Non-Hodgkins lymphoma
Description
● Overview
➣ Definition and categorisation:
Malignancies of the lymphoreticular system include lymphomas.
More than 40 B-cell neoplasms and more than 25 T-cell/NK-cell neoplasms are recognised under the 2016 WHO classification.
All lymphomas excluding Hodgkin's lymphoma are included in NHL.
➣Epidemiology: Over the previous three decades, incidence has increased globally.
Men are around 1.5 times more likely to have NHL.
Although some subtypes (Burkitt, lymphoblastic) occur in younger children, the mean age at diagnosis is in the sixth
decade.
Compared to HL, extranodal illness is more common in NHL.
GI tract, head and neck, Waldeyer's ring, and the sinonasal area are typical locations.
Involvement of the oral cavity is uncommon and might resemble other tumours.
● Presentation of a Case
A 58-year-old man's main complaints were: Gum discomfort and swelling in his right upper back for a month.
➣ History: One month of haemoptysis and epistaxis.
Due to loosening, the tooth was extracted two months ago without incident.
➣ Family history: Not relevant.
➣ Examination: Swelling on the right side of the face.
➣ Intraoral: Tender, reddish-pink, sessile, firm, large noduloproliferative growth on the right maxillary ridge (14-tuberosity) that extends to the mid-palate.
There are no palpable regional lymph nodes.
Maxillary antrum carcinoma is the tentative diagnosis.
Nasopharyngeal carcinoma and other tiny round cell tumours are examples of differential diagnoses.
● Investigations
➣Radiology:
•OPG: Alveolar bone degradation, soft-tissue shadow, loss of maxillary antral bone with jagged edges up to orbital floor.
•PNS view: Infraorbital margin damage, nasal conchae involvement, enlargement of the malar bone, and destruction of the maxillary antrum walls.
➣Histopathology: Comedone necrosis, lymphoproliferative illness, and diffuse monotonous proliferation of tiny, spherical cells that resemble lymphocytes in fibrocellular stroma.
➣Immunohistochemistry: haematopoietic origin → CD45 positive.
The non-B-cell lineage is CD20 negative.
➣The final diagnosis was T-cell-derived non-Hodgkin's lymphoma.
➣Additional test results: normal chest X-ray, urine, and hemogram. HIV/HBV negative.
● Discussion
➣Malignant tiny round cell tumours (such as Ewing's sarcoma, rhabdomyosarcoma, neuroblastoma, retinoblastoma, granulocytic sarcoma, etc.) are a differential diagnosis.
Oral cancers: typically manifest as painful, asymptomatic, or extranodal soft-tissue lesions.
➣Immunophenotyping: Haematopoietic origin is confirmed by CD45.
→ T-cell lineage via CD3/CD5.
B-cell lineage → CD20/CD79a.
ALK-1, cyclin D1, CD10, CD15, CD30, and CD138 are other markers that help with subclassification.
➣T-cell NHL epidemiology: around 12% of all lymphomas.
Incidence is rising in India, however it is more prevalent in wealthy countries.
Therapy is guided by Ann Arbour staging.
➣Treatment: Radiotherapy only; slow.
➣Chemotherapy combination (CHOP/CHOP-like regimens ± targeted medicines) was spread.
➣Isolated lesions: adjuvant treatment plus surgery.
➣The outcome depends on the stage and location.
➣The 5-year survival rate for maxillofacial NHL was around 50%.
Protocol
● Management
•Surgical excision under general anesthesia.
•Postoperative radiotherapy + chemotherapy planned.
•Follow-up: 2 years → no local relapse.
● Nursing Intervention:
➣Issue: Handling Symptoms
Pain, exhaustion, respiratory compromise, and discomfort are prominent side effects of lymphoma and its therapy.
➣ Management: Use non-pharmacologic techniques (such as relaxation and heat treatment) in addition to analgesics and tranquillizers to manage pain. To lessen weariness, promote striking a balance between activity and relaxation and employ energy-saving techniques. Respiratory function is supported by more oxygen and respiratory treatments, particularly when there is airway impairment.
➣Issue: Risk of Infection
Immunotherapy and chemotherapy impair immune function, raising the risk of infection.
➣Management: Put in place stringent infection control procedures, include washing your hands, isolating yourself in reverse, and avoiding crowded places. Keep an eye out for illness symptoms and teach patients how to spot them early (fever, chills). When appropriate, provide immunisations.
➣Issue: Emotional and Psychosocial Stress
Patients and carers frequently experience worry, tension, and panic as a result of diagnosis and protracted therapy.
➣Management: Offer emotional support, counselling, and connections to mental health specialists or support groups. Recognise that emotional reactions to disease are natural and encourage people to express their feelings freely. Anxiety over the course of an illness and its treatment might be decreased with education and consistent communication.
➣ Issue: Adverse Reactions to Treatment
Therapy side effects include hair loss, nausea, vomiting, neutropenia, and more.
➣ Management: Use antiemetics, dietary changes, and symptomatic care to keep an eye out for and control side effects. Inform patients about common adverse effects and coping mechanisms, such staying hydrated and eating a healthy diet.
➣ Issue: Lack of Knowledge and Self-Care
Families and patients frequently don't know enough about lymphoma, its therapies, or self-care.
➣ Management: Teach self-monitoring for symptoms, promote drug adherence, and offer thorough knowledge about the illness and treatment. Teach patients and carers about potential problems, follow-up, and when to get help.
➣ Issue: Coordinating Care
A multidisciplinary approach and smooth provider communication are necessary for complex regimens.
➣ Management: Organise the treatment of social workers, therapists, nurses, and oncologists. Speak out for the patient's needs and help the patient and care team make well-informed decisions.
Notes
For more information visit https://pmc.ncbi.nlm.nih.gov/articles/PMC7802842/
