Lymphoma

Introduction

• Lymphoma is the term applied

to a collection of diseases
characterized by a malignant
proliferation of lymphoid cells.
 Introduction
Lymphoma are malignant proliferation
of the lymphoid system.

It is an group of cancers that affect the

cells that play an role in immune
system, and primarily represent cells
involved in the lymphatic system of the
body.
 Lymphoma
• Lymphoma is a condition in which
the cells of the lymphatic system
begin to grow abnormally, which can
then spread to other parts of your
lymphatic system.
 Function of LYMPHATIC system

• Tissue drainage
• Absorption in the small
intestine
• Immunity
 Classification
According to presence or absence of Reed
Sternberg giant cells.

• Hodgkin’s lymphoma

• Non- Hodgkin’s lymphoma

• Hodgkin’s lymphoma
 Definition
• Any of various usually malignant
tumors that arise in the lymph nodes
or other lymphatic tissues, often
manifested by painless enlargement
of one or more lymph nodes.
 Classification

1.Nodular sclerosis
2.Mixed cellularity
3.Lymphocytic depleted
4.Lymphocytic predominant
 Definition
• Hodgkin's is type of lymphoma, a cancer that
starts in white blood cells is called
lymphocytes.

• Lymphocytes is part of the body immune

systems

• It is characterized by the presence of a

distinctive abnormal cell known as a Reed-
Sternberg cell.
 Reed-Sternberg cell present under microscope
• It begins when a
lymphocyte (usually a B
cell) becomes abnormal.

• The abnormal cell is called

a Reed-Sternberg cell. They
are different giant cells
found in Hodgkin’s
lymphoma
 Causes of Hodgkin’s lymphoma

• Unknown
 Risk factors include:
• Family history
• Infection with Epstein-Barr virus

• Weakened immune system, including

infection with HIV /AIDS

• Prolonged use of human growth hormone

• Exposure to occupational toxins.
 History
Hodgkin’s lymphoma/
disease is a type of
lymphoma first
described by Thomas
Hodgkin in 1832.
 Path physiology

Hodgkin's lymphoma is characterized by painless the

orderly spread of disease from one lymph node
group to another and by the development of
systemic symptoms with advanced disease.
and will spread throughout the lymphatic network.
 Contd..

• The malignant proliferating cells may invade

almost any area of the body and may produce
a wide variety of signs and symptoms.
 Contd…

As the disease progresses, the rapid

proliferation of abnormal lymphocytes leads
to an immunologic defect, particularly in cell-
mediated responses.
Clinical feature

• Painless swelling of the

lymph nodes :
• in the neck( Painless
lymph adenopathy)
• armpits
• groin
Hodgkin’s lymphoma in Neck
 Hodgkin’s lymphoma
• Fever at night sweats
• Weight loss.
• Fatigue & anorexia.
• Lethargy.
• Itching all over the body that cannot be
explained
• Loss of appetite
 Hodgkin’s lymphoma
• Red-coloured patches
on the skin, easy
bleeding and
petechiae due to low
platelet count.
 Investigations

• Blood for CBC

• Lymph node – biopsy
• Chest- X-ray P/A view
• USG of abdominal organ with abdominal
lymph- nodes
• CT –scan
• MRI- scan
• Bone marrow
 Treatment

• Chemotherapy
• Radiotherapy
• Antibiotics are used to control infection
• Stem cell transplant 
A stem cell transplant is a treatment to
replace your diseased bone marrow with
healthy stem cells that help you grow new
bone marrow.
 Chemotherapy drugs regimen

• The MOPP regimen

 Mechlorethamine(IV push).
 Vincristine (IV push).
 Procarbazine(oral).
 Predinisolone(oral).
• Non-Hodgkin lymphoma
 Introduction

• Non-Hodgkin's lymphoma (NHL) is a cancer of

lymphocytes, a type of white blood cell that
moves around the body as part of its role in the
immune system.
• NHL is much less predictable than HD
• It is more likely to spread to areas beyond the
lymph nodes.
• Non-Hodgkin's lymphoma represent a
monoclonal proliferation of lymphoid cells and
B – cell ( 70%) or T cell ( 30%) origin.
Definition Non-Hodgkin lymphoma

• It a form of malignant lymphoma

differing from Hodgkin's disease (HD)
by a lack of Hodgkin's-specific Reed-
Sternberg cells.
 Causes non-Hodgkin's lymphoma

• Unknown.
 Pathophysiology

• Non-Hodgkin's lymphoma occurs when body

produces too many abnormal lymphocytes —
a type of white blood cell.
 Conti..
• Normally, lymphocytes go through a
predictable life cycle. Old lymphocytes die,
and body creates new ones to replace them.
• In non-Hodgkin's lymphoma, old
lymphocytes don't die, but continue to grow
and divide.
• This oversupply of lymphocytes crowds into
lymph nodes, causing them to enlarged .
 Risk factors

• Medications that suppress immune system.

