Chapter 30: Lymphomas

Question 1

Cite what cell type proliferates in the case of lymphoma.

Answer 1

Lymphocytes

Question 2

Review Figure 30.15 on page 642 to understand the staging system used for Hodgkin’s and Non-Hodgkin’s Lymphomas.

Answer 2

Stage I and II → Above the diaphragm

Stage III and IV → Below the diaphragm

Question 3

Cite some factors that predispose a person to HL.

four: GEEH

Answer 3

*Epstein-Barr virus
*Genetic predisposition
*Exposure to occupational toxins
*HIV

Question 4

Name the 2 cell types that proliferate in HL.

Answer 4

Abnormal giant, multinucleated cells, called Reed-Sternberg cells

Hodgkin cells (variant of ↑)

Question 5

Describe what is meant by bi-modal age-specific incidence; identify the 2 groups are most often affected by HL.

Answer 5

Bimodal = 2 age-specific incidence

The incidence occurs most frequently in persons from 15-30 years of age, as well as those above 55 years of age.

Question 6

Name which lymph nodes are often the first site of HL.

Answer 6

Cervical lymph nodes in 60% - 70% of patients

Question 7

Describe clinical manifestations of initial HL. 12

Answer 7

Initial:
*gradual
*enlargement of cervical, axillary, and inguinal lymph nodes
*mediastinal node enlargement
*nodes are movable and nontender
*wt loss exceeding 10% in 6mon
*fatigue
*weakness
*fever
*chills
*tachyC
*night sweats
*increase in pain @ sites when drinking alcohol
*Cough, dyspnea, stridor, and dysphagia may all reflect mediastinal node involvement.

Question 8

Clinical manifestations of advanced HL 6

BASS DH

Answer 8

*hepatomegaly and splenomegaly
*anemia
*superior vena cava syndrome
*enlarged retroperitoneal nodes interfere w/ renal function
*spinal cord compression
*bone pain

Question 9

Discuss diagnostic tests used to evaluate HL. 4

BERP

Answer 9

*Peripheral blood analysis
-CBC
-High Sedimentation rate
-Hypercalcemia = bone involvement
*Excisional lymph node biopsy
*Bone marrow exam
*Radiologic studies
-PET (to stage and assess treatment response)
-CT (to stage and assess treatment response)

Question 10

Describe the usual treatment for HL (don’t memorize the drug names). 3

Answer 10

*ABVD regimen (4 specific meds)
*Patients with favorable early–stage disease receive 2 to 4 cycles of chemo. Patients with early-stage disease but unfavorable prognostic features (eg: B symptoms) or intermediate-stage disease receive 4 to 6 cycles of chemo. Advanced-stage HL is treated more aggressively using 6 to 8 cycles of chemo.
*A common regimen for this is BEACOPP (Again, specific meds). The role of involved-site radiation as a supplement to chemo varies depending on the extent of disease and the presence of resistant disease after chemo.

Question 11

Describe a serious consequence for patients who have endured treatment for HL. 2

Answer 11

*later development of secondary cancers and potential long-term toxicities from the tx, such as endocrine (hypothyroidism), heart, and lung dysfunction.
* Secondary solid tumor cancers may occur 10 years after tx. The most common secondary cancers are lung and breast cancer, especially with radiation therapy.

Question 12

List the cell types affected by NHL. 5

be tough not happy dandy

Answer 12

B, T, natural killer (NK), histiocytic, and dendritic cells

Question 13

Cite the most common hematological cancer.

Answer 13

NHL

Question 14

List some predisposing factors to NHL.

Answer 14

*usually unknown
May result from chromosomal translocations, infections, environmental factors, and immunodeficiency states

Question 15

Cite the most aggressive type of NHL.

the DLBL

Answer 15

Diffuse large B-cell lymphoma

Question 16

Describe the primary and other clinical manifestations of NHL. 12

Answer 16

*Painless lymph node enlargement
*Lymphadenopathy can wax and wane in indolent disease
*Hepatomegaly (with liver involvement)
*Neuro symptoms (with CNS involvement)
*Airway obstruction (from tumor lysis syndrome)
*Hyperuricemia (from tumor lysis syndrome)
*Renal failure (from tumor lysis syndrome)
*Pericardial tamponade
*GI symptoms
*Fever (B symptom)
*Night sweats (B symptom)
*Weight loss (B symptom)

Question 17

Identify a difference in HL vs NHL which may necessitate different diagnostic studies.

Answer 17

Diagnostic studies used for NHL resemble those used for HL.

However, because NHL is more often in extranodal sites, more diagnostic studies may be done, including MRI or lumbar puncture (to look for CNS involvement), barium enema or upper endoscopy (to look for GI involvement), and bone marrow biopsy (to rule out bone marrow involvement).

Question 18

Explain what the terms: indolent, high grade, and very high grade and how those terms guide NHL treatment.

Answer 18

Indolent:
Low grade

High grade:
Aggressive

Very high grade:
Highly aggressive

*In order to decide which treatment pathway to take, these, as well as other factors, known as the International Prognostic Index (IPI), may be considered for each subtype. These include the clinical stage, number of extranodal sites, serum LDH, WBC count, and patient’s age and performance status.

Question 19

Describe general nursing interventions when caring for patients have or have had NHL or HL

Answer 19

Same as HL.
It is based on managing problems r/t the disease