Lymphoma treated with chemotherapy By Allie Kruger

Cheesy Jokes What do you call bugs with cancer? An ON- CALLogist MalignANT and BEEnign What do you call a doctor who is always on the telephone? An ON- CALLogist How can nurses stand to work in busy hospitals? They have lots of patients

Denise Mitchell 21 years old Female Caucasian 5’6’’ Tall 120 lbs Full time college student Denise had the flu several weeks ago and says she has never fully recovered. She will occasionally get a fever, still has a cough, feels fatigued, and has severe night sweats.

Lymphoma Cancer of the Lymph Node Lymph nodes can be found in the chest, abdomen, neck, and armpit Starts as a growing mass in a lymph node, but can spread to other areas such as intestine, bone, brain, or spinal chord

2 Types of Lymphoma Hodgkin’s Lymphoma- spreads in an orderly manner from one group of lymph nodes to another. Also Hodgkin’s contains a special type of cell that NH does not Non-Hodgkin’s- spreads through lymphatic system in no orderly manner

Stage Criteria Stage I Stage II Stage III Stage IV The lymphoma is in a lymph node or nodes in only 1 region, such as the neck, groin, underarm, and so on. The cancer is found only in 1 area of a single organ outside of the lymph system (IE). Stage II The lymphoma is in 2 or more groups of lymph nodes on the same side of (above or below) the diaphragm.. The lymphoma extends from a single group of lymph node(s) into a nearby organ (IIE). It may also affect other groups of lymph nodes on the same side of the diaphragm. Stage III The lymphoma is found in lymph node areas on both sides of (above and below) the diaphragm. The cancer may also have spread into an area or organ next to the lymph nodes (IIIE), into the spleen (IIIS), or both (IIISE). Stage IV The lymphoma has spread outside of the lymph system into an organ that is not right next to an involved node. The lymphoma has spread to the bone marrow, liver, brain or spinal cord, or the pleura (thin lining of the lungs). This is supported by positive lymph nodes and a chest x-ray indicating a possible tumor.

Classic Signs of Lymphoma Denise’s Symptoms Enlarge Lymph Nodes Abnormal Lymph Nodes Shortness of breath or cough Cough Fever Weight loss Night sweats Night Sweats Fatigue Swollen abdomen _________ Feeling full after small amounts of food Chest pain or pressure

Treatment Chemotherapy – Blocks mitosis, or stops cells from dividing, limiting cancer cell production Radiation – used when a large amount of cancer cells have accumulated in one area of the body. It damages genetic material (DNA) within cells Patient is on prescribed CHOP, which is a combination of 4 chemotherapy drugs often used to treat lymphoma.

Burning during urination Severe diarrhea Platelets Thrombocytopenia Affected Cell Result Symptoms Red Blood Cells Anemia Fatigue Shortness of breath Chest pain White Blood Cells Neutropenia Fever Chills Cough/sore throat Skin or mouth rashes Burning during urination Severe diarrhea Platelets Thrombocytopenia Easy bruising Bleeding from skin >10 minutes or poor clotting ability Blood in urine or stool headaches Any rapidly reproducing cells in the body Hair follicles, mucous membranes, gastrointestinal cells, and bone marrow. Hair loss Nausea Ulcers Mouth sores Radiation and chemotherapy also affect healthy tissue. In lymphoma, red blood cells, white blood cells, and platelets can also be killed along with the cancer cells.

Factors Affecting Nutritional Status of Cancer Patient Constipation, diarrhea, inhibition of bowel mobility, taste abnormalities, chewing and swallowing problems, corticosteroids causing tissue breakdown, excessive loss of urinary protein, calcium, and potassium Cancer- cachexia may occur, which is characterized by weight loss, anorexia, muscle wasting and weakness, and immunosuppression. Patients with cachexia will require increased energy and protein in their diets. Until the tumor growth is under control, it will continue to increase the body’s protein, carbohydrate, and fat metabolism

Nutrition Therapy for Symptoms from chemotherapy Compromised immune system-safe food practices, avoid communal foods, proper hygiene Loss of calcium and potassium: take a multivitamin or a nutritional supplement. Chewing and swallowing problems: softened or pureed foods. Taste abnormalities: Try different seasonings or bland tasting foods. Constipation: increased fiber and fluids Diarrhea: increased fluids, reduced dietary fat, sugar, caffeine, and spicy foods which may irritate the problem Cancer-cachexia: increase protein and caloric intake

Body Weight Evaluation BMI 120lbs/2.2 = 54.5kg 66in x 2.54 = 168/100 = 1.68 m 54.5/(1.68)(1.68) = 19.7 kg/m2 %UBW 120lbs/130lbs x 100 = 92% UBW Patient lost 8% body weight over 2 -3 months >7.5% weight loss in 3 months is considered significant

Factors contributing to the weight loss Severe night sweats causing water loss and dehydration Fatigue causing lack of physical activity Sore throat causing less caloric intake Glucose, protein, and fat are metabolized at a faster rate to aid the tumor in growth

Possible Nutrition Problems Increased Nutrient Needs (N1-5.1) Inadequate Protein-energy intake (N1-5.3) Inadequate Fluid intake (N1-3.1) Increased energy expenditure (N1-1.2)

Resources American Cancer Society. (10-25-2010). Non-Hodgkin Lymphoma. http://www.cancer.org Center for Disease Control and Prevention. (3-3-2011). Hematologic (Blood) Cancers. http://www.cdc.gov/cancer/hematologic/lymphoma/ Leukemia and Lymphoma Society. (3-16-2011). Disease Information and Support. http://www.lls.org/diseaseinformation Mahan, K. L., & Scott-Stump, S. (2008). Krause’s Food and Nutrition Therapy. St. Louis, Missouri: Sanders Elsevier Schmidt, Char. Medical Nutrition Therapy for Cancer Prevention, Treatment, and Recovery. [PowerPoint]. Retrieved from D2L website. https://uwstout.courses.wisconsin.edu http://www.thefurrymonkey.co.uk/jokes_cancer.htm