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1. Subtitle HODGKIN LYMPHOMA & NON HODGKIN LYMPHOMA

2. Lymphatic System The lymphatic system is a network of vessels, nodes, and ducts that pass through almost all bodily tissues. It allows the circulation of a fluid called lymph through the body in a similar way to blood. It is part of the immune system. Lympahtic system is responsible for fluid balance ,absorption of fatty acid in the stomach.

3. Anatomy of lymphatic system The lymphatic system consists of lymph vessels, ducts, nodes, and other tissues throughout the body. Lymphatic vessels collect interstitial fluid and transport it to lymph nodes. These nodes filter out damaged cells, bacteria, and other foreign bodies. Once this fluid passes out of the lymph nodes, it travels to larger vessels and eventually lymph ducts, which converge in the thoracic duct at the base of the neck. The thoracic duct returns filtered lymph into the bloodstream. .

4. Anatomy of lymphatic system Lymph nodes are not the only lymphatic tissues in the body. The tonsils, spleen, and thymus glands are also lymphatic tissues. Thymus gland T onsils Spleen Bone marrow .

5. T hymus gland – Responsible for the development and maturation of T lymphocyte cells. Tonsils - The tonsils produce lymphocytes and antibodies. They can help protect against inhaled foreign bodies

6. Spleen – Functions mainly as a blood filter, removing old red blood cells. It also plays a role in the immune response. Bone Marrow - Bone marrow is not lymphatic tissue but is part of the lymphatic system because it is here that the B cell lymphocytes of the immune system mature.

7. Function of lymphatic system The lymph system has three main functions. Fluid balance The lymphatic system returns excess fluid and proteins from the tissues that cannot return through the blood vessels. The fluid often collects in the tiny spaces surrounding cells, known as the interstitial spaces. Small lymph capillaries connect these spaces to the lymphatic system. Around 90% of the plasma that reaches tissues from the arterial blood capillaries returns through the venous capillaries and veins. The remaining 10% travels through the lymphatic system. A disruption of fluid processing can result in localized swelling, known as lymphedema .

8. Function of lymphatic system Absorption T he lymphatic system plays a key role in intestinal function. It assists in transporting fat, fighting infections, and removing excess fluid. Part of the gut membrane in the small intestine contains tiny finger-like protrusions called villi. Each villus contains tiny lymph capillaries, known as lacteals. These absorb fats and fat-soluble vitamins to form a milky white fluid called chyle. This fluid contains lymph and emulsified fats, or free fatty acids. It delivers nutrients indirectly when it reaches the venous blood circulation. Blood capillaries take up other nutrients directly.

9. Function of lymphatic system The immune system The third function of lymph nodes is to defend the body from exposure to potentially hazardous microorganisms, such as infections. The body’s first line of defence involves; physical barriers, such as the skin toxic barriers, such as the acidic contents of the stomach " friendly" bacteria in the body However, pathogens often do succeed in entering the body despite these defenses . In this case, the lymphatic system enables the immune system to respond appropriately .

10. How does the lymphatic system fight infection The lymphatic system produces white blood cells called lymphocytes. There are two types of lymphocytes: T cells and B cells. They both travel through the lymphatic system. As they reach the lymph nodes, they come into contact with viruses, bacteria, and foreign particles in the lymph fluid. following contact, lymphocytes form antibodies and start to defend the body. They can also produce antibodies from memory if they have already encountered the specific pathogen in the past. The lymphatic system and the action of lymphocytes form part of the body's adaptive immune response. These are highly specific and long lasting responses to particular pathogens.

11. 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, GI tract (e.g., the wall of the stomach), liver, or bone marrow. They are often classified according to the degree of cell differentiation and the origin of the predominant malignant cell.

12. LYMPHOMA Lymphomas can be broadly classified into two categories: Hodgkin lymphoma N on-Hodgkin lymphoma (NHL).

13. Hodgkin’s Lymphoma Hodgkin lymphomas frequently present in lymph nodes and in most cases have an orderly pattern of spread to contiguous lymph node regions, with frequent involvement of the mediastinal and cervical lymph node areas. This lymphoma  typically start in RS cells. While the main cause of Hodgkin’s lymphoma isn’t known, certain risk factors can increase your risk of developing this type of cancer .

