Hodgkin's and NonHodgkin's Lymphoma

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Hodgkin's and Non-Hodgkin's Lymphoma

• Developed by Leslie S. Lorette RN, MSN

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Classification of Lymphomas

• Hodgkins
• Reed-Sternberg cells
• Metastasizes to other nearby lymphoid structures
  eventually invades nonlymphoid tissues
• Implicated factors
• Viral infections
• Exposure to alkylating chemical agents

• Non-Hodgkins
• All cancers originating from lymphoid tissues not
  diagnosed as Hodgkins
• gt 12 subtypes
• Low grade lymphomas
• Progress slowly
• High grade lymphomas
• Aggressive tumors
• More responsive to chemotherapy

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Clinical Manifestations

• The most common symptom is a painless swelling of
  the lymph nodes in the neck, underarm, or groin.
• Unexplained fever
• Night sweats
• Constant fatigue
• Unexplained weight loss
• Itchy skin
• Reddened patches on the skin

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Diagnostics

• Medical History
• Physical exam
• Laboratory
• Positron Emission Tomography (PET)
• CAT scan
• MRI
• Gallium Scan
• Lymph angiogram
• Biopsy
• Laparotomy

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Staging

• Stage I
• Hodgkin's disease is found in only 1 lymph node
  area, or has extended locally into adjacent
  tissue .
• Stage II
• Hodgkin's disease is found in 2 or more lymph
  node areas on the same side of the diaphragm
  (muscle beneath the lungs that moves up and down
  to help you breathe).
• The cancer extends locally from the lymph node(s)
  to adjacent tissue.
• Stage III
• Hodgkin's disease is found in lymph node areas on
  both sides of the diaphragm.
• The cancer may also have extended to an area or
  organ adjacent to the lymph node and/or to the
  spleen.
• Stage IV
• Hodgkin's disease has spread to 1 or more organs
  outside the lymphatic system such as the bone
  marrow or liver.

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Survival Rates for Hodgkins

• 5-year relative survival rate
• Stage
• I 90 to 95
• II 90 to 95
• III 85 to 90
• IV about 80

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Treatment

• Radiation
• Stage I and II w/o mediastinal node involvement
• External radiation of involved node regions
• Chemotherapy
• Multi-agent therapy
• Coupled with radiation
• Bone Marrow Transplantation
• Surgical Removal

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Expected Side Effects

• Pancytopenia
• Risk for infection, bleeding, and anemia
• Severe N V
• Skin irritation breakdown at radiation site
• Impaired hepatic function

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Nursing Interventions

• Excellent hand washing
• Aseptic technique
• Reverse isolation
• Monitor visitors
• No fresh fruits, vegetables or flowers
• Skin care for irritations
• Patient and family teaching
• Monitor laboratory results