• Due to organ transplant.

• Infection with certain viruses eg: HIV, Epstein-Barr

virus

• Bacteria such as ulcer-causing Helicobacter pylori.

• Chemicals
 Non-Hodgkin’s clinical features

• Hepatosplenomegaly may present

• Other symptoms :
• weight loss
• fever
• sweats and
• itching
 Non-Hodgkin’s lymphoma

• Lymph node
enlargement
 Investigations

• Diagnosis is made by laboratory study of tissue obtained by taking a biopsy of

the suspicious lymph node or nodes by FNAC for biopsy

 
• Bone marrow examination. This is done by collecting a biopsy of the bone
marrow. Samples of both liquid (aspirate) and solid bone marrow (biopsy) are
taken, usually from a hip bone. Bone marrow containing certain types of
abnormal B or T lymphocytes confirms lymphoma.

• HIV testing : This may appropriate if risk factors are present

 
• Blood CBC
• Computerized tomography (CT)

• Magnetic resonance imaging (MRI)

 Treatment
• Chemotherapy.
• Radiation therapy.
• Stem cell transplant.
• Medications that enhance your immune
system's ability to fight cancer.
• Medications that deliver radiation directly to
cancer cells.
 Chemotherapy drugs regimen
• I/V combination chemotherapy,
CHOP regimen.
1) Cyclophoshamides.
2) Adriamycin
3) Vincristin( Oncovin).
4) Predinisolone
 Difference between
• Hodgkin’s lymphoma
• Non Hodgkin’s lymphoma
 Hodgkin’s summary
• Much less common
• Hodgkin's lymphoma is one of the rarer types of
lymphoma
• Reed-Sternberg giant cell present on lymph node
biopsy
• It is most common ages at young and elderly
• Onset is gradual
• Systemic features are common esp. Pruritus is most
common

• Lympadenopathy
i. More often localized to a single axial group of node( cervical)
ii. Extra nodal involvement uncommon
 Non-Hodgkin’s summary
• Most common cancer
• Non-Hodgkin's lymphoma is more common than —
Hodgkin's disease.
• Reed-Sternberg giant cell absent on lymph node biopsy
• Extremes of age
• Onset is any time
• Systemic features are uncommon
• Lympadenopathy
I. More frequent involvement of multiple
peripheralnodes
II. Extra nodal involvement common
 Complications

• CNS: It can affect the

eyes, brain, and spinal
cord.
 Cardiovascular and Pulmonary Systems

• There are collections of lymph nodes in the

chest which grown to compress the heart, its
blood vessels and the tubing, called bronchi,
leading from the throat to the lungs.
 Liver and Kidneys

• Liver dysfunction can lead to jaundice and

increased toxins in the blood such as
ammonia, which causes confusion and
lethargy
• Without the proper function of kidney toxins
such as urea may build up, the blood may
become more acidic and the blood
pressure can rise, leading to lethargy,
confusion, headaches or shortness of breath.
 References
• Brunner and Suddarth (2008), Textbook of
Medical-Surgical Nursing, 11th edition,
Lippincott Williams and Wilkins.
• Google(
http://en.wikipedia.org/wiki/Lymphoma).

• http://www.emedicinehealth.com/lymphom
a/article_em.htm
 References
• Haslett Christopher.et all (2002) Davidson’s
Principles and practice of Medicine, 19th edi,
Churchill Livingstone London
• Lange Patrica, A (2002) Pathophysology
made Incresibly Easy, 10th edi, Lippincott ,
Philadelphia, London
 Rferences

• Monahan Frances Donovan (2007), Phipps’

Medical Surgical Nursing- Health and Illness
Perspectives, 8th edi, Mosby Inc, Philadelphia.
• Nettina Sandra M. (1996), The Lippincot
Manual of Nursing Practice, 6th edi, J.B
Lippincott, Philadelphia.
• Thank you
Date: 9.9.2012