Lymphoma – Definition, Types, Symptoms, and Treatment

Lymphoma:

Definition: Lymphoma is the broadest category of blood cancer that involves lymphocytes that are found primarily in the lymphatic system.

Lymphoma is cancer of lymph tissue found in the lymph nodes, spleen, liver, and bone marrow. Lymph nodes make and store infection-fighting white blood cells, called lymphocytes

Classification of Lymphoma

• It is classified as Hodgkin’s Lymphoma and Non-Hodgkin’s Lymphoma.

History of HL       

• Hodgkin’s lymphoma was first described in an 1832 report by Thomas Hodgkin.
• In 1898 and 1902, respectively, Carl Sternberg and Dorothy Reed independently described the cytogenetic features of the malignant cells of Hodgkin’s lymphoma, now called Reed-Sternberg cells.

Main Difference between HL and NHL

• Both Hodgkin’s lymphoma and non-Hodgkin’s lymphoma are cancers that originate in a type of white blood cell (lymphocyte).
• Both of these malignancies may cause similar symptoms, but the conditions themselves are different.
• In Hodgkin’s disease, the abnormal lymphocyte is the Reed-Sternberg cell (B lymphocyte) that can be distinguished by examining the cell sample from a biopsy under a microscope but Non-Hodgkin’s lymphomas do not have Reed Sternberg cells.
• Hodgkin’s are often curable whereas Non- Hodgkin’s are noncurable.

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Hodgkin’s Lymphoma:

Because lymphatic tissue is present in many parts of the body, Hodgkin’s disease can start almost anywhere, but most often starts in lymph nodes in the upper part of the body. The most common sites are in the chest, neck, or under the arms. Hodgkin’s disease enlarges the lymphatic tissue, which can then cause pressure on important structures. It can spread through the lymphatic vessels to other lymph nodes.

The first sign of Hodgkin’s disease is often an enlarged lymph node. The disease can spread to nearby lymph nodes. Later it may spread to the lungs liver or bone marrow. The cause is unknown. The disease occurrence shows two peaks: the first in young adulthood (age 15-35) and the second in those over 55 years old.

When Hodgkin’s cells are examined microscopically, multinucleated Reed-Sternberg cells (RS cells) are the characteristic histopathologic finding. The survival rate is generally 90 % or higher when the disease is detected during the early stages.

When B cells develop into large abnormal cells these abnormal, cancerous cells are called Reed- Sternberg cells. Reed-Sternberg cells don’t die, and they continue to produce abnormal B cells in a malignant process. These cells also attract other normal immune cells that cause the lymph nodes to enlarge.

Risk factors:

The following are risk factors for Hodgkin’s lymphoma:

• Age: People between the ages of 15 and 40, as well as those older than 55, are most at risk of Hodgkin’s lymphoma.
• Family history
• Sex: Males are slightly more likely to develop Hodgkin’s lymphoma
• Viral infection: People who have had illnesses caused by the Epstein-Barr virus, such as infectious mononucleosis (characterized by fatigue, fever, pharyngitis, and Lymphadenopathy), are more likely to develop Hodgkin’s lymphoma.
• Compromised immune system: such as from HIV/AIDS or from having an organ transplant requiring medications to suppress the immune response, also appears to put the person at a greater risk of HL
• Socioeconomic status: Hodgkin’s lymphoma is more common in people with a higher socioeconomic background.

Signs and symptoms:

