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Non-Hodgkin's Lymphoma (Diagnosis (Biopsy: Small operation or via a…
Non-Hodgkin's Lymphoma
Pathophysiology
A type of tumor that arises from the lymphatic system (lymphocytes).
NHL can begin in T or B cells (B cells represent the cells of origin in excess of 90% of cases).
Reed-Sternberg cells are not present in NHL (but are in Hodgkins).
Signs and Symptoms
Painless, swollen lymph nodes in your neck, armpits or groin
Abdominal pain or swelling
Chest pain, coughing or trouble breathing
Persistent fatigue
Fever
Night Sweats
Unexplained weight loss.
Risk Factors
Medications that suppress your immune system.
Infection with HIV or Epstein-Barr.
Bacteria including Helicobacter pylori.
Insecticides and chemicals used to kill weeds
Old age. Most common in people over 60 years.
Family History
More common in women than men.
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Diagnosis
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Imaging tests (CT scan or MRI): To see whether the cancer has spread or to determine whether other symptoms, such as abdominal pain, are caused by the cancer.
Heart and lung function tests: Some treatments for NHL can have a negative effect on the hear and lungs.
Physical Exam: Swollen lymph nodes (neck, underarm and groin), swollen liver or spleen.
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Treatment
CHOP
Cyclophosphamide (hemorrhagic cystitis, N&V) - administer with MENSA
Doxorubicin (cardiotoxicity, red-stained urine)
Vincristine (neurotoxicity) only for IV use. Neuropathy (tingling sensation in the extremities)
Prednisone (glucocorticoud)
CHOP-R
The addition of Rituximab (monoclonal antibody)
Targets CD20 cells → lysis
Hypersensitivity, infusion-related reactions
Fewer side effects compared to chemotherapy
Radiotherapy
Radiotherapy has a limited role in NHL relative to HL. Typically used for consolidation after chemotherapy.
Either mono therapy at stage 1 or as an adjunct.