Non – Hodgkin’s Lymphoma (NHL)

7/29/2019 Non – Hodgkin’s Lymphoma (NHL)

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By: Yamon, Abigail Faye A.



There are 3 basic functions:Transports interstitial fluid oback to the blood.Transports absorbed fat frointestine to the blood.And helps provide immuno

defenses against pathogens

Lymphatic capillaries are closed-ended but highly permeable and forms vast nintercellular spaces.They drain excess tissue fluid into lymph ducts or nodes.



Lymph passes through lymph nodes aby way of the lymph ducts to the ven



The lymph nodes filter lymph before returninginto the Right and Left subclavian veinsthrough the thoracic duct or right lymphaticduct.

Nodes make lymphocytes and containphagocytic cells that remove pathogens. Theyare also made in the tonsils, spleen, andthymus.

LYMPHOID ORGANS:Bone marrow central lymphoid organs, theyThymus Gland function in forming & maturing lymphocytes

Peripheral or Secondary Lymphoid Organs: Lymph nodes

Mucosa Associated lymphoid tissues Spleen (largest internal lymphatic organs)



Two groups of cells responsible for

adaptive, specific immunity:

B lymphocytes – humoral immunity or

immunoglobulin-mediated immunity, originate in the

in the bone marrow and mature

T lymphocytes – originate from the stem cells

in the bone marrow but are matured in the

thymus.



Also called malignant lymphomas and

lymphosarcomas Heterogeneous group of malignant diseases th

originate in lymph glands and other lymphoid t

Occur three times more commonly than Hodg

disease and the incidence is increasing, especpatients with autoimmune disorders and thosereceiving immunosuppressant treatment, cons85% of all cases.



Most NHLs involve malignant B lymphocytes; only 5involve T lymphocytes.

Fifth most common type of cancer diagnosed in U

Tenth most common cause of cancer in Philippine

In 2008, less than one (0.2) out of 100 men and lessone (0.1) out of 100 women have died from Non-Hlymphoma before age 75. (Philippine Cancer Soc

Prognosis varies greatly among the more than 30 sof NHL. 30% - newly diagnosed & 80% of all aggrestypes.



Indolent (low-grade) NHL- grow very slowly and often have spread by the timediagnosed. Several different types of treatment usuallywell for this type of lymphoma, but it may come backor years after treatment is complete.

*Indolent and aggressive NHL are equally common in a*Patients with indolent NHL may not need to start treatm

when it is first diagnosed. They may be followed closelstart treatment only when they develop symptoms or tdisease begins to change; this is called watchful waiti

*When indolent lymphoma is located only in one area (localized disease, stages I and II; radiation therapy mathe NHL.



Aggressive (high-grade) NHL- usually need more intensive chemotherapy.

Treatment is usually started immediately, and radiationmay be recommended in addition to chemotherapy.lymphomas are often curable. (more common in child

B-cell lymphoma- about 90% of people with lymphoma have B-cell lym

T-cell lymphoma

-about 10% of people with lymphoma have T-cell lymp



Diffuse large B-cell lymphoma (DLBCL)- most common form of lymphoma; about 30% of peoNHL have this type. It is an aggressive form of NHL that(about 40% of the time) involves organs other than thenodes.

Follicular lymphoma- second most common form of lymphoma in the Unit

and Europe. About 20% of people with NHL have this tusually begins in the lymph nodes, is most often indolegrows very slowly.*There is no known cure; however, recent studies showabout 80% of patients live at least five years after beindiagnosed with follicular lymphoma.



Diffuse large B-cell lymphoma (DLBCL)





Mantle cell lymphoma- about 7% of people with NHL have mantle celllymphoma. It most often appears in people older It usually involves the bone marrow, lymph nodes, and gastrointestinal system (esophagus, stomach,intestines).

Small lymphocytic lymphoma- this type of lymphoma is very closely related to acalled B-cell chronic lymphocytic leukemia (CLL), about 5% of people with NHL have this subtype. It considered an indolent lymphoma



Mediastinal large B-cell lymphoma- an aggressive form of Diffuse large B-cell lymphoDLBCL. It appears as a large mass in the chest aremay cause breathing problems or superior vena csyndrome (SVCS).

Splenic marginal zone B-cell lymphoma- this type of lymphoma begins in the spleen and cinvolve the blood. It is usually slow-growing, and thtreatment approach is often watchful waiting. Somsurgical removal of the spleen is recommended.



Extranodal marginal zone B-cell lymphoma of mucosaassociated lymphoid tissue (MALT) - most commonly occurs in the stomach, but it may alin the lung, skin, thyroid, salivary gland, or eye.

