Lymphoma & Leukemia

what is the main difference between Hodgkin vs. Non-Hodgkin Lymphoma?

• Hodgkin lymphoma (HL)
  👉 Characterized by the presence of large, abnormal Reed–Sternberg cells (usually derived from B cells).

• Non-Hodgkin lymphoma (NHL)
  👉 Does NOT have Reed–Sternberg cells and instead involves cancers of other lymphocytes — most commonly B cells, but sometimes T cells or NK cells.

what is the characteristics of Hodgkin’s Lymphoma?

1. start at one site and spreads in an orderly fashion through lymphatic system

2. can start anywhere BUT it is very common for it to start mostly in the upper body like in the neck or in the axilla

3. most patient (2/3) are diagnosed between the age of 20-30 and 55+ (bimodal distribution)

4. males are more likely to develop Hodgkin’s lymphoma compsre to female patients

   1. most common cancer seen in adolescent

what is the most common cancer seen in adolescent?

Hodgkin’s lymphoma

true or false: there aren’t any prevention, screening, and detection for Hodgkin’s Lymphoma because the cancer tend to spread to other lymph nodes before we really make the diagnosis

true

what are the clinical manifestations of Hodgkin’s Lymphoma?

1. painless lymphadenopathy (swollen lymph nodes that are bigger - over an inch in size, non-tender, painless, last for more than 6 weeks, immovable)

2. unintended weight loss (10% drop in the overall weight in the last 6 months) → this is because the rapidly multiplying cancer cells consume significant energy, while the body expends even more trying to fight them, leading to a negative energy balance → loss of appetite + nausea + fatigue → muscle and fat loss (cachexia)

3. intermittent fever (temp of at least over 100 or 100.5 → because these cancerous lymphocytes release inflammatory factors (e.g., cytokines) and causes lymph node inflammation and necrosis, which trigger the body’s temperature regulation cancer (an immune overreaction)

4. night sweat (similar to the above → the body’s temperature regulation center is messed up and it is like the body are fighting an infection)

5. fatigue

what are B symptoms? what are the B symptoms for Hodgkin’s Lymphoma?

B symptoms are symptoms that are more common in Hodgkin’s Lymphoma and are the one when you have more advanced disease

1. unintended weight loss

2. intermittent fever

3. night sweat

how are Hodgkin’s Lymphoma diagnosed?

1. CBC + chemistries to see the overall health of cells and abnormal cells levels (like low red cells and high white cells → a hallmark sign of lymphoma & to make sure not else is going on)

2. PET scan (nuclear medicine test → radioactive glucose tracer to measure the uptake of those glucose by the lymphoma, which would light up area of cancer as the cancer cells eats the glucose)

3. CT scan (the most important type of imaging done for HL → it help stage the disease)

4. MRI

5. tissue biopsy of the affected node to see if Reed-Sternberg cells are involved and confirmed lymphoma

6. bone marrow biopsy to determine the spread (has it metastasize?)

what are the different staging of Hodgkin’s Lymphoma?

1. stage1: localized disease; single lymph node region or single organ

2. stage 2: two or more lymph node regions on the same side of the diaphragm

3. stage 3: two or more lymph node region above and below the diaphragm

4. stage 4: widespread disease; multiple organ; with or without lymph node involvement

A or B are refering to more advance symptoms?

B

what are the treatment for Hodgkin’s Lymphoma?

treatment largely depending on the subtypes of HL, what stage it is, whether the patient have B symptoms or not, how large the tumor is, and the overall health of the patient

1. chemotherapy

2. radiation

3. targeted therapy

4. bone marrow transplant

what are the nursing intervention for Hodgkin’s and Non-Hodgkin’s Lymphoma?

1. patient education

2. symptom management (chemotherapy/radiation side effects)

3. coping/support

4. finances

5. fertility (might the patient want to bank eggs/sperms)

how do Hodgkin’s and Non-Hodgkin’s Lymphoma differ in how they spread?

1. Hodgkin’s lymphoma have an orderly and predictable spread with the cancer moving from one lymph node group to the next - usually spreading in a straight-line patterns

2. Non-Hodgkin’s lymphoma have a more random spread with the lymphoma have a skipping patterns of which the cancer jumps between lymph nodes groups and can show up in multiple places at once

true or false: both Non-Hodgkin’s and Hodgkin’s lymphoma usually starts in the cervical, axillary, inguinal, and femoral nodes

true

true or false: the causes for both Non-Hodgkin’s and Hodgkin’s are unknown

true

can Non-Hodgkin’s lymphoma be prevented?

No! As the cause is unknown…

however there are risk reductions available

1. avoiding immune suppression when possible

2. limiting chemical exposures

3. managing HIV or autoimmune disease

is there routine screening fro Non-Hodgkin’s Lymphoma?

there are no routine screening test exist

how is non-hodgkin’s lymphoma usally detected?

through symptoms and physical exam, then confirmed with:

1. enlarged painless lymph nodes

2. biopsy (gold standard)

3. CT, PET scans for staging

what is the clinical manifestations of Non-Hodgkin’s Lymphoma?

