LymphomasLymphomasLymphomasLymphomas

Mona Lisa U. Pua, RNMona Lisa U. Pua, RNUST Graduate SchoolUST Graduate School

OverviewOverview

Neoplasms of cells of lymphoid originNeoplasms of cells of lymphoid origin Usu. Start in lymph nodesUsu. Start in lymph nodes Classified according to the degree of cell Classified according to the degree of cell

differetation and origin of the differetation and origin of the predominant malignant cellpredominant malignant cell

Classified as Hodgkin’s or Non-Hodgkin’sClassified as Hodgkin’s or Non-Hodgkin’s

Hodgkin’s Hodgkin’s DiseaseDisease

Rare malignancy that has an impressive cure Rare malignancy that has an impressive cure raterate

Men > womenMen > women 2 peaks of incidence: early 20’s and after 50 2 peaks of incidence: early 20’s and after 50

years oldyears old Has a familial patternHas a familial pattern Common in patients receiving chronic Common in patients receiving chronic

immunosuppresive therapyimmunosuppresive therapy

The Lymphatic SystemThe Lymphatic System Consists of two semi-independent partsConsists of two semi-independent parts

Lymphatic vesselsLymphatic vessels Lymphoid tissues and organsLymphoid tissues and organs

Lymphatic system functionsLymphatic system functions Transport fluids back to the bloodTransport fluids back to the blood Play essential roles in body defense and Play essential roles in body defense and

resistance to diseaseresistance to disease

Lymphatic Lymphatic CharacteristicsCharacteristics Lymph – excess tissue fluid carried by Lymph – excess tissue fluid carried by

lymphatic vesselslymphatic vessels Properties of lymphatic vesselsProperties of lymphatic vessels

One way system toward the heartOne way system toward the heart No pumpNo pump Lymph moves toward the heartLymph moves toward the heart

Milking action of skeletal muscleMilking action of skeletal muscle Rhythmic contraction of smooth muscle in vessel Rhythmic contraction of smooth muscle in vessel

wallswalls

Lymphatic VesselsLymphatic Vessels

Lymph CapillariesLymph Capillaries Walls overlap to form flap-like minivalvesWalls overlap to form flap-like minivalves Fluid leaks into lymph capillariesFluid leaks into lymph capillaries Capillaries are anchored to connective Capillaries are anchored to connective

tissue by filamentstissue by filaments Higher pressure on the inside closes Higher pressure on the inside closes

minivalvesminivalves

Lymphatic VesselsLymphatic Vessels

Figure 12.2

Lymphatic VesselsLymphatic Vessels

Lymphatic Lymphatic collecting vesselscollecting vessels Collects lymph from Collects lymph from

lymph capillarieslymph capillaries Carries lymph to Carries lymph to

and away from and away from lymph nodeslymph nodes

Figure 12.1

Lymphatic VesselsLymphatic Vessels

Lymphatic Lymphatic collecting vessels collecting vessels (continued)(continued) Returns fluid to Returns fluid to

circulatory veins circulatory veins near the heartnear the heart Right lymphatic ductRight lymphatic duct Thoracic ductThoracic duct

Figure 12.1

LymphLymph

Materials returned to the bloodMaterials returned to the blood WaterWater Blood cellsBlood cells ProteinsProteins

LymphLymph

Harmful materials that enter lymph Harmful materials that enter lymph vesselsvessels BacteriaBacteria VirusesViruses Cancer cellsCancer cells Cell debris Cell debris

Lymph NodesLymph Nodes

Figure 12.3

Lymph Node StructureLymph Node Structure Most are kidney-shaped, less than 1 inch Most are kidney-shaped, less than 1 inch

longlong CortexCortex

Outer partOuter part Contains follicles – collections of Contains follicles – collections of

lymphocyteslymphocytes MedullaMedulla

Inner partInner part Contains phagocytic macrophagesContains phagocytic macrophages

Lymph Node StructureLymph Node Structure

Figure 12.4

Flow of Lymph Through Flow of Lymph Through NodesNodes

Lymph enters the convex side through Lymph enters the convex side through afferent lymphatic vesselsafferent lymphatic vessels

Lymph flows through a number of Lymph flows through a number of sinuses inside the nodesinuses inside the node

Lymph exits through efferent lymphatic Lymph exits through efferent lymphatic vesselsvessels

Fewer efferent than afferent vessels Fewer efferent than afferent vessels causes flow to be slowedcauses flow to be slowed

Malignant LymphomaMalignant LymphomaHeredity, exposure to carcinogens, Epstein-Barr Virus Infection

