Lymphomas account for 10-15% of childhood cancers and are cancers of lymphocytes. The two main forms are Hodgkin's lymphoma and non-Hodgkin's lymphoma. Hodgkin's lymphoma is characterized by abnormal Reed-Sternberg cells in lymph nodes and commonly presents with painless lymphadenopathy. It has a bimodal age distribution and is treated with chemotherapy and/or radiation. Non-Hodgkin's lymphoma is more aggressive and heterogeneous, involving lymphocytes at different developmental stages. It has a variety of clinical presentations depending on the site of spread and commonly presents with widespread disease.
Adcetris 50 mg is an antibody-drug conjugate approved for the treatment of patients with relapsed/refractory Hodgkin lymphoma (HL) and systemic anaplastic large cell lymphoma (ALCL). The adcetris 50 mg selectively targets tumor cells expressing the CD30 antigen, a defining marker of HL (Hodgkin lymphoma) and Anaplastic Large Cell Lymphoma.
The non-Hodgkin lymphomas include a diverse and complex group of malignancies of lymphoreticular histogenesis and differentiation.
In most instances, they initially arise within lymph nodes and tend to grow as solid masses.
The non-Hodgkin lymphomas most commonly originate from cells of the B-lymphocyte series, with an estimated 85% of European and American lymphoid neoplasms having this derivation.
Tumors with a T-lymphocyte derivation are less common, whereas true histiocyte-derived lymphomas are even rarer.
Genetic abnormalities like nonrandom chromosomal and molecular rearrangements play an important role in the pathogenesis of many lymphomas and correlate with histology and immunophenotype.
Most lymphomas do not have a familial pattern; however, coexistence of multiple breast cancers, ovarian cancer, sarcomas, and lymphomas in a family may suggest an inherited abnormality in tumor suppressor genes.
Environmental factors also seem to play a role in the development of NHL. Certain chemicals have been linked to the development of NHL include a variety of pesticides and herbicides (e.g. organophosphates, chlorophenols), solvents and organic chemicals (e.g. benzene, carbon tetrachloride), and wood preservatives.
Thus certain workers like pesticide applicators, workers in the petroleum, rubber, plastics, and synthetic industries have a slightly increased risk of NHL.
Patients who receive cancer chemotherapy and/or radiation therapy are at increased risk of developing NHL.
Several viruses have been implicated in the pathogenesis of NHL, including the Epstein-Barr virus in Burkitt’s lymphoma (especially in endemic areas of Africa), sinonasal lymphoma in Asia and South America, and lymphomas in immunocompromised patients; HTLV-1 Human T-lymphotropic Virus in adult T-cell lymphoma/leukemia; and human herpesvirus 8 (HHV 8) in body cavity-based lymphomas in patients with HIV infection.
Immunodeficiency states that seem to predispose to NHL include congenital immunodeficiency states (e.g. ataxia telangiectasia, Wiskott–Aldrich syndrome, common variable hypogammaglobulinemia, severe combined immunodeficiency (SCID) as well as acquired immunodeficiency states (e.g. HIV infection, iatrogenic immunosuppression for solid organ or bone marrow transplant recipients).
Connective-tissue disorders, including Sjögren syndrome, rheumatoid arthritis, chronic lymphocytic thyroiditis, and systemic lupus erythematosus (SLE) are also associated with increased risk of NHL.
The microscopic appearance of the lesional cells was used in the past to classify the tumors as either lymphocytic or histiocytic.
With the development of modern immunologic techniques, however, it is now known that many of the lesions that had been classified as histiocytic were in fact neoplasms composed of transformed B lymphocytes. In the early 1980s, a group of American pathologists devised a classification scheme, known as the Working Formulation for Clinical Use.
Adcetris is approved for treating patients with relapsed/refractory Hodgkin lymphoma. It is also approved to treat patients with anaplastic large cell lymphoma. Adcetris comes in a single strength: 50 mg. It is available as a powder in a single-dose vial. The powder is mixed into a liquid solution, which is then administered by a healthcare provider as an intravenous (IV) infusion. Patients will likely have adcetris infusions each two/three weeks.