1. painless lymphadenopathy

2. vague ABD pain/swelling

3. vague back pain

4. chest pain, SOB, cough

5. weight loss

6. night sweat

7. fatigue

what are the main difference in clinical manifestation between Non-Hodgkin’s and Hodgkin’s Lymphoma?

1. typically manifestations: cervical/mediastinal nodes (Hodgkin’s), cervical/axillary/inguinal/femoral (Non-Hodgkin’s)

2. node involvement: usually one group first (Hodgkin’s), multiple group (Non-Hodgkin’s)

3. spread: orderly, contiguous (Hodgkin’s) and random, non-contiguous (Non-Hodgkin’s)

4. B symptoms: common for both Hodgkin’s and Non-Hodgkin’s

5. pruritus: common for Hodgkin’s and less common for Non-Hodgkin’s

6. extra-nodal disease: rare early for Hodgkin’s and common for Non-Hodgkin’s

what is the testing for both Hodgkin’s and Non-Hodgkin’s Lymphoma?

1. CBC

2. chemistries

3. protein electrophoresis

4. HIV

5. HBV

6. HCV

7. PET scan, CT, or MRI

8. lymph node bx

9. bone marrow bx

10. and reed-steinberg for Hodgkin’s

what is the staging for Non-Hodgkin’s lymphoma?

1. stage 1: NH: in 1 lymph node area or in 1 organ outside of the lymph node

2. stage 2: NHL in several lymph nodes areas either above or below the diaphragms

3. stage 3: NHL in several lymph node areas both above and below the diaphragm

4. stage 4: widespread NHL found beyond the lymph nodes and spleen that has spread or more organs

what is the difference in staging between Non-Hodgkin’s and Hodgkin’s?

1. Non-Hodgkin’s spread unpredictably while Hodgkin’s spread predictably

2. NHL can appear anywhere and often present at a more advance stage while the location of HL can often be predicted and are found when the cancer is less advance

what are the difference type of treatment avaialble for low, intermediate, and high grade of NHL?

1. low-grade (indolent) NHL: since the lymphomas is growing slowky and are often widespread but may not have cause symptoms for years: watch and wait is often popular, where areas therapy like radiation, immunotherapy, chemotherapy can be consider to treat the cancer when it is not as aggressive

2. intermediate-grade NHL: since these are considered aggression, prompt treatment usually include combination chemotherapy, radiation therapy, targeted therapies - these patient are usually highly responsive to therapy

3. high-grade NHL: very fast-growing and aggressive: requires intensive chemotherapy, CNS prophylaxis, stem cell transplant, CAR T-cell therapy

what is CAR T-cell therapy for Lymphoma?

immunotherapy that genetically engineers a patient’s own T-cells in a lab to recognize and attack lymphoma cancer cells using a process where T-cells are collected, modified with Chimeric Antigent Receptors (CARs), multipled, and then infused back into the patient to hunt down and destroy cancer

review the nursing consideration for Non-Hodgkin’s lymphoma…

1. teach the patient about the signs and symptoms of the disease and infection

2. assess for inefective coping

3. asses for sensory alternations d/t peripheral neuropathy

4. teach abot sexual dysfunction

5. knowledge deficit regarding treatment options

what is leukemia?

loss of control of cell dvision lead to malignant bone marrow cells accumulate or proliferate, leading to disorder affecting the blood and blood-forming tissues

do we know the cause of leukemia?

no as the etiology is unknown but risk factors alter DNA, of which preventing cellular maturation is a must - exposures to chemical is a big one

1. benzenes

2. smoke

3. benzene

4. radiation

5. infection: hepatitis C, HIV

what is the different type of leukemia?

1. acute lymphocytic (ALL) → impact more immature cells

2. acute myelogenous (AML) → impact more immature cell

3. chronic myelogenous (CML) → impact more mature cells

4. chronic lymphocytic (CLL) → impact more mature cells

what is the most common type of Non-Hodgkin’s lymphoma? does it respond well to treatment?

diffused large B-cell lymphoma - it respond well to treatment

is follicular NHL slow-growing or fast-growing? does it need to be treated?

it is slow-growing and in most cases it does not need to be treated and is often on the wait-and-watch method because it might be counterinuitive but the slower-growing NHL are seemingly harder to treat

what is the rarest form of NHL? is it aggressive?

Burkett’s - very aggressive - but responsive to chemotherpay if treated early

true or false: the most aggressive form of lymphomas can kill you in 2-3 weeks but it is also the most treatable form of NHL as the cells are constantly mutating and that put them at a weak spot, which is needed for treatment to work!

true

what type of cells can leukemia originate from?

