Malignant Lymphoma

1
Malignant Lymphoma

• Presented by
• Manny Ramos RN, MSN

2
Malignant Lymphoma

• proliferation of lymphocytes, histocytes and
  precursors and derivatives
• Hodgkins disease
• Non-Hodgkins disease
• Sixth leading cause of cancer deaths in US

3
Risk Factors

• Immunosuppression due to drug therapy
• Viruses HTLV-1 and Epstein-Barr
• Occupational herbicide or chemical exposure

4
Hodgkins Disease

• Develops from single lymph node or chain of nodes
  and spreads to adjoining nodes
• Malignant cells are Reed-Sternberg cells which
  can invade almost any tissue in body (spleen,
  liver, lungs, digestive tract, CNS)
• Impaired immune response

5
Hodgkins disease

• Manifestations
• painless enlarged lymph node in cervical or
  subclavicular region
• Persistent fever, night sweats, fatigue, weight
  loss
• Late signs malaise, pruritus, anemia
• Involvement of spleen, lungs, GI tract
• One of most curable cancers

6
Non-Hodgkins Disease

• do not contain Reed Sternberg cells
• genetic and environmental factors
• Spreads early to lymphoid tissues and organs
  including nasopharynx, GI tract, bone, CNS
• low grade and better differentiated tumors are
  more curable

7
Non-Hodgkins Disease

• Manifestations
• Early painless lymphadenopathy, local or
  wide-spread
• Less often than with Hodgkins fever, night
  sweats, fatigue, weight loss
• GI abdominal pain, nausea, vomiting
• CNS neurological signs, headache
• Collaborative Care
• Treatment includes chemotherapy and radiation
• Investigative treatments include monoclonal
  antibodies, bone marrow and stem cell transplants

8
Non-Hodgkins Disease

• Collaborative Care
• Treatment includes chemotherapy and radiation
• Investigative treatments include monoclonal
  antibodies, bone marrow and stem cell transplants

9
Diagnostic Tests

• CBC
• Hodgkins disease anemia, leukocytosis, high
  sedimentation rate
• Non-Hodgkins lymphoma pancytopenia late in
  disease
• Chest Xray enlarged mediastinal lymph nodes and
  pulmonary involvement
• Chest or abdominal CT scan abnormal or enlarged
  nodes
• Bipedal lymphangiography identify extent of
  lymph node involvement
• Biopsy of largest most central lymph node to
  establish diagnosis
• Staging Determines extent of disease and
  appropriate treatment

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Treatment

• Combination chemotherapy
• Radiation therapy
• Long term effects of chemotherapy and radiation
  therapy
• Permanent sterility
• Bone marrow depression leading to anemia,
  bleeding and immunosuppression
• Secondary cancers and cardiac injury
• Increased risk of acute leukemia
• Thoracic radiation CHD and hypothyroidism

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Nursing Care

• Nursing Diagnoses
• Ineffective Protection
• Fatigue
• Nausea
• Disturbed Body Image, including dealing with
  alopecia
• Sexual Dysfunction
• Risk for Impaired Skin Iintegrity, including
  radiation burns
• Home Care
• Education regarding disease, treatment, symptoms
  to report to physician
• Referrals to home health care agencies and local
  chapter of American Cancer Society