Lymphoma Medical surgical nursing..).pdf

Medical Surgical

1. Lymphoma

Group(C)

2. 1.Introduction
2.ANATOMY OF LYMPHATIC SYSTEM
3.Definition of lymphoma
4.Pathophysiology
5.Causes and risk factors
6.Types of lymphoma
7.Sings and symptoms
8.Diagnostic Procedures
9.Medical Management
10.Nursing management

3. The lymph (or lymphatic) system is a
part of our body’s immune system. This
system is group of organs, vessels and
tissues that protect us from infection
and keep a healthy balance of fluids
throughout your body. Lymphatic
system organs That contain lymphatic
tissue : spleen , thymus ,bone marrow,
Lymph nodes.


Introduction

4. 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.

5. Other lymphatic tissues
Lymph nodes are not the only lymphatic tissues in the body. The tonsils, spleen, and
thymus glands are also lymphatic tissues.

•Thymus gland: The thymus gland is a lymphatic organ and an endocrine gland
behind the sternum. It secretes hormones and is crucial to the production,
maturation, and differentiation of immune T cells.

•Tonsils: The tonsils produce lymphocytes and antibodies. They can help protect
against Trusted Source inhaled and swallowed foreign bodies.

•Spleen: The spleen is not part of the connected lymphatic system, but it is lymphoid
tissue. It produces white blood cells and filters the blood to remove microbes as well
as old and damaged red blood cells and platelets.

•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. Why do lymph nodes swell?

•Lymph nodes can swell for two common reasons: a reaction to an infection and direct infection of the
lymph nodes.

•In the former, the lymph nodes react when coming into contact with foreign materials from infected
tissue.

•Direct infection can cause lymphadenitis. In this, infection causes inflammation in the lymph nodes,
and a person will require antibiotic treatment.

•Most people who have swollen glands with a cold or flu do not need to contact a doctor.
However, a person should seek medical advice if:

- lymph nodes stay swollen for longer than 2 weeks
- A swollen lymph node feels hard or fixed in place
- Swelling accompanies a fever, night sweats, or unexplained weight loss

8. Definition
The lymphomas: are neoplasms of cells of
lymphoid origin. These tumors usually
start in lymph nodes but can involve
lymphoid tissue in the spleen, the
gastrointestinal tract , the liver, or the
bone marrow. They are often classified
according to the degree of cell
differentiation and the origin of the
predominant malignant cell.

9. Pathophysiology
The uncontrolled growth and accumulation of
abnormal lymphocytes in the lymph nodes and
other lymphoid tissues. leading to the formation of
tumors ,and causing in enlargement of the lymph
nodes, spleen, liver, and bone marrow. The
lymphocytes proliferate rapidly and become non-
functional, and this abnormal cells can crowd out
the normal cells and interfere with the functioning
of the immune system, making the body more
vulnerable to infections and other diseases.

Understanding the pathophysiology of lymphoma
is crucial for developing targeted treatments and
therapies that can halt the progression of the
disease, minimize complications, and improve the
quality of life for affected individuals.

10. Causes & Risk factors
The exact causes of lymphoma are unknown. However, there are several risk
factors associated with lymphoma development, including:

1. Genetic Factors: Certain genetic mutations or inherited genes may increase the
risk of developing lymphoma.

2. Age: People over the age of 60 are at a higher risk of developing lymphoma.

3. Gender: Men are slightly more at risk of developing lymphoma than women.

4. Weak Immune System: People with compromised immune systems, such as those
with HIV/AIDS, organ transplant recipients, and people taking immunosuppressant
medications, are at a higher risk of developing lymphoma.

11. Cont..
5. Viral Infections: Viruses such as Epstein-Barr virus (EBV), human T-
cell leukemia/lymphoma virus (HTLV-1), human immunodeficiency
virus (HIV), and hepatitis C virus (HCV) can increase the risk of
developing certain types of lymphomas.

6. Exposure to Certain Chemicals: Exposure to certain chemicals such as
pesticides, herbicides, and solvents has been linked to an increased risk
of developing lymphoma.

7. Previous Treatment with Radiation and Chemotherapy: Exposure to
radiation and certain chemotherapy drugs can increase the risk of
developing lymphoma.08:02 AM

12. Types of
lymphoma
Hodgkin Lymphoma Non-Hodgkin Lymphoma

14. Hodgkin Lymphoma
• Hodgkin lymphoma (HL) is a less common type of lymphoma, characterized by the
presence of a specific type of abnormal cell called Reed-Sternberg cells in the lymph
nodes.

• HL usually starts in a single lymph node and spreads to nearby nodes over time.