Lymphoma is the cancer of immune cells or infection-fighting cells of the immune system known as lymphocytes. These cells are present in the lymph nodes, bone marrow, spleen, thymus, and other parts of the body.
For more information: www.cancertame.com
Email Id: support@cancertame.com
Adcetris 50 mg is an antibody-drug conjugate approved for the treatment of patients with relapsed/refractory Hodgkin lymphoma (HL) and systemic anaplastic large cell lymphoma (ALCL). The adcetris 50 mg selectively targets tumor cells expressing the CD30 antigen, a defining marker of HL (Hodgkin lymphoma) and Anaplastic Large Cell Lymphoma.
The non-Hodgkin lymphomas include a diverse and complex group of malignancies of lymphoreticular histogenesis and differentiation.
In most instances, they initially arise within lymph nodes and tend to grow as solid masses.
The non-Hodgkin lymphomas most commonly originate from cells of the B-lymphocyte series, with an estimated 85% of European and American lymphoid neoplasms having this derivation.
Tumors with a T-lymphocyte derivation are less common, whereas true histiocyte-derived lymphomas are even rarer.
Genetic abnormalities like nonrandom chromosomal and molecular rearrangements play an important role in the pathogenesis of many lymphomas and correlate with histology and immunophenotype.
Most lymphomas do not have a familial pattern; however, coexistence of multiple breast cancers, ovarian cancer, sarcomas, and lymphomas in a family may suggest an inherited abnormality in tumor suppressor genes.
Environmental factors also seem to play a role in the development of NHL. Certain chemicals have been linked to the development of NHL include a variety of pesticides and herbicides (e.g. organophosphates, chlorophenols), solvents and organic chemicals (e.g. benzene, carbon tetrachloride), and wood preservatives.
Thus certain workers like pesticide applicators, workers in the petroleum, rubber, plastics, and synthetic industries have a slightly increased risk of NHL.
Patients who receive cancer chemotherapy and/or radiation therapy are at increased risk of developing NHL.
Several viruses have been implicated in the pathogenesis of NHL, including the Epstein-Barr virus in Burkitt’s lymphoma (especially in endemic areas of Africa), sinonasal lymphoma in Asia and South America, and lymphomas in immunocompromised patients; HTLV-1 Human T-lymphotropic Virus in adult T-cell lymphoma/leukemia; and human herpesvirus 8 (HHV 8) in body cavity-based lymphomas in patients with HIV infection.
Immunodeficiency states that seem to predispose to NHL include congenital immunodeficiency states (e.g. ataxia telangiectasia, Wiskott–Aldrich syndrome, common variable hypogammaglobulinemia, severe combined immunodeficiency (SCID) as well as acquired immunodeficiency states (e.g. HIV infection, iatrogenic immunosuppression for solid organ or bone marrow transplant recipients).
Connective-tissue disorders, including Sjögren syndrome, rheumatoid arthritis, chronic lymphocytic thyroiditis, and systemic lupus erythematosus (SLE) are also associated with increased risk of NHL.
The microscopic appearance of the lesional cells was used in the past to classify the tumors as either lymphocytic or histiocytic.
With the development of modern immunologic techniques, however, it is now known that many of the lesions that had been classified as histiocytic were in fact neoplasms composed of transformed B lymphocytes. In the early 1980s, a group of American pathologists devised a classification scheme, known as the Working Formulation for Clinical Use.
Adcetris is approved for treating patients with relapsed/refractory Hodgkin lymphoma. It is also approved to treat patients with anaplastic large cell lymphoma. Adcetris comes in a single strength: 50 mg. It is available as a powder in a single-dose vial. The powder is mixed into a liquid solution, which is then administered by a healthcare provider as an intravenous (IV) infusion. Patients will likely have adcetris infusions each two/three weeks.
