin
lymphoma.
The difference is that Hodgkin is localized to
cervical and supraclavicularnodes 80%-90% of
the time.
Whereas NHLis localized 10-20%of the time.
CNS involvement is more common with NHL.
HIV positive patients often have CNS involvement

23. STAGINGANDDIAGNOSIS
Staging and Diagnosis are the same as for
Hodgkin lymphoma.

24. GRADES
NHL divided into Low or high grade
A high grade lymphoma has cells which look quite
different from normal cells.
They tend to grow fast (aggressive) usually look
follicular, potentially curable, Wider dissemination
at presentation.

26. Low grade lymphomas have cells which look much
like normal cells and multiply slowly, usually look
diffuse,Incurable.

27. TREATMENT
Same principles of treating Hodgkin Lymphoma.
The initial chemotherapeutic regimen is CHOP
(Cyclophosmamide, Hydroxy-adriamycine,
Oncovinand Prednisolone).
CNS lymphoma is often treated with radiation in
addition to CHOP.
Relapses can be controlled with BM (Bone
marrow) transplantation.

28. COMPLICATIONS
CNS involvement
Thrombocytopenia (reduced platelet count)
Compression of spinal cord.
Pleural & pericardial effusion

29. NURSINGDIAGNOSIS
Acute pain related to metastasis of tumor as
evidenced by facial expression & pain scoring.
Hyperthermia related to secondary infections as
evidenced by body temperature measurement.
Imbalanced nutrition less than body requirement
related to anorexia as evidenced by rejection to
consume food.

30. Activity intolerance related to weakness as
evidenced by patient’s verbalization.
Risk for infection related to
immunodeficiency.