lymphomas with pathophysiology
DESCRIPTION
This presentation is made for Advanced Medical Surgical Nursing 1 (Pathophysiology) class at University of Santo Tomas - Graduate School, Manila, PhilippinesTRANSCRIPT
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