Lymphoma

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1. LYMPHOMA RATHEESH R.L

2. DEFINITION Lymphomas are malignant neoplasms originating in the bone marrow & lymphatic structures resulting in the proliferation of lymphocytes .

3. Classification Hodgkin’s lymphoma Non Hodgkin’s lymphoma

4. Hodgkin’s lymphoma It is a type of lymphoma in which cancer originates from a specific type of white blood cells called lymphocytes.

5. Non Hodgkin’s lymphoma It is a different group of blood cancer that include any kind of lymphomas except Hodgkin’s lymphoma

6. Comparison of HL &NHL HL NHL Cellular origin B lymphocytes B lymphocytes (90%), T lymphocytes (10%) Extent of disease Localized to regional, but may be more widesrpread Disseminated B symptoms common 40% Extranodal involvement rare common

7. Hodgkin’s lymphoma Staging system for HL & NHL Stage I : involvement of single lymph node Stage II : involvement of two or more lymph nodes on one side of diaphragm

8. Stage III : lymph node involvement above & below the diaphragm Stage IV : involvement outside of diaphragm.

9. ETIOLOGY Infection with Epstein Barr virus, HIV Genetic predisposition Occupational toxins such as pesticides or benzene

10. CLINICAL MANIFESTATIONS fever Cervical axillary , inguinal lymph node enlargement Fever night sweats weight loss Fatigue Severe itching

11. Weakness Chills Tachycardia Alcohol induced pain Aanemia hepatosplenomegaly

12. Weight loss Bone or flank pain Coughing Shortness of breath Red patches over the skin suffocation

13. Diagnostic studies History collection and physical examination Blood and urine study ( CBC, ESR - elevated) Lymph node biopsy ( presence of Red blood cells) Lumbar puncture: to find out whether the lymphoma is affected to brain and spinal cord

14. Bone marrow examination Peripheral blood analysis (microcytic hypochromic anemia, neutrophilic leukocytocytosis )

15. CT-scan and MRI-scan provides three dimensional view and much greater details of the enlarged lymph nodes over the body. PET A tiny amount of radio active glucose is injected to the blood stream. Tissues that uses glucose more than normal can be detected by scanning machine.

16. MANAGEMENT 1.CHEMOTHERAPY chemotherapy is the main treatment for lymphoma. ABVD regimen ( A driamycin or doxorubicin, B leomycin , V inblastine, D acarbazine ) BEACOPP ( B leomycin , E toposide , A driamycin, Cyclophosphamide, O ncovin , P rocarbazine , P rednisone

17. 2. RADIATION THERAPY Radiation therapy uses X-Ray or high energy beam to kill the cancerous cells or to shrink the tumor

18. 3.BIOLOGICAL THERAPY it is used to help the immune system to recognize and attack leukemia cells . Eg : Rituximab, Gemtuzumab ozogamicin

19. 4.STEM CELL TRANSPLANTATION it is a procedure to replace diseased bone marrow with healthy bone marrow.

20. 5 . SURGICAL MANAGEMENT If the lymphomas are severely affected the lymph nodes means the doctor may go for lymphadenectomy. if the metastasis occurs to any other organs such as thyroid or stomach, the surgical removal of the affected organ is indicated.

21. NURSING MANAGEMENT Parents and adolescent must be educated and prepared for diagnostic and therapeutic procedures. Emotional reassurance in terms of verbal communication. Nursing care also includes preventing any complications or side effects of the treatment .

22. Adequate explanation regarding the side effects must be given about the treatment and its complication.