• Lymph nodes: the most common symptom is the painless enlargement of one or more lymph nodes. The cervical and supraclavicular nodes are most frequently involved (80-90 %). The lymph nodes of the chest are often affected, and these may be noticed on a chest radiograph
• Splenomegaly: Enlargement of the spleen occurs in about 30 % of people with Hodgkin’s lymphoma.
• Hepatomegaly: Enlargement of the liver due to liver involvement, is present in about 5 % of cases
• Hepatosplenomegaly: the enlargement of both the liver and spleen caused by the same disease.
• If the tumor infiltrates the spine and presses of the spinal cord, the client may develop manifestations range from early back pain with motor weakness and sensory loss to loss of motor function, urinary retention, constipation.
• If tumor infiltrates bone Marrow: may cause easy bleeding and petechiae due to low platelet count (as a result of decreased production, increased removal).
• If mediastinal mass enlarges: nonproductive cough and the chest film may reveal a mediastinal mass.
• Cyclical fever: patients may also present with a cyclical high-grade fever known as the Pel-Ebstein fever or more simply “P-E fever”.
• Systemic symptoms: about one-third of patients with Hodgkin’s disease present with systemic symptoms, including
• Low-grade fever
• Night Sweats
• Unexplained weight loss of at least 10 % of the patient’s total body mass in six months or less
• Fatigue (lassitude).

Systemic symptoms such as fever, night sweats, and weight loss are known as B symptoms.

Tests and diagnosis:

• Bone marrow aspiration and biopsy: A small amount of bone marrow, through a needle and are examined.
• Physical exam: Check for swollen lymph nodes, including in the neck, underarm, and groin, as well as a swollen spleen or liver
• X-rays: Can reveal swollen lymph nodes in the body
• Computerized tomography (CT) scan: Usually the chest, abdomen, and pelvis.
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) scan: A small amount of radioactive glucose (sugar) is injected into the vein. Glucose becomes more concentrated around cancerous cells, so when a scanner takes pictures of the body it can reveal where the cancer is located.

Staging Hodgkin’s lymphoma:

• Stage I: involvement of a single lymph node region or lymphoid structure.
• Stage II: Involvement of two or more lymph node region on the same side of the diaphragm or either above or below the diaphragm
• Stage II: Involvement of lymph node region or lymphoid structure on both side of the diaphragm or both above and below the diaphragm
• Stage IV: Involvement of extranodal site. Stage IV Hodgkin’s lymphoma affects not only the lymph nodes but also other parts of the body, such as the liver, lungs or bones.

Additional Definitions of Cancer:

• The letter means that patients have no significant symptoms.
• The letter B indicates that patients may have significant signs and symptoms, such as persistent fever, unintended weight loss or severe night sweats.
• The letter E stands for extranodal, which means that cancer has spread beyond lymph nodes.
• The letter S designates cancer that has spread into the spleen.

NOTE: The letters B, E, and S indicate potentially more serious.

Treatment:

1. Chemotherapy: Drug regimens have been developed for Hodgkin’s lymphomas are:

• ABVD, which consists of Adriamycin, Bleomycin, Vinblastine, and Dacarbazine.
• BEACOPP, which consists of Bleomycin, Etoposide, Adriamycin (doxorubicin), Cyclophosphamide, Vincristine, Procarbazine, and Prednisone.
• Stanford V, which consists of doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, and prednisone. Those taking this regimen are also treated with radiation therapy.
• COPP/ABVD, which consists of cyclophosphamide, vincristine, procarbazine prednisone, doxorubicin, bleomycin, vinblastine, and dacarbazine.
• MOPP, which consists of mechlorethamine vincristine, procarbazine, and prednisone

2. Radiation: When the disease is confined to a limited area, radiation therapy may be the treatment of choice. The length of radiation treatment varies, depending on the stage of the disease. Radiation therapy may be used alone, but it is commonly used with chemotherapy. Most children with Hodgkin’s lymphoma are treated with chemotherapy, but they may also receive low-dose radiation therapy
3. Stem cell transplantation: Stem cell transplants take place in the hospital. The stem cells may come from the patient’s own body or from a donor. New blood cells develop from the transplanted stem cells. Autologous stem cell transplantation: This type of transplant uses the patient’s own stem cells. Patient’s stem cells are removed before high-dose treatment. The cells may be treated to kill lymphoma cells that may be present. The stem cells are frozen and stored. After the patient receives high dose treatment, the stored stem cells are returned to the patient. Allogeneic stem cell transplantation: sometimes healthy stem cells from a donor are available. Patients’ brother, sister, or parent may be the donor But blood tests are essential to be sure whether the donor’s cells match patient’s cells.
4. Syngeneic stem cell transplantation: This type of transplant uses stem cells from a patient’s healthy identical twin

