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30 Cards in this Set

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ANN ARBOR CLASSIFICATION STAGES FOR LYMPHOMA
STAGE 1=1 NODE AFFECTED
STAGE 2=2 OR MORE MODES AFFECTED/ON SAME SIDE OF DIAPHRAM (1 SIDE)
STAGE 3=BOTH SIDES OF DIAPHRAM
STAGE 4=DIFFUSE/DISSEMINATED DISEASE
LYMPHOMA
A GENERAL TERM FOR NEOPLASMS (SOLID TISSUE MASSES)OF THE LYMPHOID TISSUE AND IMMUNE SYS
-THE LYMPHOCYTES AND HISTIOCYTES(RETICULOENDOTHELIA CELLS-LARGE MARCROPHAGIC PHAGOCYTES)
LYMPHOMA BEGINS IN THE__
1.LYMPH NODES
2.SPEADS TO EXTRANODAL LYMPH TISSUE AND OTHER ORGANS (SPLEEN,GI TRACT,LIVER,BONE MARROW)
PROGNOSIS AND TXT FOR LYMPHOMA
DEPENDENT ON CORRECT STAGING
(STAGE 1-4)****
HODGKINS DISEASE
-40% OF ALL LYMPHOMAS
-CHARACTERIZED BY ABNORMAL HISTOCYTES=REED-STERNBERG CELLS
-ONSET AGE=15-35,THAN AFTER AGE 50
MORE MALES THAN FEMALES
ETIOLOGY OF HODGKINS
UNKNOWN
?VIRAL,?INFECTIOUS,IMMUNOSUPPRESSED,INCREASED INCIDENCE OF PEOPLE W/ HIGH TITERS OF THE **EPSTEIN-BARR VIRUS**(CAUSATIVE VIRUS IN MONO)
PROLIFERATION OF THE REED-STERNBERG CELLS
REPLACES THE NORMAL CELLULAR COMPONENTS OF THE LYMPH SYS
-PROGRESSES TO ADJACENT STRUCTURES AND DISSEMINATES VIA THE LYMPHATICS AND BLD
WHAT IS THE CLASSIC S/S OF HODGKINS?
CERVICAL NODES-PAINLESS ON SIDE OF NECK
HISTORY/ASSESSMENT OF HODGKINS
1.PAINLESS LYMPH NODES
2.SOON NODES OF NECK ENLARGE
3.SYMPTOMS DUE TO PRESSURE OF NODES
4.NON SPECIFIC SYMPTOMS:DYSPNEA,DYSPHAGIA,HOARSENESS,WT LOSS
5.ETOH-CAUSES SHARP PAIN
6.PRURITIS
7.INCREASED RISK OF TB
WHAT IS ASSESSED DURING PHYSICAL EXAM FOR HODGKINS
ENLARGED NODES ALL OVER BODY
SLIGHT FEVER
CLINICAL DATA
1.CBC-LEUKOCYTOSIS
2.BLOOD CHEMISTRIES
3.CXR
4.BONE MARROW BIOPSY
5.LYMPHANGIOGRAM
6.CT SCAN
7.GALLIUM SCAN
8.LYMPH NODE BIOPSY
9.STAGING LAPAROTOMY
LYMPHANGIOGRAM
RADIOPAQUE DYE INJECTED BETWEEN TOES INTO THE LYMPH SYSTEM WHICH WHEN X-RAYED OUTLINES THE LYMPH SYS WITH ANY ABNORMALITIES (CAN TAKE 3 DAYS FOR EXAM)
CT SCAN IS FOR __
OF CHEST,ABNOMEN/PELVIS WITH CONTRAST
GALLIUM SCAN
RADIOACTIVE SUBSTANCE ABSORBED IN AREA OF HODGKINS
LYMPH NODE BIOPSY WILL SHOW __
WILL SHOW REED-STERNBERG CELLS
STAGING LAPAROTOMY
MUST WEIGHT BENEFIT VS. RISK FOR STAGING
-OFTEN NOT NEEDED DURE TO BETTER SCREENING
NSG DIAGNOSIS
SAME AS FOR APLASTIC ANEMIA AND LEUKEMIA
MEDICAL TXT FOR STAGE 1 AND 2 OF HODGKINS
SHORT COURSE (2-4 MONTHS) OF CHEMOTHERAPY FOLLOWED W/RADIATION TO TUMOR SITE
MEDICAL TXT FOR STAGES 3 AND 4 OF HODGKINS
CHEMOTHERAPY(MAYBE RADIATION AS WELL FOR PALLIATION)
NSG CARE IS AIMED AT
MINIMIZING SIDE EFFECTS AND PROMOTING COMFORT DURING TXT
WHICH COMBINATION OF DRUGS USED FOR HODGKINS? (SIMILAR AS FOR LEUKEMIA0
1.CYCLOPHOSPHAMIDE (CYTOXAN) IV
2.DOXORUBICIN OR HYDROXYDAUNORUBICIN (ADRIAMYCIN) IV
3.ONCOVIN (VINCRISTINE) IV
4.PREDNISONE P.O.
WHAT TO LOOK FOR IN PT AFTER CHEMO TXT
1.PT WILL BE PANCYTOPENIC 10-14 DAYS AFER TXT
2.BMT SO CAN GIVE HIGHER DOSE OF CHEMO
PROGNOSIS OF HODGKINS
1.DEPENDS ON STAGE,PRESENCE/ABSENCE OF SYSTEMIC SYMPTOMS,AND CELL TYPE
2.USUALLY 75% CURABLE IF ACCURATELY STAGED AND TREATED
-5 YR SURVIVAL RATE FOR STAGE 1 AND 2 90%
NON HODGKINS LYMPHOMA (NHL)
MORE COMMON THAN HODGKINS
-SIMILAR BUT LESS PREDICTABLE AND GREATER PROPENSITY TO DISSEMINATE TO EXTRANODAL SITES
-ONSET-ANY AGE,RARE UNDER AGE 2
ETIOLOGY OF NON HODGKINS
?VIRAL,?ENVIRONMENTAL (RADIATION),IMMUNOSUPPRESSIVE DRUG THERAPY,?HELICOBACTER PYLORI**WHICH CAUSES STOMACH ULCERS IS IMPLICATED IN LYMPHOMA OF STOMACH
WHAT STAGE IS RARELY SEEN WITH NON HODGKINS
STAGE 1
-ITS OFTEN MORE WIDESPREAD AT DIAGNOSIS
-EXTRANODAL DISEASE MORE PREVALENT THAN W/HODGKINS (EXP:STOMACH,SM.INTESTINE,BLEEDING,OBSTRUCTION,SKIN LESIONS)
CLINICAL DATA:
**ABSENCE OF REED-STERNBERG CELLS**
-OTHERS SAME AS FOR HODGKINS
ASSESSMENT/HISTORY
1.PAINLESS ENLARGEMENT IN ANY NODE
(NECK,GROIN,AXILLA)
2.RARER:LUMPS ON SKIN,RASH,NIGHT SWEATS,INCREASED URIC ACID=GOUT,ANEMIA,CNS,ABDOMINAL SWELLIN
PLAN/INTERVENTION
MED TXT
SAME AS FOR HODGKINS
PROGNOSIS FOR NON HODGKINS
1.WITHOUT TXT ITS QUICKLY FATAL
2.OVER ALL 5 YR SURVIVAL RATE IS 50-60%
3.50% CURE RATE ,SOME FORMS CHRONIC