*Patients with this type of lymphoma often have a histoautoimmune disease, such as lupus, rheumatoid arthri

*When MALT occurs in the stomach, it is often successfu

treated with antibiotics to treat an infection with Helicpylori bacteria, which is thought to cause the lymphomOther times, radiation therapy, surgery, chemotherapmonoclonal antibodies, or a combination of these is tcommon treatment plan. For disease in only one part body, radiation therapy can often cure the NHL.



Nodal marginal zone B-cell lymphoma. - involves the lymph nodes. It is rare; about 1% of pwith lymphoma have this subtype. In general, this of lymphoma is treated similarly to follicular lympho



Lymphoplasmacytic lymphoma

- an indolent form of lymphoma, and 1% of people with NHthis subtype. This form of lymphoma most often involves themarrow, lymph nodes, and spleen. In many patients, this lyproduces proteins that are found at high levels in the bloothis occurs, the condition is called Waldenstrom’smacroglobulinemia (WM).

*Patients with WM sometimes have thickened blood, which

cause symptoms such as headache, blurry vision, dizzinessshortness of breath. Treatment is similar to chronic lymphoclymphoma/leukemia and may include watchful waiting,chemotherapy, monoclonal antibodies, or combinations ochemotherapy and monoclonal antibodies. Chemotherapfollowed by stem cell transplantation is being studied in cli



Primary effusion lymphoma.- very aggressive form of lymphoma most often ocpeople who have the human immunodeficiency v(HIV, the virus that causes autoimmune deficiencysyndrome or AIDS), people whose immune systemnot work well for other reasons, or people who are- begins in the lung, heart, or abdominal cavities; othere is not one tumor. It is treated the same as othdiffuse large cell lymphoma.



Burkitt lymphoma/Burkitt cell leukemia

- a very rare and aggressive form of lymphoma.

*It occurs most commonly in Africa, appears most often jawbones of children, and is usually associated with thEpstein-Barr virus (EBV, the virus that causes mononuclIt can also be associated with HIV. In the United States

lymphoma appears most commonly with a mass in thabdomen. Because this type of lymphoma spreads quneeds immediate treatment that includes intensivechemotherapy, usually with some treatment for the cenervous system to prevent it from spreading to the bratype of NHL is often curable.





Anaplastic large cell lymphoma, primary cutaneo-only involves the skin, often indolent, although agsubtypes of the disease are possible. When the calocalized, radiation therapy is often effective. If it hspread, chemotherapy is the usual treatment.

*New drugs have recently been developed for thetreatment of cutaneous lymphomas, some of whicbe given orally (by mouth) as a pill.





Angioimmunoblastic T-cell lymphoma

- an aggressive form of lymphoma with specific syswollen lymph nodes, fever, weight loss, rash, andlevels of antibodies called gamma globulin in the Since patients with angioimmunoblastic lymphomlowered immune systems, infections are also comm

type of lymphoma is identified by what it looks likemicroscope and by certain proteins found in the tcells. It is treated like other diffuse large cell lymph



Anaplastic large cell lymphoma, systemic type

-makes up about 2% of all lymphomas and about all childhood lymphomas. It is an aggressive form olymphoma, but treatment often works well.



Precursor T-lymphoblastic lymphoma/leukemia (precursor T-ce

lymphoblastic leukemia). - rare type of lymphoma that makes up about 2% of all NHL.

-most common for young adults and is more common for men twomen.

- the same as a form of leukemia called acute lymphoblastic le(ALL).

*When it is mainly located in the lymph nodes it is called lymphoblymphoma, and when it is mainly found in the blood or bone macalled ALL.*When it is mainly in the lymph nodes, it most commonly involvelymph nodes in the center of the chest. Both lymphoblastic lympand ALL are aggressive diseases that require intensive chemothincluding treatment for the central nervous system to prevent it spreading to the brain. Stem cell transplantation is sometimes usoften cured with these treatments.



Adult T-cell lymphoma/leukemia (human T-cell lymph

virus type I positive)- caused by a virus called the human T-cell lymphotrop

type I.

- an aggressive disease that most often involves the boskin; often, lymphoma cells are found in the blood, whwhy this condition is sometimes also called leukemia.

Chemotherapy does not usually work well for this formlymphoma, although zidovudine (Retrovir) and interfehelped some patients. About two-thirds of patients exremission (temporary or permanent absence of cancesymptoms).



Extranodal NK/T-cell lymphoma, nasal type

-an aggressive type of lymphoma that is very rare in thStates and Europe overall but more common in Asian Hispanic communities.

- can occur in children or adults, most often involving area and sinuses. It can also involve the trachea (windgastrointestinal tract, testicles (in men), or skin.

Standard chemotherapy does not often work well for of NHL, but radiation therapy followed by chemotherahelp treat the disease.