Nursing Intervention: Hodgkin’s disease:

• Provide a well balanced, high calorie, high protein diet.
• Offer the patient grapefruit juice, orange juice, ginger ale to alleviate nausea and vomiting
• Perform comfort measures that promote relaxation
• Assess the patient for nutritional deficiencies and malnutrition
• Explain all the procedures and treatments associated with the plan of care.
• If the patient is a woman of childbearing age, advise her to delay her pregnancy until long- term remission occurs
• Stress the importance of maintaining good nutrition by eating small frequent meals and drinking plenty of fluids.
• Instruct the patient to pace his activities to counteract therapy-induced fatigue
• Stress the importance of good oral hygiene to prevent stomatitis.
• Advise the patient to avoid crowds and any person with the known infection.
• Make sure that the patient understands the possible adverse effects of his treatments.
• Advise the patient to seek follow-up care after he has completed the initial treatment.

Non-Hodgkin lymphoma:

Non-Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal but not Reed-Sternberg cells (RS cells). The abnormal cell divides to make copies of itself, making more and more abnormal cells. The abnormal cells don’t die when they should. They don’t protect the body from infections or other diseases. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Types of non-Hodgkin lymphoma:

Lymphomas may be grouped by how quickly they are likely to grow:

• Indolent (also called low-grade) lymphomas grow slowly. They tend to cause few symptoms.
• Aggressive (also called intermediate-grade and high-grade) lymphomas grow and spread more quickly. They tend to cause severe symptoms.

Risk factors:

The following are the main types of infection that can increase the risk of lymphoma:

• Human immunodeficiency virus (HIV) People who have HIV infection are at much greater risk of some types of non-Hodgkin lymphoma.
• Epstein-Barr virus (EBV); Infection with EBV has been linked to an increased risk of lymphoma
• Helicobacter pylori: pylori are bacteria that can cause stomach ulcers. They also increase a person’s risk of lymphoma in the stomach lining.
• Hepatitis C virus: Some studies have found an increased risk of lymphoma in people with hepatitis C virus.
• Age: Most people with non-Hodgkin lymphoma are older than 60.

Symptoms: Non-Hodgkin’s lymphoma can cause many symptoms

• Swollen, painless lymph nodes in the neck, armpits, or groin
• Unexplained weight loss
• Fever
• Night Sweats
• Coughing, trouble breathing, or chest pain
• Weakness and tiredness
• Pain, swelling, or a feeling of fullness in the abdomen

Diagnosis:

• Physical Examination
• Chest x-rays to check for swollen lymph nodes or other signs of disease in the chest.
• Bone marrow biopsy
• CT scan
• MRI
• Ultrasound
• Spinal tap: The lab checks the fluid for lymphoma cells or other problems
• PET Scan
• Blood tests: Check for lactate dehydrogenase (LDH). Lymphoma may cause a high level of LDH.

Staging:

• Stage I to IV are the same as HD
• In addition to these stage numbers, we can describe the stage as A or B:

A: No weight loss, night sweats, or fevers.

B: weight loss, night sweats, or fevers.

Treatment:

• The choice of treatment depends mainly on the following:
  • It’s stage
  • How quickly the cancer is growing (whether it is. indolent or aggressive lymphoma)
  • Patient’s age
  • Whether the patients have other health problems
• Chemotherapy
• Radiation therapy
• Stem cell transplantation

Supportive care:

• Supportive care is essential to improve comfort and quality of life during treatment.
• Antibiotics and other drugs can be used to help protect from infections.
• Isolation: Advise the patients to stay away from crowds and from people with colds and other contagious diseases.
• Drugs or blood transfusions for anemia: Non- Hodgkin lymphoma and its treatment also can lead to anemia. Drugs or blood transfusions can help with this problem.
• Remember all care to be provided to all patients receiving radiation and chemotherapy.