Lymphoma is the cancer of immune cells or infection-fighting cells of the immune system known as lymphocytes. These cells are present in the lymph nodes, bone marrow, spleen, thymus, and other parts of the body.
For more information: www.cancertame.com
Email Id: support@cancertame.com
oth Hodgkin's lymphoma and non-Hodgkin's lymphoma are lymphomas — a type of cancer that begins in a subset of white blood cells called lymphocytes. Lymphocytes are an integral part of your immune system, which protects you from germs.
REFERENCES
cancer.org | 1.800.227.2345
Advances in the diagnosis and management
of lymphoma
Zachary H Word1
Matthew J Matasar1,2
1
Lymphoma Service, Department of
Medicine, Memorial Sloan–Kettering
Cancer Center, 2
Department of
Medicine, New York Presbyterian
Hospital, New York, NY, USA
Correspondence: Matthew J Matasar
Memorial Sloan–Kettering Cancer Center,
1275 York Avenue, New York,
NY 10065, USA
Tel +1 212 639 8889
Fax +1 646 422 2291
Email matasarm@mskcc.org
Lymphoma and CLL Forms
Parameswaran Hari, MD, MS
CLymphoma 101: The Basics
Neha Mehta-Shah, MD, MSCI
Assistant Professor
Department of Medicine
Division of Oncology
IBMTR , Milwaukee
This is a lecture on Lymphoma, exploring the different types and subtypes of Lymphomas. It also discusses the epidemiology, stages, clinical features, diagnosis, treatment and prognosis.
This was presented to undergraduate medical students at University Teaching Hospital (UTH), department of Cancer Disease Hospital by Nghitukuhamba Tangi Elikana Kalipi (6th year medical student) at Cavendish University Zambia, School of Medicine.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
oth Hodgkin's lymphoma and non-Hodgkin's lymphoma are lymphomas — a type of cancer that begins in a subset of white blood cells called lymphocytes. Lymphocytes are an integral part of your immune system, which protects you from germs.
REFERENCES
cancer.org | 1.800.227.2345
Advances in the diagnosis and management
of lymphoma
Zachary H Word1
Matthew J Matasar1,2
1
Lymphoma Service, Department of
Medicine, Memorial Sloan–Kettering
Cancer Center, 2
Department of
Medicine, New York Presbyterian
Hospital, New York, NY, USA
Correspondence: Matthew J Matasar
Memorial Sloan–Kettering Cancer Center,
1275 York Avenue, New York,
NY 10065, USA
Tel +1 212 639 8889
Fax +1 646 422 2291
Email matasarm@mskcc.org
Lymphoma and CLL Forms
Parameswaran Hari, MD, MS
CLymphoma 101: The Basics
Neha Mehta-Shah, MD, MSCI
Assistant Professor
Department of Medicine
Division of Oncology
IBMTR , Milwaukee
This is a lecture on Lymphoma, exploring the different types and subtypes of Lymphomas. It also discusses the epidemiology, stages, clinical features, diagnosis, treatment and prognosis.
This was presented to undergraduate medical students at University Teaching Hospital (UTH), department of Cancer Disease Hospital by Nghitukuhamba Tangi Elikana Kalipi (6th year medical student) at Cavendish University Zambia, School of Medicine.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Surgical Site Infections, pathophysiology, and prevention.pptx
LYMPHOMA.pptx
1. . Lymphomas
• Lymphomas account for 10–15% of childhood cancers.
• Lymphomas, are cancer of called lymphocytes, classified as
Hodgkin’s and non-Hodgkin’s depending on the immune cell
type, are characterized by abnormal proliferation of
lymphocytes.
• The two forms of lymphoma are:
i. Hodgkin ’s disease
ii. Non -Hodgkin ’s lymphoma
2. Hodgkin ’s disease:
• Is a cancer of the antigen-processing cells found within the
lymph nodes or spleen and sometimes tonsils and bone
marrow
• It makes up about 11% of all lymphomas.