Enteropathy-associated T-cell lymphoma

-rare in the United States but more common in Eur

-it is an aggressive form of T-cell lymphoma that inthe intestines of patients who have celiac diseaseintolerance). High-dose chemotherapy may be ustreat enteropathy type T-cell lymphoma.

Gamma/delta hepatosplenic T-cell lymphoma- aggressive form of peripheral T-cell lymphoma thinvolves the liver and spleen. It occurs most often iadolescent and young men.



Subcutaneous panniculitis-like T-cell lymphoma-a form of peripheral T-cell lymphoma that is similar to gamhepatosplenic T-cell lymphoma-involves the tissue under the skin and is often first diagnosepanniculitis (inflammation of fatty tissues). It is treated as a aggressive lymphoma.

Mycosis fungoides- a rare T-cell lymphoma that primarily involves the skin. It overy long and indolent course, but may become more agand spread to lymph nodes or internal organs. Radiation thchemotherapy, or immunotherapy can help treat this formNew drugs have been developed for the treatment of cutlymphomas, some of which can be taken orally as a pill.





No common etiologic factor

Immunodeficiencies or autoimmune disease

Prior treatment for cancer;prior organ transplant

Viral infections (somesubtypes linked to Epstein-Barr virus, others to hepatitisB virus, some to herpesvirus)

Exposure to pesticidsolvents, dyes, defoagents including AgOrange



Appears to develop mainly from B cells but also from T cells & histocyte

Abnormal lymphoid tissue is diffuse or nodular (identified by tissue structure & patterns of infiltration)

Lymphoma may be follicular, interfollicular, mantle, or medullary(depends on distribution of malignant cells in specific regions of lymph no

Prognosis is more favorable in nodular lymphoma(diffuse form may spread throughout lymphatic system)



Lymphadenopathy (66%) swollen lymph glands; etonsils & adenoids; painless, rubbery nodes in cervsupraclavicular areas due to cellular proliferation

Dyspnea & coughing due to lymphocytic infiltratiooropharynx & thorax

Abdominal pain & constipation due to mechanicaobstruction of abdominal tissues

Fatigue, malaise, fever, weight loss, & night sweatsdisseminated disease & extensive tumor growth & to organs





Hypercalcemia

Hyperuricemia

Lymphomatosis (occurrence of multiple, widely dissites of involvement with lymphoma)

Meningitis

Anemia

Liver, kidney & lung problems from impingement blymphatic tumor growth

Possible increased intracranial pressure resulting frolymphatic involvement



CBC

Blood Test

Lymph node biopsy

Biopsy of tonsils, bone marrow, liver, bowel, or skin

Bone & chest X-rays, lymphagiography ( a test wh

utilizes x-ray technology, along with the injection ocontrast agent, to view lymphatic circulation and nodes for diagnostic purposes.), liver & spleen scaabdominal CT scanning, PET scans



Acute pain

Anxiety

Fatigue

Fear

Imbalanced Nutrition: Less than body requirement

Ineffective coping

Ineffective protection

Risk for infection



Radiation therapy

Chemotherapy

Bone marrow & stem cell transplants

Psychological support





Administer ordered pain medication & monitor its

effectiveness.

Provide for rest periods if the patient tires easily.

Watch for complications of chemotherapy such anausea & vomiting, anorexia, hair loss, mouth ulceinfection.

Offer the patient fluids such as grapefruit juice, ora juice, or ginger ale to counteract nausea.



Provide the patient with lots of fluids to help flush o

cells that are destroyed during treatment; this helpprevent tumor lysis syndrome

Provide a well-balanced, high calorie, high proteinConsult with the dietitian & plan small, frequent minclude the patient’s favorite foods. Schedule the

around the patient’s treatment. If the patient can’t tolerate oral feedings, administ

necessary, give antiemetics & sedatives as ordere





Make sure the patient receives thorough explanat

about all forms of treatment.

Instruct the patient to keep irradiated skin dry.

Urge the patient to report to physician any infectiodevelop.

Stress the importance of maintaining a well-balanhigh calorie, high protein diet.







1. Which one of the following organs is NOT a part of the

lymphatic system?a. spleenb. thymusc. bone marrowd. gallbladder

Answer is letter dRationale: The spleen, thymus, and bone marrow are a

important organs of the lymphatic system. The gallblapart of the digestive system, and stores bile that the livproduces.



