Lymphoma is a cancer that affects the lymphatic system. There are two main types: Hodgkin's lymphoma and non-Hodgkin's lymphoma. Hodgkin's lymphoma is characterized by the presence of Reed-Sternberg cells and most often presents with painless swelling of lymph nodes in the neck. Treatment involves chemotherapy, radiation therapy, and sometimes stem cell transplantation. Nurses play an important role in managing side effects of treatment and providing psychological support.

2. LYMPHOMA
Lymphoma are malignant neoplasm's
originating in the bone marrow &
lymphatic structures resulting in the
proliferation of lymphocytes

3. LYMPHOMA
 Lymphoma are a
cancer of the
lymphatic system
 Lymphatic vessels
 Lymph nodes
(underarms, groin,
neck, spleen,
tonsils and bone
marrow)

5.  The lymphatic system is part of the circulatory
system and a vital part of the immune system,
comprising a network of lymphatic vessels that
carry a clear fluid called lymph (from
Latin lympha meaning water) directionally
towards the heart

7. LYMPH NODES
 Lymph nodes are small ,bean shaped organs
that filter lymph.
 Lymph nodes vary in size but are usually <2.5
cm across.
 Lymph nodes contain 2 types of WBC that
fight invading microorganisms
1) Lymphocytes
2)macrophage

8.  Lymphocytes (B-cell and T-cell)
 Carried through our lymphatic system and help our
bodies fight infection
 Lymphocytes are carried through the lymph vessels
as well as the blood stream, so cancer can start in
nodes and spread anywhere throughout the body.

9. How do lymphomas develop?
 Our lymphocytes are always dividing to make
new lymphocytes .when fighting an
infection,lots of nwe lymphocytes are
made.only those that are very specific for
that target infection are useful to the immune
system ,rest die.
 Lymphoma occur when instead of dying in
the normal way,untargeted “rogue”
lymphocytes divide in a uncontrolled
way&collect toghether to form a lump in
lymph node called LYMPHOMAS

10. Lymphoma
Hodgkin’s
Non Hodgkin’s
15% 85%

12.  Hodgkin’s disease primarily
arises within the lymph nodes
involves the extranodal sites.

13. DEFINITION
 HL is a malignant condition
characterised by proliferation of
abnormal giant ,multinucleated
cells called REED –STRENBERG
CELLS which located in lymph
nodes.

14. INCIDENCE
 Bimodal age distribution :
 young adults ( 20-30 yrs) & elderly (>
50yrs) May occur at any age
 It is more prevalent in young adult males
than females.

16. REED –STERNBERG CELL
 The diagnosis of HD rests on identification of
RS cells.
 The various of RS cells which characterise
different histologic subtypes of HD:-
1) Classic RS cells
2)Lacunar type RS cell
3) Polypoid type
4)Pleomorphic RS cells

18. RS cell and variants
popcorn celllacunar cellclassic RS cell
(mixed cellularity) (nodular sclerosis) (lymphocyte
predominance)

19. Hodgkin lymphoma
Histologic subtypes
 Classical Hodgkin lymphoma
 nodular sclerosis (most common subtype)
 mixed cellularity
 lymphocyte-rich
 lymphocyte depleted

20. Classical Hodgkin Lymphoma

21. Etiology
 Idiopathic
 EBV infection(Epstein –barr virus)
 Age
 Past epstein –barr infection
 Weakened immune system
 Alchohol &smoking
 UV radiation exposure

22. PATHOPHYSIOLOGY
 EPSTEIN –BARR VIRUS
INFECTED B-CELLS LYMPHOCYTES
EXPRESS LATENT MEMBRANE PROTEIN
UPREGULATES NUCLEAR FACTOR-kB

23. LEAD TO EXCESSIVE B-CELLS
PROLIFERATION
INCREASE B -CELLS
MUTATION IN IMMUNOGLOBULIN GENE OF
B-CELL
PRODUCTION OF RS CELL
HODGKIN LYMPHOMA

25. Clinical features
 Lymphadenopathy:
 most often cervical region
 asymmetrical, discrete
 painless, non-tender
 elastic character on palpation ( rubbery)
 not adherent to skin
 fluctuate in size

