Staged by regional involvement: CT and multiple lymph node and bone
marrow biopsies:
Non-Hodgkin Lymphoma or Hodgkin Lymphoma
- Stage 1: One lymph node area or maximum of one extralymphatic
site (IE) - Stage II: Two or more lymph node regions, or one added extralymphatic
site or organ involved, on same side of diaphragm or abdomen (IIE) - Stage III: Lymph node regions on both sides of diaphragm, or one
extralymphatic site (IIIE), spleen (IIIS), or both (IIISE) - Stage IV: Cancer has spread throughout body with one or more extra-
lymphatic sites with or without lymph node involvement
Treatments
Non-Hodgkin lymphoma: Similar to leukemia treatment with induc-
tion, consolidation, and maintenance phases based on lymphoblastic or
nonlymphoblastic cells:
- Lymphoblastic lymphoma: Multiple chemotherapy regimens—
commonly cyclophosphamide or ifosfamide, vincristine, intrathecal
chemotherapy such as L-asparaginase, prednisone, daunomycin,
6-thioguanine,cytosine arabinoside, and BCNU. - Nonlymphoblastic cells: Cyclic drug combinations with cyclophos-
phamide and methotrexate plus anthracycline
Hodgkin treatmentalso involves irradiation and chemotherapy: - Treatment:
Aggressive irradiation: Involved field (IF), extended field (EF)
including involved area and adjacent nodes, or total nodal irradiation
(TNI).
Mechlorethamine (nitrogen mustard), vincristine (Oncovin), procar-
bazine, and prednisone, a protocol commonly called MOPP therapy.
Cyclophosphamide and cytarabine and other chemotherapy may
be used.
Five-year survival for stage I or II is 90%; stage III or IV is 60
to 90%.
Relapse in adulthood is possible.
Nursing Interventions
Reinforce physician’s explanation of diagnosis and treatment plan.
Explain procedure at child’s level of understanding including what will
be seen.
Address fear related to diagnostic tests, procedures, and treatments.
- Reinforce physician’s explanation of diagnosis and treatment plan.
- Explain procedure at child’s level of understanding including what
will be seen, felt, heard, and smelled; use drawings when appropriate.
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CHAPTER 8/ Oncology Conditions^159