• Hodgkin's disease is considered one of the most curable forms of cancer, especially
if it is diagnosed and treated early.

• Several types of treatment can be used against Hodgkin lymphoma, including
chemotherapy, immunotherapy, and stem cell transplantation.

16. The two main subtypes of Hodgkin lymphoma are:

Classical Hodgkin's lymphoma
Classical Hodgkin's lymphoma is the more common type of this disease. People diagnosed
with this type have large lymphoma cells called Reed-Sternberg cells in their lymph nodes.


Nodular lymphocyte-predominant Hodgkin's lymphoma
This much rarer type of Hodgkin's lymphoma involves lymphoma cells that are sometimes
called popcorn cells because of their appearance. Nodular lymphocyte-predominant
Hodgkin's lymphoma is usually diagnosed at an early stage and may require less intensive
treatments compared to the classical type of the disease.


Cont..

17. Non-Hodgkin Lymphoma

• Non-Hodgkin lymphoma (NHL) is a more common type of lymphoma, They
represent about 90% of all lymphomas diagnosed each year ,which can originate
from different types of lymphocytes and is characterized by a wide range of cell
markers.

• NHL can develop in any part of the body, including the lymph nodes, bone
marrow, and other organs, and can spread quickly to other. Most people with
NHL are older than 55 at diagnosis.

• Several types of treatment can be used against non-Hodgkin lymphoma,
including chemotherapy, radiation therapy, immunotherapy, targeted therapy,
and stem cell transplantation.

19. Cont..

Diffuse large B-cell Lymphoma (DLBCL)
This is the most common type of non-Hodgkin lymphoma, accounting for about 30% of all
cases in the U.S. DLBCL grows very quickly and may start in lymph nodes or in other parts
of your body. Medical researchers have identified three different DLBCL subgroups. These
are germinal center B-cell-like (GCB), activated B-cell-like (ABC) and unclassified. GBC
and ABC have several different genetic subtypes and react to chemotherapy in different
ways.

Follicular lymphoma
is the most common type of of low-grade non-Hodgkin lymphoma (NHL). It develops
when white blood cells cluster together to form lumps in your lymph glands or organs.

Mantle cell lymphoma
An aggressive (fast-growing) type of B-cell non-Hodgkin lymphoma that usually occurs in
middle-aged or older adults. It is marked by small- to medium-size cancer cells that may
be in the lymph nodes, spleen, bone marrow, blood, and gastrointestinal system.


There are many subtypes of NHL*. Some grow slowly, and others are more aggressive
Some of the most common include:

20. T-cell lymphomas
These are subtypes of NHL that arise from T-cells instead of B-cells. They can be
fast- or slow-growing and can involve the lymph nodes, skin, and other organs.

bukitt lymphoma
rare but highly aggressive (fast-growing) B-cell non-Hodgkin lymphoma (NHL).
This disease may affect the jaw, central nervous system, bowel, kidneys, ovaries,
or other organs. Burkitt lymphoma may spread to the central nervous system
(CNS).




Cont..

21. Hodgkin Non-Hodgkin
Definition Type of lymphoma that is
characterized by the presence of a
specific type of cell called Reed-
Sternberg cells.
A more diverse group of cancers that
arise from lymphatic cells and can
affect a wide range of lymphatic cells.
Age of onset Between the ages of 20 and 40, and
those over the age of 55.
Occur at any age, but it is more
common in people over 60.
Progression Typically progresses in an orderly
fashion from one group of lymph
nodes to another, and can eventually
spread to other organs.
Can be more unpredictable in its
progression, and can sometimes skip
lymph nodes and spread directly to
other organs.
Prognosis Is generally good, with a 5- year
survival rate of around 85%.

Has a more varied prognosis,
depending on the specific subtype, the
stage at diagnosis, and other factors.
Affected cells Characterized by the presence of Reed-
Sternberg cells, which are large
abnormal cells that are derived from
B-cells.


Can arise from a variety of lymphatic
cells, including B- cells, T-cells, and
natural killer cells.

22. Signs & Symptoms
•Enlarged lymph nodes.
•Chills
•Weigh loss
•Chest pain or pressure
•Shortness of breath or cough
•Feeling full after small amount of food
•Fatigue
•Swollen abdomen
•Severe itching
•Night sweat

24. Diagnostic Procedures

1.Physical Examination: A thorough physical examination may be conducted to check
for enlarged lymph nodes, organ enlargement, or other signs of lymphoma.

2.Medical History: Gathering a detailed medical history from the patient, including
symptoms, past medical conditions, family history, and exposure to risk factors.

