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Flashcards in hodgkin's/NHL Deck (29):
1

what is lymphoma

An overgrowth of lymphocytes (cancer of the lymph system)

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cause of lymphoma

1. Viral Cause (Epstein-Barr virus implicated)- often seen in patients immunocompromised (HIV, organ transplants) or with autoimmune disorders
2. Genetics? (increased among twins, Jews)
3. Exposure to herbicides, chemicals

3

lymphoma differs from leukemias in

Degree of cell maturation
Location of cell production
Discrete tumor formation

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types of lymphomas

Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma (NHL)
Burkitt’s lymphoma (seen in children, persons with AIDs)

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primary lymphoma

overgrowth occurs in thymus and bone marrow

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secondary lymphoma

overgrowth occurs in lymph nodes, spleen, tonsils, intestinal lymphoid tissue (more common)

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hodgkin's lymphoma patho

Characterized by a distinctive large cell, called a Reed and Sternberg cell
Enlargement of lymph glands, spleen & liver can occur

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hodgkin's incidence

Bimodal: peaks incidence occurs in mid 20s and after age 50
Males affected more than females

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hodgkin's clinical manifestations

1. Painless Lymphadenopathy (Cervical, supraclavicular, mediastinal regions)
2.Mediastinal Mass on CXR (50% of cases)
3. Nonproductive cough
4. unexplained weight loss
5.night sweats
6. Fatigue, weakness,
7. Pruritus
8. Alcohol induced bone pain
9. Unexplained fever

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other symptoms of hodgkin's based on location and degree of lymph node obstruction with disease progression

 Jaundice
 Hepatomegaly
 Spleenomegaly
 Nerve Pain

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hodgkin's diagnostics

1. Biopsy of Nodes
2. CXR
3. Bone Marrow Biopsies
4. CT/MRI of Chest/Abdomen
5. CBC
6. Liver function tests
7. Lymphangiography

12

hodgkin's staging is critical for

Selecting appropriate treatment
Determining prognosis

13

If diagnostic tests cannot determine extent of disease (hodgkin's)

a staging laparotomy may be performed

14

hodgkin's stage 1

single node/organ/site

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hodgkin's stage 2

2 or more nodes, or one nodes and one organ/site on the same side of diaphragm

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hodgkin's stage 3

nodes on both sides of diaphragm (with or without spleen or organ/site involvement

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hodgkin's stage 4

Disseminated involvement, widespread disease

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hodgkin's stage 1&2 management

radiation and chemo

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hodgkin's stage 3&4 management

Combination chemo and (targeted) radiation

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hodgkin's prognosis

One of most curable cancers
10yr. survival rate of 76%

21

teachable nursing considerations for hodgkin's

Precautions related to pancytopenia
Precautions related to external radiation

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hodgkin's concerns related to sexuality

infertility (esp because it occurs in mid 20s age group)

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non-hodgkin's lymphoma

5-7X more common than Hodgkin’s lymphoma
Males affected more than females
More predominant in whites
Increased incidence after 50 to 60 years

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NHL patho

Abnormal growth of lymphocytes fixed at one phase of development

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NHL types

The REAL (Revised European-American Lymphoma) classification recognizes 30 subtypes
For practical purposes, NHLs grouped as aggressive (high-grade) or indolent (low-grade)

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NHL clinical manifestations

1. Similar to those for Hodgkin’s
2. Asymptomatic; incidental mss identified on CXR
3. Enlarged, “painless” lymph node “B” symptoms: (night sweats, fever, unexplained weight loss)
4. fatigue
5. Anemia
6. Spleen or liver enlargement
7. Obstructive sx of pressure on other tissues/structures (kidneys, nerves, trachea, etc)

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NHL diagnostics

Diagnostics similar to those for Hodgkin’s
Gallium Scan: Use of radioactive gallium IV to locate aggressive lymphoma

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NHL management

-Dependent upon grade (low or high) and stage (Staging for NHL is similar to that used for Hodgkin’s lymphoma)
-Standard treatments for early stage are localized radiation and chemo
-Autologous stem cell transplants (for those who do not respond or relapse) or BMT for persons with high-grade NHL

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NHL nursing diagnostics

1. Risk for Infection
2. Risk for Injury: bleeding
3. Fatigue
4. Risk for Sexual Dysfunction
5. Imbalanced Nutrition
6. Disturbed Body Image
7. Risk for Ineffective Therapeutic Regimen Management