14. Reed- sternberg cells are large , abnormal lymphocytes (a type of white blood cells)that may contain more than one nucleus . These cells are found in people with Hodgkin lymphoma. Reed Sternberg cell are also called Hodgkin and Reed- sternberg cells.

15. Characteristics of Hodgkin’s Lymphoma Hodgkin lymphomas (HL) share the following characteristics: They usually arise in lymph nodes, preferentially in the cervical region The majority of them manifest clinically in young adults; Neoplastic tissues usually contain a small number of scattered large mononucleated and multinucleated tumour cells (designated Hodgkin and Reed-Sternberg cells or HRS cells) residing in an abundant heterogeneous admixture of non- neoplastic inflammatory and accessory cells; The tumour cells are often ringed by T lymphocytes in a rosette-like manner. Hodgkin lymphomas account for ~30% of all lymphomas. Their absolute incidence has not apparently changed, in contrast with non-Hodgkin lymphomas where there has been a steady increase in incidence .

16. Sub classification NLPHL (nodular lymphocytic predominant  HL) Patients with NLPHL generally present with localized, non- bulky disease. The only symptom for most people with NLPHL is one or more lumps. These are enlarged lymph nodes (swollen glands). They are often in only one place in the body. A few people have other general symptoms of lymphoma, like night sweats, weight loss and fevers. Classical Hodgkins Lymphoma Hallmark of classic Hodgkin lymphoma is the Reed- Sternberg cell. This is a binucleated or multinucleated giant cell that is often characterized by a bilobed nucleus, with two large nucleoli, giving an owl’s eye appearance to the cells. 

17. INCIDENCE Hodgkin’s lymphoma global incidence – Age standardize rate (ASR) per 100,000 for women 0.8 and for men 1.2 Hodgkin lymphoma is a relatively rare malignancy that has a high cure rate. It is somewhat more common in men than in women and has two peaks of incidence: one in the early 20s and the other after 55 years of age.

18. INCIDENCE Disease occurrence has a familial pattern: First-degree relatives have a higher- than-normal frequency of disease, but the actual incidence of this pattern is low. No increased incidence for non-blood relatives (e.g., spouses) has been documented. Hodgkin lymphoma is seen more commonly in patients receiving chronic Immunosuppressive therapy ( e .g. for renal transplant) and also in veterans of the military who were exposed to the herbicide Agent Orange.)

19. Causes Are in 60s or older for non-Hodgkin lymphoma. Between 15 and 40 or older than 55 for Hodgkin lymphoma. Are male, although certain subtypes may be more common in females.

20. Causes of lymphoma Have a weak immune system from HIV/AIDS, an  organ transplant , or because you were born with an immune disease. Have an immune system disease such as rheumatoid arthritis, lupus, or celiac disease. Have been infected with a virus such as Epstein-Barr, hepatitis C, or human T-cell leukemia /lymphoma (HTLV-1).

21. Causes of lymphoma Have a close relative who had lymphoma. Were exposed to benzene or chemicals and pesticides that kill bugs and weeds.eg organophosphate, phenoxy herbicides. Were treated for Hodgkin or non-Hodgkin lymphoma in the past .

22. pathogenesis

23. Clinical manifestation It usually begins as an enlargement of one or more lymph node, T he individual sites for lymphadenopathy nodes are painless and firm but not hard. Commonly involve cervical, supraclavicular, and mediatinal nodes;s impaired cellular immunity Mild anemia

24. Clinical manifestation A bdominal pain (from splenomegaly or retroperitoneal adenopathy), bone pain (from skeletal involvement) Herpes zoster infections are common. Pruritus is common; A mediastinal mass may be seen on chest X-ray; occasionally, the mass is large enough to compress the trachea and cause dyspnea .

