Lymphomas

Lymphomas Pediatric lymphomas are the third most common group of malignancies in children and adolescents. Lymphoma's types: Hodgkin disease, more in children 14-19 years Non-Hodgkin disease more in children younger than 14 years .

Hodgkin disease Hodgkin disease is a neuplastic disease that originate in the lymphoid system and primarily involves the lymph nodes. It predictably metastasizes to nonnodal or extra lymphatic sites, especially the spleen, liver, bone marrow, and lungs. The Ann Arbor stages system (box 26-10) Assigns stage based on the number of sites of lymph node involvement, present of extranodal disease, and history of any symptoms.

Hodgkin disease Patients are classified as A if asymptomatic (box 26-11) and as B if they have temp of 38c or higher for 3 consecutive days, drenching night sweats, or unexplained loss of body weight(10% or more) over the preceding 6 months.

Hodgkin disease Diagnosis is based on several tests includes: CBC, ESR, serum copper, ferritin level, fibrinogen, immunoglobulin, uric acid level, LFT, T-cell function studies and urine analysis. CT-scan, bone scan, chest x-ray, rarely lympfoangography. A lymph node biopsy is essential to establish histological diagnosis and staging . Bone marrow aspiration or biopsy

Hodgkin disease Therapeutic management: radiation and chemotherapy. Prognosis :long term survival for all stages Nursing considerations: is very similar to that required for children with leukemia.

Non-Hodgkin lymphoma The disease is usually diffuse rather than nodular. The cell type is either undifferentiated or poorly differentiated. Dissemination occur early, more often, and rapidly. Mediastinal involvement and invasion of meninges are common. Classification is based on the histologic pattern: 1.lymphoblastic,2 Burkitt or non-Burkitt ,or 3. large cell. Immunologically these cells are also classified as T cells; B cells; or non-T cells, non B-cell.

Non-Hodgkin lymphoma Diagnostic evaluation: Clinical manifestation depend on the anatomic site and extent of involvement. A surgical biopsy of an enlarged node. Histopathology confirmation of disease with cytochemical and immunogic evaluation. Bone marrow examination Radiographyic studies.GI, and lungs. Lp.

Non-Hodgkin lymphoma Therapeutic management: the protocol of NHL include aggressive use of irradiation and chemotherapy similar to leukemia. Prognosis: is excellent for children with localized disease, survival after 24 months is considered a cure. Nursing considerations: is very similar to that required for children with leukemia.