2.The spleen is an organ that plays an important role in the ly

system's disease fighting abilities. Where is the spleen locata. the lower left side of the abdomen

b. the lower right side of the abdomen

c. the upper right side of the abdomen

d. the upper left side of the abdomen

Answer: letter d

Rationale: The spleen is a spongy organ located in the uppeof the abdomen, just underneath the left rib cage. Althougperson can live without a spleen (if the spleen becomes daand has to be removed), that person runs a higher risk of gdisease

3. Lymph nodes can sometimes become swollen and painfu



y p pcondition called lymphadenopathy. Which of the followingreason why your lymph nodes might swell?

a. arthritis

b. chickenpox

c. malignant cells

d. heartburn

Answer: letter d

Rationale: Because lymph nodes produce antibodies that fi

illnesses, when an disease starts to attack the body the discells are carried to the lymph nodes to be neutralized. Thisthem to grow larger. Viral illnesses (such as chickenpox), mcells (such as cancer), and inflammatory diseases (such ascan all cause swollen lymph nodes. Heartburn is caused byacid rising into the esophagus from the stomach, and doe

cause lymph nodes to enlarge



4. The thymus is a two-lobed organ located in the upper cits primary function is to mature lymphocytes (disease-fightblood cells) that help the body ward off illnesses. Does thegrow larger after puberty?

a. Yes

b. No

c. Maybe

d. none of the above

Answer: letter b

Rationale: The thymus actually grows smaller after puberty. Tbecause the thymus produces more lymphocytes than theneeds during childhood, so that by the time of puberty thehas compiled a stock of them. Therefore, the thymus can bremoved with little effect in an adult, but removing the thychild can seriously compromise their ability to fight infectio



5. A client diagnosed with Non-Hodgkin’s Lymphoma u

treatment (chemotherapy). To combat most commoneffect of chemotherapy, the nurse would administer aa. antiemeticb. antimetabolitec. antibioticd. anticoagulant

Answer: aRationale: Antiemetics are used to treat nausea and vo

Antimetabolites & tumor antibiotics are classes ofchemotherapeutic medications. Anticoagulants slow clotting time, thereby helping prevent thrombi & emb



6. A client is in the terminal stage of cancer (NHL) & he’s beitransferred to hospice care. Which information should the include in the teaching plan regarding hospice care?a. focus of care is on control of symptoms and relief of paib. a multidisciplinary team provides carec. services are provided on the ability to payd. bereavement care is provided to the family

Answer: a,b,d

Rationale: hospice care focuses on the control of symptomsrelief of pain at the end of life. A multidisciplinary team posconsisting of nurses, physicians, chaplains, aides & volunteprovides the care. After the client’s death, hospice providebereavement care to the grieving family. Hospice servicesprovided based on need not on the ability to pay.



7. A client recently diagnosed with metastatic cancer of the lymadmitted for hospice care. An acquaintance of the client calls

to ask how the client is doing. Which response by the nurse is bea. “He’s not doing to well; he has been admitted to hospice ca

b. “He’s” doing better, but he’s been admitted to the hospital”

c. “I’m not permitted to give you any information about his conconfidentially reasons; I’ll tell him you were asking about him”

d. “I don’t know who you’re talking about; you must have dialewrong number”

Answer: letter cRationale: The nurse must protect the client’s confidentiality; the n

shouldn’t disclose any information about the client’s condition. and b provide the caller with information about the client’s conOption d is an unprofessional response. The nurse can acknowleclient’s presence without breeching client confidentiality.

8. An adult client with Hodgkin’s disease who weighs 143lbs. T



8. An adult client with Hodgkin s disease who weighs 143lbs. Treceive vincristine (Oncovin) 25mcg/kg I.V. What is the corrin micrograms that the client should receive?

a. 1625 mcg

b. 1265 mcgc. 1562 mcg

d. 1652 mcg

Answer: letter a

First convert the client’s weight from pounds to kilograms:

1lb = 2.2 kg143lb / 2.2kg = 65kg

Next multiply the weight in kilograms by the number of microdesired per kilogram

65kg X 25mcg/kg = 1625mcg



9. A client who was diagnosed with lymphosarcomas is scheradiation therapy. The nurse knows that radiation at any tsite may cause a certain adverse effect. Therefore, the nuprepare the client to, except.a. hair lossb. stomatitisc. fatigued. vomiting

Answer: letter cRationale: Radiation therapy may cause fatigue, skin toxiciti

anorexia regardless of the treatment site. Hair loss, stomatitvomiting are site-specific, not generalized adverse effects radiation therapy



10. A client has malignant lymphoma. As part of her chemo

the physician prescribes chlorambucil (Leukeran), 10mg bydaily. When caring for the client, the nurse teaches her abadverse reactions to chlorambucil such as alopecia. How the administration of chlorambucil might reaction occur?

a. immediately

b. 1 week

c. 2 -3 weeks

d. 1 month

Answer: letter c

Rationale: Chlorambucil-induced alopecia occurs 2-3 weektherapy begins.

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Non – Hodgkin’s Lymphoma (NHL)