25. Ann Arbor Staging: STAGE DEFINITION I   Involvement of a single lymph node region or lymphoid structure.( eg ; spleen, thymus ). II   Two or more region, same side of diaphragm(the mediastinum is asingle site , hilar lymph nodes are lateralized)   III III(1) III(2) III(3) Involvement of lymph node region or structure on both sides of the diaphragm. With or without splenic ,hilar or portal nodes. With spleen Both IV Diffuse or multifocal involvement of extra lymphatic organs All stages divided Without weight loss/fever/sweats- A With weight loss/fever /sweats-B STAGING Ann Arbor stage summary:Hodgkin lymphoma

26. Diagnostic Evaluation History collection and physical examination Chest x-ray Computed tomography (CT scan) of chest, abdomen and pelvis. PET Scan Blood test, (CBC, platelets count, ESR, LFT, KFT) A  bone marrow aspiration , where a small amount of liquid is taken from bone marrow and tested

27. Diagnostic Evaluation A lumbar puncture (spinal tap) , where a small amount of fluid from the spine is removed and tested An  abdominal ultrasound Bone marrow biopsy is performed if there are sign of marrow involvement , Bone scans

28. Treatment Treatment of limited-stage Hodgkin lymphoma commonly involves a short course (2 to 4 months) of chemotherapy followed by radiation therapy to the specific involved area. Combination chemotherapy with doxorubicin (Adriamycin), bleomycin ( Blenoxane ), vinblastine ( Velban ), and dacarbazine (DTIC), referred to as ABVD, is considered the standard treatment for more advanced disease (stages III and IV and all stages with B symptoms).

29. Treatment Other combinations of chemotherapy may afford higher response rates but result in more toxicity, In addition, chemotherapy is often successful in obtaining remission even when relapse occurs. Transplantation is used for advanced or refractory disease. Revised treatment approaches are aimed at diminishing the risk of complications without sacrificing the potential for cure

30. Complication Cardiac disease from radiotherapy. This can lead to pericarditis, valvular heart disease, and coronary artery disease. Pulmonary disease can result from drugs like bleomycin and radiation therapy. Secondary cancers are a common cause of morbidity and mortality. The most common secondary malignancy following treatment of patients with Hodgkin lymphoma is lung cancer. Other cancers that may develop include breast, soft tissue sarcoma, pancreatic, and thyroid. Infertility varies but occurs in over 50% of patients. Infectious complications do occur but can be managed with empirical antibiotic treatment. Finally, patients may develop depression, peripheral neuropathy, family issues, and disturbed sexual functioning.

31. Non-Hodgkin’s Lymphoma The NHLs are a heterogeneous group of cancers that originate from the neoplastic growth of lymphoid tissue. Most NHL involve malignant B lymphocytes and only 5% T lymphocytes. In contrast to Hodgkin lymphoma, the lymphoid tissues involved are largely inhalated with malignant cells. The spread of these malignant lymphoid cells occurs unpredictably, and true localized disease is uncommon. Lymph nodes from multiple sites may be infiltrated, as may sites outside the lymphoid system.

32. Non-Hodgkin’s Lymphoma

33. Types of Non-Hodgkin Lymphoma- Indolent lymphoma Aggressive lymphoma Burkit lymphoma

34. Indolent lymphomas Indolent lymphomas advance more slowly than aggressive lymphomas, and they often don’t cause apparent symptoms early on. Many indolent lymphomas respond well to treatment, but they are usually challenging remove completely. Treatment may not need to be initiated right away for these cancers. When treatment is delayed, care team will closely monitor the cancer’s progress and recommend starting treatment if any problems or complications arise. Symptoms may vary widely based on the subtype of the disease.

35. Cont. The subtypes of NHL that are usually considered indolent include: Follicular lymphoma Cutaneous T-cell lymphoma Lymphoplasmacytic lymphoma Marginal zone  B-cell lymphoma   MALT lymphoma Small-cell lymphocytic lymphoma

36. Follicular Lymphoma (FLs). Follicular lymphoma is the second most common type lymphoma, accounting for about 20% of all NHL cases. It is usually indolent (slow growing) but about half of follicular lymphomas transform over time into the aggressive diffuse large B-cell lymphoma.

