Introduction Lymphoma is a cancer in the lymphatic cells of the immune system.

Typically, lymphomas present as a solid tumor of lymphoid cells. These malignant cells often originate in lymph nodes, presenting as an enlargement of the node (a tumor). Classification of Lynphoma There are many types of lymphoma. One type is called Hodgkin disease. The first sign of Hodgkin disease is often an enlarged lymph node. The disease can spread to nearby lymph nodes. Later it may spread to the lungs, liver or bone marrow. The cause is unknown. Doctors can diagnose Hodgkin disease with a biopsy. This involves removing and examining a piece of tissue under a microscope. Treatment varies depending on how far the disease has spread and often includes radiation therapy or chemotherapy. The earlier the disease is diagnosed, the more effective the treatment. In most cases, Hodgkin disease can be cured. Symptoms include painless swelling of the lymph nodes in the neck, armpits, or groin, fever and chills, night sweats, weight loss, loss of appetite, and itchy skin. Non-Hodgkin lymphomas begin when a type of white blood cell, called a T cell or B cell, becomes abnormal. The cell divides again and again, making more and more abnormal cells. These abnormal cells can spread to almost any other part of the body. Most of the time, doctors can't determine why a person gets non-Hodgkin lymphoma. Non-Hodgkin lymphoma can cause many symptoms, such as Swollen, painless lymph nodes in the neck, armpits or groin, Unexplained weight loss, Fever, Soaking night sweats, Coughing, trouble breathing or chest pain, Weakness and tiredness that don't go away, and Pain, swelling or a feeling of fullness in the abdomen Causes of lymphoma Cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in the body follow an orderly path of growth, division, and death. Programmed cell death is called apoptosis, and when this process breaks down, cancer results. Scientists do not know exactly what causes lymphoma, but they have identified several potential risk factors: Genetics Lymphoma can be the result of a genetic predisposition that is inherited from family members. It is possible to be born with certain genetic mutations or a fault in a gene that makes one statistically more likely to develop cancer later in life. Carcinogens Carcinogens are a class of substances that are directly responsible for damaging DNA, promoting or aiding cancer. Exposure to certain pesticides, herbicides, and solvents such as benzene has been associated with lymphoma. Similarly, black hair dye has been linked to higher rates of NHL. When our bodies are exposed to carcinogens, free radicals are formed that try to steal electrons from other molecules in the body. These free radicals damage cells, affecting their ability to function normally, and the result can be cancerous growths. Other medical factors As we age, there is an increase in the number of possible cancer-causing mutations in our DNA. The risk of NHL increases as we age, and HL is most common between ages 16-34 and 55 years and older. Additional medical conditions that have been associated with higher lymphoma rates include infection with HIV, human T-lymphocytic virus type 1 (HTLV-1), Epstein-Barr virus, Helicobacter pylori, or hepatitis B or C; autoimmune disease (such as lupus); diseases that require therapies that suppress the immune system; and any other immunodeficiency diseases.

Diagnosis of Lymphoma In order to diagnose lymphoma, physicians will request a complete physical exam as well as personal and family medical histories. An oncologist (cancer specialist) will usually be consulted to review the results of several tests. Blood tests will be used to test blood cell, kidney, and liver performance. They can also detect a chemical called lactase hydrogenase (LDH), of which high levels have been associated with an aggressive form of NHL. Several imaging techniques are employed in order to see if cancer exists and to find out how far they have spread. Common imaging tests include: X-rays Computerized tomography (CT) scans Magnetic resonance imaging (MRI) Lymphangiogram Gallium scan Positron emission tomography (PET) scans Physicians may also perform bone marrow examinations to see if the lymphoma has infected the bone marrow. Bone marrow samples are often taken from the hip and examined for the presence of abnormal B or T cells. The only absolute way to make a cancer diagnosis is to remove a small sample of the tumor and look at it under the microscope in a procedure called a biopsy. Doctors may gather the sample by inserting a needle through the skin, surgical methods, or laparoscopic methods. A pathologist examines the sample under a microscope to determine if cancer exists. After a diagnosis is made, doctors analyze the tissue samples and test results to find out how far the cancer has spread and to determine the stage of the cancer. The stage lets oncologists know which choices will be available for treatment and it informs prognoses. A common and simple classification scheme for Hodgkin's lymphoma considers it to be bulky (large tumor, worse prognosis) or nonbulky (small tumor, better prognosis). NonHodgkin's lymphoma is classified according to its microscopic appearance, location in the body, and genetic and molecular features. It is frequently divided into three grades. Low grade, or indolent, lymphomas grow slowly and often do not require immediate treatment. Intermediate grade lymphomas are rapidly growing and require immediate treatment. They are often curable. High grade lymphomas are aggressive and rapidly growing, require intesive and immediate treatment, and are often uncurable. HL and NHL use a similar staging system to describe the extent of the disease. Stage I or early disease is when lymphoma is found in a single lymph node region or in a single organ outside the lymph node. Stage II or locally advanced disease is when two or more lymph node regions on the same side of the diaphragm or one lymph node region and a nearby tissue or organ carries lymphoma. Stage III or advanced disease is when two or more lymph nodes or a lymph node and an organ on the opposite side of the body are affected by lymphoma. Stage IV or widespread, disseminated disease is when the lymphoma has spread to the spleen, bone marrow, bone, or central nervous system. Both types of lymphoma may also receive an A classification to indicate no symptoms like fever and weight loss, a B classification to indiciate such symptoms, or an E classification to indicate that the tumor has spread directly from a lymph node to an organ.

Treatment of Lymphoma Chemotherapy Chemotherapy utilizes chemicals that interfere with the cell division process - damaging proteins or DNA - so that cancer cells will commit suicide. These treatments target any rapidly dividing cells (not necessarily just cancer cells), but normal cells usually can recover from any chemical-induced damage while cancer cells cannot. Chemotherapy is generally used to treat cancer that has spread or metastasized because the medicines travel throughout the entire body. Treatment occurs in cycles so the body has time to heal between doses. However, there are still common side effects such as hair loss, nausea, fatigue, and vomiting. Combination therapies often include multiple types of chemotherapy or chemotherapy combined with other treatment options. Radiation Radiation treatment, also known as radiotherapy, destroys cancer by focusing highenergy rays on the cancer cells. This causes damage to the molecules that make up the cancer cells and leads them to commit suicide. Radiotherapy utilizes high-energy gammarays that are emitted from metals such as radium or high-energy x-rays that are created in a special machine. Radiotherapy can be used as a standalone treatment to shrink a tumor or destroy cancer cells, and it is also used in combination with other cancer treatments. Side effects of radiation therapy may include mild skin changes resembling sunburn or suntan, nausea, vomiting, diarrhea, and fatigue. Patients also tend to lose their appetites and have trouble maintaining weight, but most side effects subside a few weeks after completing treatment.

Objectives By the end of this case study, the group would like to meet the following objectives: To identify what is Lymphoma To classify the different types of Lymphoma To discuss the factors involved in the development of Lymphoma To list the diagnostic procedures in identifying Lymphoma To explain the disease process of Lymphoma To identify treatments involved in Lymphoma To discuss relevant laboratory results in Lymphoma To List and discuss different medications for Lymphoma To identify nursing interventions for patients with Lymphoma