Lippincott Certification Review Medical-Surgical Nursing

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Non-Hodgkin Lymphoma

Non-Hodgkin Lymphoma ●● Description ●● Non-Hodgkin lymphoma describes a group of malignant neoplasms arising from abnormal lymphocytes that affect the immune system; this disease typically produces systemic symptoms as it is usually disseminated when diagnosed. ●● It may be associated with viral infection (T-cell lymphotropic virus, EBV, human immunodeficiency virus, congenital immunodeficiency, autoimmune diseases, or immunosuppression after organ transplantation) ●● Exposure to radiation and chemicals, including certain herbicides and insecticides, has been linked to an increased lymphoma risk. ●● The prognosis for non-Hodgkin lymphoma varies greatly and depends on the histologic type and progression of the disease. ●● Signs and symptoms ●● Non-Hodgkin lymphoma can affect any organ or tissue and produces a wide range of symptoms. ●● Signs and symptoms resemble those of Hodgkin lymphoma. ●● Fever, painless lymphadenopathy, night sweats, severe pruritus, chest pain or pressure, shortness of breath, cough, abdominal pain or swelling, and weight loss are common signs and symptoms. ●● Diagnosis and treatment ●● Diagnostic procedures are similar to those for Hodgkin lymphoma; however, Reed–Sternberg cells are not present. ●● Staging is similar to Hodgkin lymphoma (see Staging lymphomas ). ●● Radiation therapy, chemotherapy, immunotherapy, targeted therapy, and stem cell transplantation are used to treat non-Hodgkin lymphoma. ●● Nursing interventions ●● Educate the patient and family about treatment, transfusions, chemotherapy, and stem cell transplantation. ●● Initiate interventions similar to those for leukemia and Hodgkin lymphoma. ●● Prevent infection. ●● Support nutritional status. Hodgkin lymphoma and non-Hodgkin lymphoma are classified into stages so that treatment protocols can be established and outcomes predicted. The Lugano classification system is used that is based on the original Ann Arbor classification system. Stage I Involvement of a single lymph node region OR Localized involvement of a single extranodal organ or site Stage II Involvement of two or more lymph node regions on the same side of the diaphragm OR Localized involvement to a single associated extranodal organ or site and its regional lymph nodes with or without other lymph node regions on the same side of the diaphragm Stage III Involvement of lymph node regions on both sides of the diaphragm that may also be accompanied by localized involvement of an extranodal organ or site, by involvement of the spleen, or by both Stage IV Widespread involvement of one or more extralymphatic sites with or without associated lymph node involvement OR Isolated extralymphatic organ involvement with distant (nonregional) nodal involvement Extralymphatic sites include the liver, lungs, bone marrow, pleurae, bone, and skin as well as tissues separate from but near to major lymphatic clusters. The spleen is considered a lymphatic site. Letter Designation The stages are also accompanied by a letter designation that refers to patient symptoms as follows: • A means absence of the specific symptoms listed in B but may include other common symptoms such as pruritus. • B includes the presence of at least one of the following three symptoms: ––Temperature greater than 100.4°F (38°C) ––Unexplained loss of more than 10% of body weight in the preceding 6 months ––Drenching night sweats Box 8-2: Staging Lymphomas

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From American Cancer Society (ACS). (2023). Hodgkin lymphoma . https://www.cancer.org/cancer/hodgkin-lymphoma/about.html