37. Marginal Zone Lymphomas (MZL). MZLs are categorized depending on where the lymphoma is located. Mucosa-associated lymphoid tissue lymphomas (MALT) usually involve the gastrointestinal tract, thyroid, lungs, saliva glands, or skin. MALT is often associated with a history of an autoimmune disorder (such as Sjogren syndrome in the salivary glands or Hashimoto's thyroiditis in the thyroid gland).

38. Small Lymphocytic Lymphoma (SLL). SLL is an indolent type of lymphoma that is closely related to B-cell chronic lymphocytic leukemia (CLL). It accounts for about 5% of NHL cases.

39. Aggressive lymphomas Aggressive lymphomas advance more quickly than indolent lymphomas. Patients with aggressive lymphomas often develop symptoms sooner and require treatment immediately after their diagnosis. Based on the subtype of lymphoma, symptoms may vary from enlarged lymph nodes and weight loss to broader bone and skin issues. That said, aggressive lymphomas tend to respond well to cancer treatments. The subtypes of NHL that are usually considered aggressive include: Diffuse large B-cell lymphoma Mantle cell lymphoma

40. Diffuse Large B-Cell Lymphoma (DLBLC). DLBCL is the most common type of non- Hodgkins lymphoma, accounting for about 30% of all NHL cases. It is an aggressive, fast-growing lymphoma that usually affects adults but can also occur in children. DLBCL can occur in lymph nodes or in organs outside of the lymphatic system. DLBCL includes several subtypes such as mediastinal large B-cell lymphoma, intravascular large B-cell lymphoma, and primary effusion lymphoma.

41. Mantle Cell Lymphoma . Mantle cell lymphoma is an aggressive type of lymphoma that represent about 7% of NHL cases It is a difficult type of lymphoma to treat and often does not respond to chemotherapy It is found in lymph nodes, the spleen, bone marrow, and gastrointestinal system Mantle cell lymphoma usually develops in men over age 60.

42. Burkitt lymphoma Burkitt lymphoma is considered the most aggressive form of lymphoma and is one of the fastest growing of all cancers. But it is very rare, accounting for about 2 percent of all lymphoma diagnoses. The disease originates in mature B-lymphocytes, which are cells of the acquired immune system that produce antibodies to help fight off disease. Burkitt lymphoma, a type of  non-Hodgkin lymphoma , is most often diagnosed in young adults and children, especially male. certain types of  Burkitt lymphoma have been diagnosed  in adults, especially those with a weakened immune system. The disease is named for Denis Burkitt, the British surgeon who first identified the cancer in African children in the late 1950s.

43. Cont.. Other symptoms include: Swollen lymph nodes Night sweats Fever Fatigue Loss of appetite Weight loss A biopsy, usually of an infected lymph node, is required for an accurate diagnosis if Burkitt lymphoma is suspected

44. Burkitt’s lymphoma

45. Burkitt’s lymphoma - ovaries

46. T cell lymphoblastic lymphoma   The most common presentation is - peripheral lymphadenopathy , - respiratory distress, wheezing, -and superior vena cava syndrome from mediastinal involvement . more common in males. The incidence is stable across all pediatric age groups with a median age of diagnosis of 12 years. Children diagnosed with lymphoblastic lymphoma whose bone marrow is more than 25 percent replaced by lymphoblasts are classified and treated as acute lymphoblastic leukemia .

47. Histologic classification of non-Hodgkin’s lymphomas 1. Rappaport - 1966 2. Lukes and Collins - 1974 3. Dorfman - 1974 4. Bennet et al., - 1974 5. Lennert - 1974 6. WHO - 1976 7. Working Formulation - 1982 8. REAL - 1994 9. WHO - 1999

48. Non-Hodgkin’s Lymphoma Working Classification Low Grade Small Lymphocytic Follicular small-cleaved cell Follicular mixed small-cleaved and large cell Intermediate Grade Follicular large cell Diffuse small cleaved cell Diffuse mixed small and large cell Diffuse large cell High Grade Large cell immunoblastic Lymphoblastic Small non-cleaved cell (Burkitt's and non-Burkitt's type)

