hodgkin's/NHL

Question 1

what is lymphoma

Answer 1

An overgrowth of lymphocytes (cancer of the lymph system)

Question 2

cause of lymphoma

Answer 2

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

Question 3

lymphoma differs from leukemias in

Answer 3

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

Question 4

types of lymphomas

Answer 4

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

Question 5

primary lymphoma

Answer 5

overgrowth occurs in thymus and bone marrow

Question 6

secondary lymphoma

Answer 6

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

Question 7

hodgkin’s lymphoma patho

Answer 7

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

Question 8

hodgkin’s incidence

Answer 8

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

Question 9

hodgkin’s clinical manifestations

Answer 9

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

Question 10

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

Answer 10

 Jaundice
 Hepatomegaly
 Spleenomegaly
 Nerve Pain

Question 11

hodgkin’s diagnostics

Answer 11

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

Question 12

hodgkin’s staging is critical for

Answer 12

Selecting appropriate treatment

Determining prognosis

Question 13

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

Answer 13

a staging laparotomy may be performed

Question 14

hodgkin’s stage 1

Answer 14

single node/organ/site

Question 15

hodgkin’s stage 2

Answer 15

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

Question 16

hodgkin’s stage 3

Answer 16

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

Question 17

hodgkin’s stage 4

Answer 17

Disseminated involvement, widespread disease

Question 18

hodgkin’s stage 1&2 management

Answer 18

radiation and chemo

Question 19

hodgkin’s stage 3&4 management

Answer 19

Combination chemo and (targeted) radiation

Question 20

hodgkin’s prognosis

Answer 20

One of most curable cancers

10yr. survival rate of 76%

Question 21

teachable nursing considerations for hodgkin’s

Answer 21

Precautions related to pancytopenia

Precautions related to external radiation

Question 22

hodgkin’s concerns related to sexuality

Answer 22

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

Question 23

non-hodgkin’s lymphoma

Answer 23

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

Question 24

NHL patho

Answer 24

Abnormal growth of lymphocytes fixed at one phase of development

Question 25

NHL types

Answer 25

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

Question 26

NHL clinical manifestations

Answer 26

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)

Question 27

NHL diagnostics

Answer 27

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

Question 28

NHL management

Answer 28

-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

Question 29

NHL nursing diagnostics

Answer 29

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