26.  Contiguous spread via the lymphatic chain
eg.involvement of abdominal & thoracic LNs
 Extra nodal disease - rare
 Hepatospleenomegaly

27.  Constitutional symptoms ( B symptoms ))
 Night sweats,
 sustained fever > 38 degree celsius,
 loss of weight >10% of body weight in 6 mo
 Fever sometimes cyclical (‘Pel-Ebstein fever’)
 Pain at the site of disease after drinking alcohol
 Pallor
 Pruritis
 Symptoms of Bulky (>10 cm) disease

28. >10 cm
Bulky disease

29. DIAGNOSTIC EVALUATION
 Physical examination
 Peripheral blood analysis
 Excisional lymph node biopsy
 Radiologic examination
1)X-Ray
2) Computerised tomography
3)PET

30.  LN FNAC / biopsy :
 Malignant REED-STERNBERG ( RS) Cell: Bi-
nucleate cell with a prominent nucleolus.
Derived from B cell, at an early stage of
differentiation
 Reactive background of eosinophils,
lymphocytes, plasma cells
 Fibrous tissue

32. LymphangiographyLymphangiography

33. Ann Arbor staging classification
 Stage I : Involvement of single LN region (I) or extra
lymphatic site (IAE )
 Stage II : Two or more LN regions involved (II) or an extra
lymphatic site and lymph node regions on the same side
of diaphragm
 Stage III : Involvement of lymph node regions on both
sides of diaphragm, with (IIIE) or without (III) localized
extra lymphatic involvement or involvement of the spleen
(IIS) or both (IISE)
 Stage IV : Involvement outside LN areas (Liver, bone
marrow)
A : Asymptomatic
B : B symptoms present
E : Extranodal involvement S:spenomegaly

36.  Non-Hodgkin lymphoma (also known as non-
Hodgkin’s disease, NHL, or sometimes just
lymphoma) is a cancer that starts in cells
called lymphocytes, which are part of the
body’s immune system.

39. Contrasting feature of HL &NHL
FEATURE
Cell derivation
Nodal
involvement
Extranodal
spread
HL NHL
B cell mostly 90%B
10% T
Localised disseminated
nodal spread
Uncommon common

40. Bone marrow
involement
Constitutional
symptoms
Chromosomal
defects
prognosis
Uncommon common
common uncommon
Aneuploidy translocation
,deletion
Better bad

48. RADIATION THERAPY
Radiation therapy is a local treatment modality
for cancer.
• Radiation therapy uses high –energy rays to
destroy cancer cells
• External beam radiation is delivered to treat
the HD
• Most often,radiation treatment are given 5
days a week for several days or week
• For classic HD ,radiation is often given after
chemotherapy.

49. Possible side -effect
 Short term side effect
1) Skin changes similar to sun burn
2)Feeling tired
3) Dry mouth
4)Nausea
5) Diarrhoea

50. Long term side effect
1) Thyroid hormone problem
2) Heart disease
3) Lung problem
4) Fatique
5) Weight gain

51. Problem Nursing management
 GIT
Stomatitis,mucositis,
esophagitis
Nausea and vomiting
Diarrhoea
 Asess oral mucosa daily and
teach patient to do so
 Discourage use of tobacco and
alcohol
 administer antiemetics
 Monitor weight
Give antidiarrheal
Encourage low-fiber ,low residue
diet
Encourage fluid intake of 3l

52. hepatotoxicity Monitor LFT
Alopecia  Suggest ways to cope with
hair loss
 Cut long hair before
therapy
 Discuss impact of hair loss
on self image

53. Surgical management
 Surgery is not really used as a treatment for
HD
 The main treatment are chemotherapy and
radiation therapy
 Surgery is associated with staging with
laprotomy and splenectomy.
 ASCT :-Autologous stem cell transplant
(ASCT) plays an integral role in the treatment
of patients with Hodgkin’s lymphoma.