49. REAL/ WHO 2001/ WHO 2008 CLASSIFICATION OF B – CELL LYMPHOMAS 51

50. REAL/ WHO 2001/ WHO 2008 CLASSIFICATION OF B – CELL LYMPHOMAS 52

51. B cell neoplasm in updated REAL/WHO Classification Precursor B-cell neoplasm Precursor B-lymphoblastic leukemia /lymphoma(B-ALL/LBL) Mature (peripheral) B-cell neoplasms B-cell chronic lymphocytic leukemia /small lymphocytic lymphoma B-cell prolymphocytic leukemia Lymphoplasmacytic lymphoma Splenic marginal zone B-cell lymphoma (+/-villous lymphocytes) Hairy-cell leukemia

52. B cell neoplasm in updated REAL/WHO Classification Plasma cell myeloma/plasmacytoma Extranodal marginal zone B-cell lymphoma of MALT type Mantle-cell lymphoma Follicular lymphoma Nodal marginal zone B-cell lymphoma (+/- monocytoid B cells) Diffuse large B-cell lymphoma Burkitt lymphoma

53. T and NK- cellneoplasms in the updated R.EAL/WHO Classification." Precursor T-cell neoplasm Precursor T-lymphoblastic lymphoma/ leukemia (T-ALL/LBL) Mature (peripheral) T-cell neoplasms T-cell prolymphocytic leukemia T-cell granular lymphocytic leukemia Aggressive NK-cell leukemia Adult T-cell lymphoma/ leukemia (HTLVI+)

54. T and NK- cellneoplasms in the updated R.E.A.L/WHO Classification." Extranodal NK/T-cell lymphoma, nasal type Enteropathy-type T-cell lymphoma Hepatosplenic yō T-cell lymphoma Subcutaneous panniculitis-like T-cell lymphoma Mycosis fungoides/Sezary syndrome Anaplastic large-cell lymphoma, primary cutaneous type Peripheral T-cell lymphoma, unspecified Angioimmunoblastic T-cell lymphoma Anaplastic large-cell lymphoma, primary systemic type

55. INCIDENCE There are geographical variations in the incidence of individual subtypes, with follicular lymphoma being more common in Western countries and T cell lymphoma more common in Asia. Overall, Non-Hodgkin lymphoma is common in ages 65 to 74, the median age being 67 years, and among male and female ratio is 3:1 . NHL is the seventh most common type of cancer diagnosed in the United States; incidence rates have almost doubled in the past 35 years.

56. INCIDENCE Recent study found that individuals who consumed more than 40 grams of alcohol weekly and were obese had a worse prognosis for both diffuse large B-cell lymphoma and Follicular lymphoma. Smoking was also associated with a worse prognosis and based on duration of smoking and cigarette consumption (number smoked per day and pack-year history). In addition, those who recently quit smoking had a worse prognosis than those who quit a longer time ago.

57. CAUSES C auses of NHL Inherited / acquired immune deficiencies Viruses HIV EBV Genetic Syndrome

58. NHL is staged according to the Murphy stage ● Stage I – Stage I disease involves a single tumor ( extranodal )  or  single anatomic area (nodal), excluding the abdomen and mediastinum . ●Stage II – Stage II disease is designated by any of the following: •Single extranodal area  plus  regional lymph nodes •Two single extranodal tumors on the same side of the diaphragm with or without regional lymph nodes •Primary gastrointestinal tumor (completely resected ) with or without mesenteric lymph nodes

59. Cont.. ●Stage III – Stage III disease is designated by any one of the following: - Primary intrathoracic ( mediastinal , thymic , pleural) disease - Two extranodal sites on opposite sides of the diaphragm - Extensive primary intra-abdominal disease - Two or more nodal areas on opposite sides of the diaphragm - Any paraspinal or epidural tumors ●Stage IV – Any of the above with involvement of the bone marrow, central nervous system, or both

60. pathogenesis

61. Malignant transformation of either the T or B cells Differentiation in the peripheral lymphoid tissues Predisposing Gender Race Family History Infections Immune System Deficiency Disorders Autoimmune Disorders Chemical Exposure Radiation Exposure Lifestyle Factors Precipitating Unknown (idiopathic)