• It is a malignant condition characterized by proliferation of
abnormal giant, multinucleated cells, called Reed-Sternberg
cells, which are located in lymph nodes.
• It’s a malignancy of the lymph nodes that originates in a
single lymph node or a chain of nodes.
3. Cont’d
• The disease has a bimodal age-specific incidence, occurring most
frequently in persons from 15 to 35 years of age and above 50 years of
age.
• In adults, it is twice as prevalent in men as in women.
• Each year, approximately 9060 new cases of Hodgkin’s lymphoma are
diagnosed and approximately 1200 deaths occur.
• However, long-term survival exceeds 85% for all stages
• Metastasis occurs to other, adjacent lymph structures and eventually
invades nonlymphoid tissue.
4. Etiology & Pathophysiology of Hodgkin’s disease
• The cause of Hodgkin’s lymphoma remains unknown,
• several key factors are thought to play a role in its development.
• The main interacting factors include:
• infection with Epstein-Barr virus (EBV),
• genetic predisposition, and
• exposure to occupational toxins.
• The incidence of Hodgkin’s lymphoma is increased among patients who have HIV
infection
Clinical features.
Most children with Hodgkin’s disease present with painless lymphadenopathy
5. CONT’D
• Normally, the lymph nodes are composed of connective tissues that
surround a fine mesh of reticular fibers and cells.
• In Hodgkin’s lymphoma the normal structure of lymph nodes is destroyed
by hyperplasia of monocytes and macrophages.
• The main diagnostic feature of Hodgkin’s lymphoma is the presence of
Reed-Sternberg cells in lymph node biopsy specimens.
• The disease is believed to arise in a single location (it originates in cervical
lymph nodes in 70% of patients) and then spreads along adjacent
lymphatics.
• However, in recurrent disease, it may be more diffuse and not necessarily
contiguous.
• It eventually infiltrates other organs, especially lungs, spleen, and liver.
When the disease begins above the diaphragm, it remains confined to
lymph nodes for a variable time.
• Disease originating below the diaphragm frequently spreads to
extralymphoid sites such as the liver.
7. Main areas of lymphadenopathy and organ
involvement in Hodgkin’s disease
8. Cont’d
• The disease predictably metastasizes to nonnodal or extralymphatic
sites, especially the spleen, liver, bone marrow, lungs, and
mediastinum.
• Hodgkin’s disease is characterized by the presence of Reed-Sternberg
cells noted in a lymph node biopsy specimen.
• Peak incidence is in mid-adolescence.
• Possible causes include viral infections and previous exposure to
alkylating chemical agents.
• The prognosis is excellent, with long-term survival rates depending on
the stage of the disease.
• The primary treatment modalities are radiation and chemotherapy;
each may be used alone or in combination, depending on the clinical
stage of the disease.
9. Clin ical Fe atu re Hodgkin’s Disease Non-Hodgkin ’s
Lymphom a
Symptom onset
Common location
Systemic
symptoms(fever, night
sweets and weight loss)
Abdominal
findings(abdominal pain,
abd mass, obstruction)
Painless adenopathy
SVC syndrome
Airway compression
Slow, indolent
Cervical and
supraclavicular nodes
Relatively common
(30%)
Rare
common
rare
rare
Rapid
Abdominal, mediastinal,
and supraclavicular
nodes
Uncommon
common
common
common
common
10.
11.
12. Assessment: signs and symptoms
• Painless enlargement of lymph nodes
• Enlarged, firm, non-tender, movable nodes in the supraclavicular
area; in children, the “sentinel” node located near the left clavicle
may be the first enlarged node
• Nonproductive cough as a result of mediastinal lymphadenopathy
• Abdominal pain as a result of enlarged retroperitoneal nodes
• Advanced lymph node and extralymphatic involvement that may
cause systemic symptoms, such as a low-grade or intermittent fever,
anorexia, nausea, weight loss, night sweats, and pruritus
• Positive biopsy specimen of a lymph node (presence of Reed-
Sternberg cells) and positive bone marrow biopsy specimen
• Computed tomography scan of the liver, spleen, and bone marrow
may be done to detect metastasis.