3. Blood Tests: Blood tests may be conducted to evaluate the levels of various blood cells
and detect abnormalities that may indicate lymphoma.

4. Imaging Tests:

- CT Scan (Computed Tomography): A CT scan produces detailed cross-sectional
images of the body, helping to identify enlarged lymph nodes or abnormal masses.
- MRI (Magnetic Resonance Imaging): MRI uses powerful magnets and radio waves
to create detailed images of the body's organs and tissues.
- PET Scan (Positron Emission Tomography): PET scans use a radioactive tracer to
highlight areas of abnormal metabolic activity, helping to detect lymphoma spread.

26. Cont..
5.Biopsy: A biopsy involves the removal of a small sample of tissue from an enlarged
lymph node or affected organ for examination under a microscope. Different types of
biopsies include:
- Excisional Biopsy: Removal of an entire lymph node or mass.
- Incisional Biopsy: Removal of a small portion of a lymph node or mass.
- Fine Needle Aspiration (FNA): Insertion of a thin needle into a lymph node to
extract cells for examination.
- Core Biopsy: Removal of a small cylinder of tissue for examination.

6. Bone Marrow Biopsy: If lymphoma involvement in the bone marrow is suspected, a
small sample of bone marrow may be extracted for examination.

7. Lymph Node Biopsy: Sentinel lymph node biopsy may be performed to determine if
the cancer has spread to nearby lymph nodes.

28. A stem cell or bone marrow transplant is a long and complicated process that
involves 5 main stages.

These stages are:

•Pre-transplantation Evaluation: This includes assessing the patient's overall health,
disease status, and compatibility for transplantation.

•Stem Cell Collection: Stem cells can be collected from the patient (autologous
transplant) or a donor (allogeneic transplant). Collection methods include bone
marrow aspiration, peripheral blood stem cell harvest, or umbilical cord blood
donation.

•Conditioning: treatment to prepare your body for the transplant.
Transplanting the stem cells.

•Recovery: you'll need to stay in hospital for at least a few weeks until the transplant
starts to take effect.

29. Types of Stem Cell Transplantation

Steam cell collection
•Autologous transplantation: uses the patient’s own stem cells. These cells are removed,
treated and returned to his or her own body after a conditioning regimen.

•Allogeneic transplantation: uses stem cells from a donor. A donor may be a family member
or someone who is not related to the patient.

Reduced-intensity allogeneic stem cell transplantation includes conditioning treatment that contains
lower, less toxic doses of chemotherapy and radiation.

31. Teaching after SCT
Once the transplant is finished, you'll need to stay in hospital for a few weeks while you wait for the
stem cells to settle in your bone marrow and start producing new blood cells.

During this period you may:

• Feel weak, and you may experience diarrhoea and vomiting, and/or a loss of appetite
be given fluids by mouth or through a tube running from your nose to your stomach (a nasogastric
tube) to prevent malnutrition
• Have regular blood transfusions, as you'll have a low number of red blood cells
• Have regular platelet transfusions, as you'll have a low number of platelets
• Stay in a special germ-free room, and visitors may need to wear protective clothing to prevent
infections, as you'll have a low number of infection-fighting white blood cells

Many people are well enough to leave hospital between 1 and 3 months after the transplant. However,
if you develop complications such as an infection, you may have to stay in hospital for longer.

Even after going home, you'll still be at risk of infections for potentially a year or longer because it can
take a while for your immune system to return to full strength.

If donated stem cells were transplanted, you'll also usually need to take medicines called
immunosuppressants that stop your immune system from working so strongly. This is to reduce the risk
of your body attacking the transplanted cells or to reduce the risk of the transplanted cells attacking
other cells in your body.

32. Medical Management
There are many different line of treatment that can be used for treating Hodgkin and
non-Hodgkin lymphoma..

The choice of treatment depends mainly on the following:

• The type of lymphoma.
• Whether the lymphoma is fast growing (high grade) or slow growing (low grade).
• The affected areas of the body.
• The symptoms the patient is experiencing.
• The patient’s overall health condition.
• How aggressive the cancer is.

33. Cont..

Treatment typically involves a combination of therapies, which may include:


Chemotherapy: This is the primary treatment for most cases of Hodgkin's
lymphoma. It involves the use of powerful drugs to kill cancer cells or stop their
growth.


Radiation therapy: High-energy beams, such as X-rays or protons, are used to
target and destroy cancer cells. Radiation therapy may be used alone or in
combination with chemotherapy, depending on the stage and location of the
lymphoma.


Immunotherapy: Monoclonal antibody therapy, such as rituximab, may be used to
help the immune system identify and destroy cancer cells.