62. T lymphocytes proliferate on antigenic stimulation and migrate into follicles, where they intact in B lymphocytes These activated follicles becme germinal centers , containing macrophages, follicular dendrite cells and maturing T and B cells Develops in any lymphoid tissues (lymph nodes

63. Spreads to various lymphoid tissues throughout the body, especially the liver, spleen and bone marrow Non- hodgkin’s lymphoma Group of tumors will develop

64. CLINICAL MANIFESTATION Indolent NHL Fever Drenching night sweats Unexpected weight loss Extreme tiredness Enlarged lymph nodes Lumps on the skin

65. CLINICAL MANIFESTATION Primary  signs and symptoms of Burkitt’s lymphoma  include the following: Lymph nodes growing together into a lump Non-tender lymph nodes Swollen lymph nodes in the abdomen, chest or throat Pain in the abdomen Nausea or vomiting Diarrhea Blockage of the bowel

66. Burkitt’s NHL Se condary or B symptoms can include the following: Unexplained fever Night sweats Weight loss

67. CLINICAL MANIFESTATION Aggressive NHL The most common symptoms is painless swelling in a lymph node , growing ,neck and armpit Other symptoms may include: Unintended weight loss Night sweats Itching skin Fever Shortness of breath Rash Fatigue

68. Diagnostic Evalution Complete blood count:  May show anemia , thrombocytopenia, leukopenia, pancytopenia, lymphocytosis, and thrombocytosis.  Serum chemistry tests:  Can help rule out tumor lysis syndrome, commonly in rapidly proliferative NHL such as Burkitt or lymphoblastic lymphoma. Lactate dehydrogenase levels can also be elevated due to high tumor burden or extensive infiltration of the liver. Imaging:  usually a CT scan of the neck, chest, abdomen, and pelvis or a PET scan. Dedicated imaging, such as an MRI of the brain and spinal cord or testicular ultrasound, might be needed.  Lymph node and/or tissue biopsy:  

69. Diagnostic Evalution Lumbar puncture:  usually reserved in those with a high risk of CNS involvement Immunophenotypic analysis of lymph node:  peripheral blood, and bone marrow. The tumor cells in Burkitt lymphoma express surface immunoglobulin (Ig) of the IgM type and immunoglobulin light, B cell-associated antigens (CD19, CD20, CD22, CD79a). Bone marrow aspiration and biopsy:  sometimes needed for the staging of the NHL.

70. TREATMENT

71. Radiation therapy -uses high doses of X-rays, gamma rays, or other types of ionizing (damaging) radiation to kill cancer cells. It may be applied to the whole body or to a specific zone.

72. Treatment Treatment is determined by the classification of disease, the stage of disease, prior treatment (if any), and the patient's ability to tolerate therapy. Tolerance to therapy is largely indictated by renal, hepatic, and cardiac function; the presence of concurrent diseases, functional status; and age. If the disease is not aggressive and is localized, radiation alone may be the treatment of choice. In aggressive types of NHL, aggressive combinations of chemotherapeutic agents are used; R-CHOP - the combination of the monoclonal antibody rituximab (Rituxan) with conventional chemotherapy (cyclophosphamide [Cytoxan], doxorubicin, vincristine, and prednisone) is now considered standard treatment for common lymphomas.

73. 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. There is no standard therapy for follicular lymphoma "Watchful waiting," symptoms develop, has often been used in those with indolent ," More recently, immunotherapy (e.g., rituximab) is delayed until being used, often in combination with conventional chemotherapy. Radiopharmaceutical agents (e.g., ibritumomab tiuxetan [ Zevalin ] or tositumomab /iodine-131 [ Bexxar ]) are also used. More aggressive treatment (often R-CHOP or rituximab plus bendamustine [ Levact ]) may provide a longer duration of remission in which additional treatment is not needed. Unfortunately, in most situations, relapse is commonly seen in patients with low-grade lymphomas. Treatment after relapse is controversial; HSCT may be considered for patients younger than 60 years.