13. CLINICAL MANIFESTATION
• The onset of symptoms in Hodgkin’s lymphoma is usually insidious.
• The initial development is most often enlargement of cervical, axillary,
or inguinal lymph nodes; a mediastinal node mass is the second most
common location. This lymphadenopathy affects discrete nodes that
remain movable and nontender.
• The enlarged nodes are not painful unless they exert pressure on
adjacent nerves.
14. CONT’D
• The patient may notice weight loss, fatigue, weakness, fever, chills,
tachycardia, or night sweats.
• A group of initial findings including fever (in excess of 100.4° F [38°
C]), drenching night sweats, and weight loss (exceeding 10% in 6
months) are termed B symptoms and correlate with a worse
prognosis.
• After the ingestion of even small amounts of alcohol, individuals with
Hodgkin’s lymphoma may complain of a rapid onset of pain at the site
of disease. The cause for the alcohol-induced pain is unknown.
• Generalized pruritus without skin lesions may develop.
• Cough, dyspnea, stridor, and dysphagia may all reflect mediastinal
node involvement.
15. CONT’D
• In more advanced disease, there may be hepatomegaly and
splenomegaly.
• Anemia results from increased destruction and decreased production
of erythrocytes.
• Other physical signs vary depending on where the disease is located.
For example, intrathoracic involvement may lead to superior vena
cava syndrome, enlarged retroperitoneal nodes may cause palpable
abdominal masses or interfere with renal function, jaundice may
occur from liver involvement, spinal cord compression leading to
paraplegia may occur with extradural involvement, and bone pain
occurs as a result of bone involvement.
16. Diagnosis
• The basis of diagnosis is histologic review of tissue obtained by
lymphnode biopsy. The hallmark histologic feature is the Reed
Sternberg cell, a large multinucleated cell with abundant cytoplasm.
Staging
• Classification by the Ann Arbor system is the basis for treatment and
provides prognostic information. There are four basic stages, and each
stage is sub-classifie d into “A” or “B,” reflecting clinical symptoms.
• A - refers to lack of systemic symptoms.
• B - refers to the presence of systemic symptoms, such as fever, night sweats,
or > 10% weight loss
17. Stages
• Stage I: involvement of a single lymph node or
extralymphatic site
• Stage II: involvement of two or more lymph node regions on
the sameside of the diaphragm, or extension to an
extralymphatic site and one or more lymph node regions on
the same side of the diaphragm
• Stage III: involvement of lymph nodes on both sides of the
diaphragm (in this case, the spleen is considered a
lymphnode)
• Stage IV: diffuse or disseminated involvement of one or more
extralymphatic organs or tissues
18. . Management
• Treatment is based on the child’s age, disease stage, and
• tumor burden. Treatment most commonly includes chemotherapy and
radiation therapy. Late complications of therapy include the following:
• Growth retardation as a result of radiation therapy
• Secondary malignancies, including breast cancer, AML, and
nonHodgkin’s lymphoma
• Hypothyroidism (10–20%)
• Male sterility (very common)
19. Interventions
• For early stages without mediastinal node involvement, the treatment of
choice is extensive external radiation of the involved lymph node regions.
• With more extensive disease, radiation and multidrug chemotherapy are
used.
• Monitor for medication-induced pancytopenia and an abnormal
depression of all cellular components of the blood, which increases the risk
for infection, bleeding, and anemia.
• Monitor for signs of infection and bleeding.
• Protect the child from infection.
• Monitor for adverse effects related to chemotherapy or radiation; the most
common adverse effect of extensive irradiation is malaise, which can be
difficult for older children and adolescents to tolerate physically and
psychologically
• Monitor for nausea and vomiting, and administer antiemetics as prescribed
20. Non-Hodgkin’s lymphoma
• is a very aggressive cancer and is 1.5 times more
common than Hodgkin’s disease.