34. Cont..

Stem cell transplant: In cases of advanced or recurrent Hodgkin's lymphoma, a stem
cell transplant may be recommended. This involves replacing diseased bone marrow
with healthy stem cells, either from the patient (autologous transplant) or a donor
(allogeneic transplant).


Targeted therapy: Drugs that target specific molecules involved in cancer growth,
such as brentuximab vedotin, may be used in certain cases of Hodgkin's lymphoma.


Clinical trials: Participation in clinical trials may be an option for some patients,
offering access to new treatments and approaches being studied in research settings.

35. Nursing Management
Nursing management of lymphoma involves the application of the nursing process, which
consists of assessment, diagnosis, planning, implementation, and evaluation. Here is how
nursing care can be provided to patients with lymphoma based on the nursing process:
1.Assessment:

- Conduct a thorough assessment of the patient's medical history, including any
previous treatments for lymphoma.

- Perform a physical assessment to identify signs and symptoms of lymphoma, such
as enlarged lymph nodes, fever, night sweats, and weight loss.

- Assess the patient's emotional and psychological well-being, as a cancer diagnosis
can have a significant impact on mental health.

- Evaluate the patient's understanding of the disease, treatment options, and
potential side effects.

36. 2. Diagnosis:

- Collaborate with the healthcare team to establish a nursing diagnosis based on the
assessment findings.

- Nursing diagnoses for patients with lymphoma may include:

- Impaired Gas Exchange related to compromised lung function due to lymphoma or its
treatment.

- Acute Pain related to tumor growth, invasion of surrounding tissues, or treatment
procedures.
- Anxiety related to diagnosis and treatment.
- Impaired physical mobility related to weakness or fatigue.

- Risk for Altered Nutrition: Less Than Body Requirements related to decreased appetite,
nausea, vomiting, or metabolic demands of the disease process.
- Risk for infection related to compromised immune system.

- Risk for Injury related to thrombocytopenia or bone marrow suppression from
chemotherapy.

37. 3. Planning:

- Develop a comprehensive care plan in collaboration with the patient,
their family, and the healthcare team.

- Set realistic goals and outcomes based on the patient's individual
needs and preferences.

- Include strategies to manage symptoms and side effects of treatment,
promote self-care and independence, and provide emotional support.

- Educate the patient and their family about the disease, treatment
options, and ways to manage potential complications.

38. 4. Implementation:

- Implement the care plan by providing holistic care to address the physical, emotional,
and psychosocial needs of the patient.

- Monitor respiratory status and provide supplemental oxygen as necessary.

- Note changes to the skin color; pallor or cyanosis.

- Observe for neck vein distention, headache, dizziness, facial edema, dyspnea and
stridor.

- Assess and manage pain; teach relaxation techniques, administer analgesics as
necessary.

- Nutrition education; monitor daily weight and caloric intake; encourage patients to eat
small frequent meals and increase protein intake.

- Provide supportive comfort measures following radiation or chemotherapy treatments.

39. Cont..

- Assist with positioning and monitor for skin breakdown.

- Offering emotional support, therapeutic communication, and relaxation techniques to
reduce anxiety.

- Assisting the patient with coping strategies and providing resources for support groups or
counseling services to address body image concerns.

- Educating the patient about the disease process, treatment options, potential side effects,
and self-care management.

40. 5- Evaluation:

- Nursing evaluation for lymphoma involves assessing the patient's response to
nursing interventions and the progress of their condition. Some aspects of
evaluation may include:

- Respiratory Status: Evaluate improvement or worsening of respiratory function,
such as improved oxygen saturation or resolution of respiratory distress.

- Infection Control: Assess for signs of infection and evaluate the effectiveness of
infection prevention measures. Monitor for any signs of infection resolution or
recurrence.

- Fatigue: Evaluate changes in fatigue levels and functional ability. Determine if
energy conservation techniques and interventions have helped manage fatigue.

- Pain Management: Assess the effectiveness of pain management interventions
and any changes in pain intensity or frequency.

41. Cont..

- Anxiety: Assess the patient's anxiety levels and coping mechanisms. Determine if
anxiety-reducing interventions have been effective in promoting emotional well-
being.

- Knowledge Acquisition: Assess the patient's understanding of lymphoma, treatment
options, and self-care management. Determine if educational interventions have
been successful in improving knowledge.

- Nutritional Status: Evaluate changes in nutritional status and intake. Determine if
dietary counseling and interventions have improved nutritional intake and
prevented malnutrition.

- Skin Integrity: Assess the skin for any signs of breakdown or infection. Evaluate the
effectiveness of interventions aimed at maintaining skin integrity and preventing
complications.

42. Thank you