54.  Autologous stem-cell transplantation (also
called autogenous, autogeneic, or autogenic stem-cell
transplantation and abbreviated auto-SCT)
is autologous transplantation of stem cells—that is,
transplantation in which stem cells (undifferentiated cells
from which other cell types develop) are removed from a
person, stored, and later given back to that same person.
Although it is most frequently performed
with hematopoietic stem cells (precursors of blood-
forming cells) in hematopoietic stem cell
transplantation, cardiac cells have also been used
successfully to repair damage caused by heart attacks.

55.  Autologous stem-cell transplantation is
distinguished from allogenic stem cell
transplantation where the donor and the
recipient of the stem cells are different
people.

58. Patient undergoing
chemotherapy and radiation
therapy
 Nurses plays an important role in identifying
,reporting &helping patient deal with the side effect
of radiation and chemotherapy
 Educating patients about their treatment regimen
and supportive care plan.
 Reduce the fear and anxiety.
 Teach about common side effect of chemotherapy

59. MANAGEMENT OF CANCER PAIN
 Moderate to severe pain occurs in
approximately 50% of patients
 Pain assessment is needed to determine the
effectiveness of the treatment plan .
Location
intensity
Quality
Pattern

61.  Drug therapy like NSAIDS and adjuvant pain
medication should be used.

62. PSYCHOLOGIC SUPPORT
 Pyschological suport of the patient is an
important aspect of cancer care.
 A positive attitudes may also influence the
prognosis of the patient ,although there is no
scientific evidence to ssupport that concept
 Common fears experienced by the patient
with cancer include disfigurement
,dependency,disruptions of relationship
,pain ,emaciation financial.

63. NURSING DIAGNOSIS
 Anxiety related to the diagnosis of hodgkin’s
disease and effects of treatment on job
performance
 Risk for infection related to potential bone
marrow depression due to chemotherapy.
 Fatique related to effects of cancer
,chemotherapy,radiation therapy.

64. Anxiety related to the diagnosis of
hodgkin’s disease and effects of
treatment on job performance
GOAL:- To reduce the anxiety
INTERVENTION:-
1)Encourage verbalization of feelings
,perception,and fears to understand patients
perspective of situation ,treatmenet and
prognosis to begin adjustment & acceptance.
2)Provide factual information concerning
diagnosis ,treatment and to reduce patients
sense of helplessness &increase sense of
control.

65. 3) Encouarge family to stay with patient to
provide caring and support.

66. Risk for infection related to
potential bone marrow depression due
to chemotherapy.
GOAL:-
INTERVENTION:-
1) Monitor for systemic &localised
signs and symptoms of infection to
promote early detection of infection.
2) Maintain sterile technique when
bonemarrow suppression technique is
done.
3) Administer the immuno sppression.

67.  4)observe & reports signs of infection such as

68. Disturbed body image
 Assess perception of body image through
subjective data such as:-
●Current understandinf of health and
limitations imposed by illness or treatment.
● feelings about the illness and its effect on
perception of self and others.
Discuss the risk for and measures to cope
with alopecia.
●Discuss available resources for financial
assistance with purchase of wigs .

69. Sexual dysfunction
 Encourage discussion of actual or potential
sexual dysfunction or sterility with the client
and significant other.
 Assess knowledge ,provide
information,clarify misconceptions.
 Discuss realistic measures for coping.(for
eg.sperm banking prior to chemotherapy or
radiation therapy).
 Refer for counselling as indicated.

70. Risk for impaired skin
integrity.
 Frequently assess skin, especially in areas
undergoing radiation .
 Provide and teach measures to promote
comfort and relieve itching.
 Use cool water and a mild soap to bathe;blot
dry skin ;use light weight blankets and
adequate.
 Maintain adequate humidity and a cool room
temperature .

71. Health Education
►Teach the patient & patient’s relative about
HL.
►Chemotherapy and radiation therapy are the
main treatment for HD.
►Preventing infection after cancer treatment .
►Teach how to prevent the infection ways
include:-
●Practice good hygiene ,including regular hand
washing,
●Avoids crowds.

72.  Eat only well-cooked foods
 Boil tap water before drinking it.
►Teach the patient’s relative to provide
pyschological support.
►Teach the patient about pain management
,chemotherapy,radiation therapy.