Epidemiology
• Male predominance
• Associated with immunodeficiency states, such as
HIV, Wiskott Aldrich syndrome, ataxia
telangiectasia syndrome, and prior EBV infection.
Increasing incidence after 5 years of age
21. Non-Hodgkin’s lymphomas (NHLs)
• Non-Hodgkin’s lymphomas (NHLs) are a heterogeneous group of
malignant neoplasms of primarily B-, T-, or natural killer (NK) cell
origin affecting all ages.
• B-cell lymphomas constitute about 85% of all NHLs.
• They are categorized by the level of differentiation, cell of origin, and
rate of cellular proliferation.
• A variety of clinical presentations and courses are recognized, from
indolent (slowly developing) to rapidly progressive disease.
• NHL is the most commonly occurring hematologic cancer and the fifth
leading cause of cancer death.
• Each year approximately 66,360 new cases of NHL are diagnosed and
approximately 19,320 deaths occur
22. Etiology and Pathophysiology
• The cause of NHL is usually unknown.
• NHLs may result from chromosomal translocations, infections,
environmental factors, and immunodeficiency states.
• Chromosomal translocations have an important role in the pathogenesis of
many NHLs.
• Some viruses and bacteria are implicated in the pathogenesis of NHL,
including HTLV-1, EBV, human herpesvirus 8, hepatitis B and C, Helicobacter
pylori, Chlamydophila psittaci, Campylobacter jejuni, and Borrelia
burgdorferi.
• Environmental factors linked to the development of NHL include chemicals
(e.g., pesticides, herbicides, solvents, organic chemicals, wood
preservatives).
• NHL is also more common in individuals who have inherited
immunodeficiency syndromes and who have used immunosuppressive
medications (e.g., to prevent rejection after an organ transplant or to treat
autoimmune disorders) or received chemotherapy or radiation therapy.
23. CONT’D
• NHLs involve lymphocytes arrested in various stages of development
and may mimic a leukemia. For example, small lymphocytic
lymphoma (SLL) and chronic lymphocytic leukemia (CLL) result from
malignant proliferation of small B lymphocytes, with CLL having the
majority of disease within the bone marrow (versus the lymph
nodes).
• Diffuse large B-cell lymphoma, the most common aggressive
lymphoma, is a neoplasm that originates in the lymph nodes, usually
in the neck or abdomen.
• Burkitt’s lymphoma is the most highly aggressive disease and is
thought to originate from B-cell blasts in the lymph nodes.
25. Clinical Manifestations Lymphomas
• NHLs can originate outside the lymph nodes, the method of spread can be
unpredictable, and the majority of patients have widely disseminated
disease at the time of diagnosis
• The primary clinical manifestation is painless lymph node enlargement.
• The lymphadenopathy can wax and wane in indolent disease.
• Because the disease is usually disseminated when it is diagnosed, other
symptoms are present depending on where the disease has spread (e.g.,
hepatomegaly with liver involvement, neurologic symptoms with CNS
disease).
• NHL can also manifest in nonspecific ways, such as an airway obstruction,
hyperuricemia and renal failure from tumor lysis syndrome, pericardial
tamponade, and GI complaints.
26. • Patients with high-grade lymphomas may have lymphadenopathy and
constitutional symptoms (B symptoms) such as fever, night sweats,
and weight loss.
• The peripheral blood is usually normal, but some lymphomas
manifest in a “leukemic” phase.
27. Diagnostic
• Diagnostic studies used for NHL resemble those used for Hodgkin’s
lymphoma.
• However, because NHL is more often in extranodal sites, more
diagnostic studies may be done, such as an MRI to rule out CNS or
bone marrow infiltration, or a barium enema, upper endoscopy, or CT
to visualize suspected GI involvement.