74. Bone marrow transplantation For patients with very advanced disease, extremely high does of chemotherapy may be needed. This type of chemotherapy wipes out the body’s entire immune system, including the bone marrow that produces blood cells. So, patients need a bone marrow transplant in order to recover .

75. Complication Febrile neutropenia Hyperuricemia and tumor lysis syndrome - Presents with fatigue, nausea, vomiting, decreased urination, numbness, tingling of legs, and joint pain. Spinal cord or brain compression Focal compression depending on the location and type of NHL - airway obstruction (mediastinal lymphoma), intestinal obstruction and intussusception, ureteral obstruction Superior or inferior vena cava obstruction Hyperleukocytosis

76. Complication Adult T-cell leukemia -lymphoma can cause hypercalcemia. Pericardial tamponade Lymphoplasmacytic lymphoma with Waldenstrom macroglobulinemia can cause hyperviscosity syndrome. Hepatic dysfunction Venous thromboembolic disease Autoimmune hemolytic anemia and thrombocytopenia - can be observed with small lymphocytic lymphoma

77. Complication

78. Nursing management 1. Monitor Respiratory Status: Assess and document the patient’s respiratory rate, effort, and oxygen saturation regularly to detect any signs of impaired gas exchange or respiratory distress. 2. Manage Pain: Implement pain management strategies, including administering prescribed analgesics and providing comfort measures to alleviate pain associated with lymph node enlargement and other symptoms. 3. Address Fatigue: Collaborate with the healthcare team to develop an activity plan that balances rest and exercise, and provide energy conservation techniques to manage fatigue effectively.

79. Nursing management   Prevent Infection: Educate the patient and family on infection prevention strategies, such as hand hygiene, avoiding crowds and sick individuals, and receiving necessary vaccinations as approved by the healthcare provider.  5.Provide Emotional Support: Offer emotional support to the patient and their family, acknowledging their fears and concerns about the diagnosis and treatment. Refer them to counselling or support groups as needed. 6. Educate on Hodgkin Lymphoma and Treatment: Provide the patient and family with comprehensive education about Hodgkin lymphoma, its stages, treatment options, potential side effects, and expected outcomes.

80. Nursing management     Promote Body Image Acceptance: Encourage the patient to express feelings about body changes, such as lymph node enlargement or hair loss, and provide information about resources like wig banks or support groups to enhance body image acceptance. 8. Implement Anxiety-Reducing Interventions: Offer relaxation techniques, deep breathing exercises, or mindfulness practices to help manage anxiety and promote a sense of calm during treatment. 9. Provide Pruritus Relief: Offer strategies to relieve pruritus, such as providing cool compresses, using mild moisturizers, and ensuring a comfortable environment.

81. Nursing management      Foster Coping Strategies: Encourage the patient to explore coping mechanisms that work for them, such as journaling, art therapy, or engaging in hobbies, to navigate the emotional challenges of the disease. 11. Nutritional Support: Collaborate with the dietitian to create a balanced diet plan tailored to the patient’s nutritional needs and preferences to maintain adequate nutrition during treatment

82. Nursing Diagnosis       Impaired Gas Exchange related to mediastinal mass compression, leading to compromised lung function and impaired oxygenation. Acute Pain related to lymph node enlargement, pressure on surrounding tissues, and possible infiltration of the bone marrow. Fatigue related to anemia , disease progression, and cancer treatment side effects. Risk for Infection related to compromised immune system function due to the underlying disease and cancer treatments. Disturbed Body Image related to visible lymph node enlargement, changes in physical appearance, and potential hair loss from chemotherapy . Risk injury related to thrombocytopenia

83. Nursing Diagnosis       Anxiety related to the uncertainty of the disease prognosis, fear of treatment outcomes, and potential disruptions in daily life. Deficient Knowledge regarding lymphoma, treatment options, and self-care management. Risk for Impaired Skin Integrity related to pruritus (itching) associated with Hodgkin lymphoma and its treatment. Ineffective Coping related to the emotional impact of the diagnosis, treatment, and potential treatment-related side effects. Risk for Altered Nutrition: Less Than Body Requirements related to anorexia, nausea, and difficulty eating due to the disease and its treatments.  

84. Thankyou