1. myeloid stem cells

2. myeloblast

3. lymphoid stem cells

4. lymphoblast

review the symptoms of leukemia (think of systemic, lungs, muscular, bones/joints, psychological, lymph nodes, spleen and/or liver, and skin)

systemic:

1. weight loss

2. fever

3. frequent infections

lungs

1. easy shortness of breath

muscular

1. weakness

bones or joints

1. pain or tenderness

psychological

1. fatigue

2. loss of appetite

lymph nodes

1. swelling

spleen and/or liver

1. enlargement

skin

1. night sweat

2. easy bleeding and bruising

3. purplish patches or spots

what cell is diagnostic for Hodgkin’s lymphoma?

Reed-Sternberg cells (large, abnormal B cells)

what are the key differences in lymph node spread between Hodgkin’s vs. Non-Hodgkin’s?

1. Hodgkin’s: orderly, continuous spread

2. Non-Hodgkin’s: non-orderly, skips around

which lymphoma is more common and more aggressive?

Non-Hodgkin’s lymphoma

how are Hodgkin’s and Non-Hodgkin’s lymphoma diagnosed?

lymph node biopsy

what are the general treatment for lymphomas?

chemotherapy and/or radiation (depending on the stages and aggressiveness)

what is leukemia?

cancer of the bone marrow which manifested as overproduction of immature WBCs (blasts)

why do leukemia patients develop anemia, thrombocytopenia, and infection risk?

malignant WBCs crowd out RBCs, platelets, and normal WBCs

what do the letters A, C, L, M in leukemia names mean?

1. A = acute (fast, immature cells)

2. C = chronic (slow, mature cells)

3. L = lymphocytic

4. M = myelogenous

what is the main different between acute vs. chronic leukemia?

1. acute: rapid onset, immature blasts

2. chronic: slow onset, mature cells

name the four main types of leukemia?

1. ALL: acute lymphocytic leukemia

2. AML: acute myeloid leukemia

3. CLL: chronic lymphocytic leukemia

4. CML: chronic myeloid leukemia

what are the goals of each stage of chemotherapy: induction, consolidation, and maintenance?

1. induction: kill cancer cells and induce remission

2. consolidation: eliminate remaining cancer cells after remission has been achieved (reinforce the remission → targeting cancer cells that are not generally high risk like those killed in induction but can till pose a risk of

3. maintenance: prevent relapse (long-term, lower-dose therpay that keep the cancer suppressed and prevent relapse)

what are the common side effects of chemotherapy?

1. bone marrow suppression

2. nausea/vomitting

3. alopecia

4. mucositis

5. infection risk

what are the nursing intervention for chemo patients?

1. infection prevention

2. antiemetics

3. oral care

4. monitor labs

5. energy conservation

what is the normal WBC count?

4000 - 11,000/mm cubed

what is the normal hemoglobin (Hgb) for men and women?

1. men (18-64) : about 14-18 g/dL

2. women (18-64): about 12-16 g/dL

3. both men and women over 64: slightly decreased in values from normal range

what is the normal hematocrit (Hct) for men and women?

the percentage of RBCs in the total blood volume

1. men (18-64): about 42-52%

2. female (18-64): about 37-47%

3. both men and women over 64: slightly decreased in value from the normal range

iron-deficiency anemia: pathophysiology, labs, clinical signs, and management?

• Pathophysiology: Low iron → hemoglobin synthesis impaired → microcytic, hypochromic RBCs.

• Labs: ↓Hgb/Hct, ↓serum ferritin (<10 ng/mL), microcytic hypochromic RBCs.

• Clinical Signs: Weakness, pallor, brittle/spoon-shaped nails, angular cheilitis, smooth/sore tongue.

• Management: Increase dietary iron (red meat, liver, leafy greens, beans, whole grains), oral iron supplements for mild deficiency, IM for severe. Monitor for bleeding (GI, menorrhagia).

vitamin B12 deficiency anemia: pathophysiology, labs, clinical signs, and management?

• Pathophysiology: B12 needed for folic acid transport → DNA synthesis impaired → macrocytic RBCs. Deficiency → abnormal RBCs and impaired nerve function.

• Labs: Macrocytic RBCs, ↓B12, hypersegmented neutrophils.

• Clinical Signs: Fatigue, pallor, jaundice, glossitis, weight loss, weakness, neurological symptoms: paresthesias, poor balance.

• Management: Increase dietary B12 (meat, fish, dairy, fortified cereals). Oral supplements for dietary deficiency; B12 injections for pernicious anemia (weekly → monthly for maintenance).

folic acid deficiency anemia: pathophysiology, labs, clinical signs, and management?

• Pathophysiology: Folic acid needed for DNA synthesis → macrocytic RBCs; unlike B12, no neurological effects.

• Labs: Macrocytic RBCs, ↓folate.

• Clinical Signs: Fatigue, pallor, jaundice, glossitis, weakness, SOB, palpitations.

• Management: Increase dietary folate (leafy greens, liver, beans, citrus, fortified grains). Oral folic acid supplements.