Mutation of proto-oncogens / disruption of tumor suppressor genes

Cell transformation

Transformed cell release of growth factors

Accumulation of inflammatory cells

Transformed cell release cytokines

Proliferation of malignant and non-

malignant lymph cells

B

B

Painless enlargement of one or more lymph nodes on one side of the neck

Mediastinal mass Compress trachea Dyspnea

Unknown cause Pruritus; Pain after drinking alcohol

Hepatic involvement or bile duct obstruction Jaundice

Splenomegaly/ retroperitoneal adenopathy Abdominal pain

Skeletal InvolvementBone pain

Suppression of hematopoiesis

Dec. RBC, WBC, PLT

C

Impaired lymph flow from serous cavity or erosion of tumor into the pleural cavity

Pleural Effusion

Anemia

C

Impaired T Lymphocyte Function

Inc. Susceptibility to opportunistic Infection

B symptoms: Fever, night

sweats, B

Catabolic effect of tumor on body metabolism and selective trapping of

nutrients by rapidly growing tumor cells

Delayed cutaneous hypersensitivity

Cachexia, weakness,

unintentional wt. loss of >

10%

Tumor cell secrete

cachectin

Act on satiety center in

hypothalamus

Macrophage secrete TNF Supress

synthesis of lipoprotein

lipase

Fatty acids not released from lipoproteins

Endogenous pyrogen

Acts on hypothalamus

Hodgkin’s DiseaseHodgkin’s Disease Unicentric in origin; initiates in a single Unicentric in origin; initiates in a single

nodenode Malignant cell is the Reed-Sternberg cell Malignant cell is the Reed-Sternberg cell

(gigantic tumor cell that is (gigantic tumor cell that is morphologically unique and of immature morphologically unique and of immature lymphoid origin)lymphoid origin)

Cause: Unknown, probably EBV infectionCause: Unknown, probably EBV infection

Ann Arbor Staging Ann Arbor Staging SystemSystem

I- single lymph node region or a single I- single lymph node region or a single extralymphatic organ or siteextralymphatic organ or site

II- 2 or more lymph node regions on the same side II- 2 or more lymph node regions on the same side of the diaphragm or localized involvement of an of the diaphragm or localized involvement of an extralymphatic organ or siteextralymphatic organ or site

III- both sides of the diaphragm or localized III- both sides of the diaphragm or localized involvement of extralymphatic organ or site or involvement of extralymphatic organ or site or spleen or bothspleen or both

IV- disseminated involvement of 1 or more IV- disseminated involvement of 1 or more extralymphatic organs with or without associated extralymphatic organs with or without associated lymph node involvementlymph node involvement

Non-Hodgkin’s Non-Hodgkin’s LymphomaLymphoma

Multicentric in origin and spread early to Multicentric in origin and spread early to various tissues of the body esp. liver, spleen, various tissues of the body esp. liver, spleen, bone marrowbone marrow

3x more frequent than hodgkins3x more frequent than hodgkins May originate from T cells, B cells and May originate from T cells, B cells and

lymphocyteslymphocytes B symptoms are less commonB symptoms are less common More frequent involvement of GI, liver, testes More frequent involvement of GI, liver, testes

and bone marrowand bone marrow Less involvement of mediastinumLess involvement of mediastinum

Nursing ProblemsNursing Problems

Increased Risk for infectionIncreased Risk for infection AnemiaAnemia Alteration in Nutrition: DeficiencyAlteration in Nutrition: Deficiency

JournalsJournals

Alterations to the Lymphatic System in Alterations to the Lymphatic System in Hogkin’s DiseaseHogkin’s Disease

Gerard P. Boe, PhDGerard P. Boe, PhD

Executive Director, American Medical Executive Director, American Medical Technologists’ Institute for Education (AMTIE)Technologists’ Institute for Education (AMTIE)

Hodgkin’s Lymphoma differs Hodgkin’s Lymphoma differs from Non-Hodgkin’s from Non-Hodgkin’s Lymphoma in:Lymphoma in:

Predictable contiguous spread from one Predictable contiguous spread from one chain of lymph node groups to anotherchain of lymph node groups to another

Presence of the Hodgkin/Reed Sternberg Presence of the Hodgkin/Reed Sternberg CellCell

Cells other than lymphocytes may be Cells other than lymphocytes may be present in the lymph nodes present in the lymph nodes

Never exhibits a leukemia phaseNever exhibits a leukemia phase

Changes that occur in Changes that occur in lymphatic system in lymphatic system in Hodgkin’s Disease:Hodgkin’s Disease:

Anatomic= enlarged spleen and lymph Anatomic= enlarged spleen and lymph nodesnodes

Histiologic= fibrosis, depletion of Histiologic= fibrosis, depletion of lymphocytes, increase eosinophils and lymphocytes, increase eosinophils and large reed-sternberg or hodgkins cells.large reed-sternberg or hodgkins cells.

Immune Function= Impaired cellular Immune Function= Impaired cellular immunity, usually normal humoral immunity, usually normal humoral immunityimmunity