Lymphomas

Question 1

Definition of Lymphomas

Answer 1

Malignant neoplasms originating in the bone marrow and lymphatic structures resulting in the proliferation of lymphocytes.

Question 2

Definition of Hodgkin’s lymphoma (aka Hodgkin’s disease)

Answer 2

A malignant condition characterized by proliferation of abnormal giant, multinucleated cells, called Reed-Sternberg cells, which are located in lymph nodes.

Question 3

Pathophysiology of Hodgkin’s lymphoma
Diagnosis &
Progression

Answer 3

the normal structure of lymph nodes is destroyed by the hyperplasia of monocytes and macrophages.
Diagnostic: presence of Reed-Sternberg cells in lymph node biobsy.
Progression: usually originates in lymph nodes, infiltrates other organs, esp lungs, spleen, and liver. Staged 1-4 (A or B: presence or absence of significant systemic symptoms- fever, night sweats, weight loss).

Question 4

Clinical Manifestations of Hodgkin’s lymphoma

Answer 4

Onset is gradual, initially enlargement of cervical, axillary or inguinal lymph nodes; a mediastinal node mass is 2nd most common. discrete nodes that remain movable and nontender.
weight loss, fatigue, weakness, fever, chills, tachycardia or night sweats
B- symptoms: fever, night sweats, and weight loss- worse prognosis. Alcohol causes pain at site

Question 5

Clinical Manifestations of Non-hodgkins lymphoma

Answer 5

painless lymph node enlargement with s/s dependent on area of disease. B symptoms only 40% common (in Hodgkins its common)

Question 6

Collaborative care for lymphomas

Answer 6

• localized radiation
• combination chemotherapy with localized radiation
• high-dose combination chemotherapy with localized radiation

Question 7

What are NHLs (non-Hodgkin’s lymphomas)

Answer 7

heterogeneous group of malignant neoplasms of primarily B- T-cell origin affecting all ages. It is the most commonly occuring hematologic cancer and the fifth leading cause of cancer death.

Question 8

Diagnostic studies for NHL

Answer 8

Staging 1-4 (similar to Hodgkins L.) NHL is more often in extranodal sites: MRIs must be done to rule out CNS or bone marrow infiltration or a barium enema, upper endoscopy or CT to visualize suspected GI involvement.

Question 9

What is a Multiple Myeloma (plasma cell myeloma)?

Answer 9

A condition in which neoplastic plasma cells infiltrate the bone marrow and destroy bone.
The malignant Plasma cells (activated B cells) produce abnormal and excessive amounts of immunoglobulins (antibodies) called myeloma protein. Production of excessive cytokines –role in bone destruction

Question 10

Clinical Manifestations of Multiple Myelomas

Answer 10

• skeletal pain is most common
• symptoms develop slowly
• fractures
• fatigue
• bone degeneration–calcium loss—hypercalcemia

Question 11

Diagnostic studies for Multiple Myelomas

Answer 11

labs (calcium, high protein levels, H/H, CBC, elevated creatinine, Beta microglobulin and albumin)
Bence Jones proteins from the myeloma cell detected in urine. Monoclonal (M) antibody protein found in blood and urine.

Question 12

Nsg management for Multiple Myelomas

Answer 12

• maintain adequate hydration (to minimize problems from hypercalcemia)
• move pt carefully
• ambulate as tol
• pain management
• teach pt. and fam about remissions and exacerbations, and need for hospitalization during acute episodes.

Question 13

Characteristics of Benign Neoplasms

Answer 13

• usually encapsulated
• normally differentiated
• absence of metastasis
• recurrence is rare
• slight vascularity
• expansive mode of growth
• cell characteristics are fairly normal, similar to parent cells

Question 14

Characteristics of Malignant Tumors

Answer 14

-rarely encapsulated
-are poorly differentiated
–capable of metastasizing
–Recurrence is possible
–moderate to marked vascularity
–infiltrative and expansive mode of growth
Cell characteristics are abnormal, become more unlike parent cells

Question 15

examples of malignant tumors

Answer 15

Carcinoma (skin and tissues lining internal organs)
Sarcoma (bone, conn. and supportive tissue)
Leukemia (starts in blood)
Lymphoma & myeloma (immune system)
CNS (brain and spinal cord)

Question 16

Cancers that can be prevented with vaccine

Answer 16

HPV and Cervical cancer

Question 17

What are the 7 warning signs of cancer

Answer 17

Change in BM habits
A sore that doesnt heal
Unusual bleeding or discharge
Thickening or a lump in breast..
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness

Question 18

3 factors that cancer staging is based on

Answer 18

• the original tumor’s size and whether or not it has grown into nearby areas
• whether or not the cancer has spread to the nearby lymph nodes
• whether or not the cancer has spread to distant areas of the body

Question 19

What are the reasons someone may have surgery for cancer (Surgical Therapy)

Answer 19

• Diagnosis-biopsy
• Prevention-removal of non-vital organs to prevent cancer
• Determine treatment plan-clinical staging
• Cure and control of cancer: removal of localized cancer tissue
• Supportive care: insertion of therapeutic devices such as feeding tube
• Rehabilitation: reconstructive surgery
• Palliation of symptoms: relief of pain, obstruction, hemorrhage

Question 20

Describe External Beam Radiation (teletherapy)

Answer 20

Delivery of radiation from a source placed at some distance from the target site in the RT department

Question 21

Describe what internal radiation (brachytherapy) is

Answer 21

involves placement of specially prepared radioisotopes directly into/near the tumor itself or close proximity

Question 22

Nsg/Collaborative Care Radiation Skin Reactions

Answer 22

• wash with mild soap, rinse well pat dry
• use warm or cool water
• use hands not washcloths
• avoid products, friction causing clothing and tape/dressings
• no direct sunlight, chlorinated swimming pools or temp extremes.