Nursing Guide to Lymphoma: Nursing Diagnosis, Interventions, & Care Plans

Lymphoma is a type of cancer that originates in the lymphatic system, which is part of the body's immune system. It primarily affects lymphocytes, a type of white blood cell that helps the body fight infections. Lymphoma can occur in any part of the lymphatic system, including the lymph nodes, spleen, bone marrow, and other organs. 

Lymphoma is divided into two main types: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells, which are large, abnormal lymphocytes. Non-Hodgkin lymphoma encompasses a diverse group of lymphomas that vary in their aggressiveness and treatment response. 

Early diagnosis and treatment are crucial to improving outcomes, and nursing care plays a significant role in managing symptoms, supporting treatment adherence, and providing emotional support to patients and their families. 

Etiology and epidemiology 

The exact cause of lymphoma is unknown, but it is believed to result from genetic mutations in lymphocytes that lead to uncontrolled cell growth. Several risk factors and environmental influences may increase the risk of developing lymphoma. 

Key risk factors: 

• Age: Hodgkin lymphoma is more common in young adults (ages 15-35) and older adults (ages 55 and older). Non-Hodgkin lymphoma is more common in older adults, typically over 60. 
• Gender: Males are more commonly affected by most types of lymphoma. 
• Family history: A family history of lymphoma may increase the risk. 
• Immunosuppression: Individuals with weakened immune systems, such as those with HIV/AIDS, organ transplant recipients, or autoimmune diseases, are at higher risk. 
• Infections: Certain infections, like Epstein-Barr virus (EBV), Helicobacter pylori, and human immunodeficiency virus (HIV), have been associated with lymphoma development. 
• Radiation exposure: Previous exposure to radiation, such as from cancer treatment, increases the risk of lymphoma. 
• Chemical exposure: Long-term exposure to certain chemicals, such as pesticides or solvents, may increase the risk of lymphoma. 

Lymphoma which arises from the clonal proliferation of lymphocytes is the most common blood cancer, with non-Hodgkin lymphoma being more prevalent than Hodgkin lymphoma. In 2024, approximately 80,620 new cases of non-Hodgkin lymphoma and 8,570 new cases of Hodgkin lymphoma were diagnosed in the United States. 

ICD-10 Code 

• ICD-10 Code for Hodgkin lymphoma: C81.9 (Hodgkin lymphoma, unspecified) 
• ICD-10 Code for non-Hodgkin lymphoma: C85.9 (Non-Hodgkin lymphoma, unspecified) 

Source: ICD-10 Data and ICD-10 Data 

Diagnosis 

The diagnosis of lymphoma is based on a combination of clinical evaluation, biopsy, and imaging studies. Symptoms of lymphoma can be vague and often mimic other illnesses, making early diagnosis challenging. 

Common lymphoma symptoms: 

• Painless swelling of lymph nodes, particularly in the neck, armpits, or groin 
• Persistent fatigue 
• Unexplained weight loss 
• Fever and night sweats 
• Itching 
• Shortness of breath or cough (if lymph nodes in the chest are enlarged) 
• Abdominal pain or swelling 

Diagnostic tests: 

• Biopsy: A lymph node biopsy is the definitive diagnostic test for lymphoma. It involves removing a portion of lymph node tissue for microscopic examination to identify cancerous cells. 
• Immunohistochemistry: This test helps determine the type of lymphoma by identifying specific markers on the surface of the cancer cells. 
• Imaging studies: 
• CT scan or PET scan: These imaging techniques help assess the spread of lymphoma throughout the body. 
• MRI: Used for specific cases, such as when central nervous system involvement is suspected. 
• Bone marrow biopsy: Performed to check if lymphoma has spread to the bone marrow. 
• Blood tests: While blood tests alone cannot diagnose lymphoma, they can help assess overall health and function of the liver, kidneys, and bone marrow. 

Differential diagnosis includes infections, other cancers, autoimmune diseases, and benign lymph node enlargement. 

Management 

The treatment of lymphoma depends on the type (Hodgkin or non-Hodgkin), stage, and aggressiveness of the disease, as well as the patient's overall health. Most treatments aim to cure the disease or achieve long-term remission. In some cases, the focus may be on controlling symptoms and improving quality of life. 

Lymphoma treatment options: 

Chemotherapy 

• Chemotherapy is the primary treatment for both Hodgkin and non-Hodgkin lymphomas. It involves the use of cytotoxic drugs to kill cancer cells or stop them from growing. Common chemotherapy regimens include: 
• ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine) for Hodgkin lymphoma. 
• CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) for non-Hodgkin lymphoma. 

Radiation therapy 

• Radiation therapy is often used in early-stage Hodgkin lymphoma or in combination with chemotherapy for some non-Hodgkin lymphomas. It involves using high-energy beams to target and kill cancer cells in specific areas. 

Immunotherapy 

• Monoclonal antibodies (e.g., rituximab): These drugs target specific proteins on the surface of lymphoma cells and help the immune system destroy them. 
• Checkpoint inhibitors (e.g., pembrolizumab): These drugs help restore the immune system’s ability to detect and fight cancer cells. 

Targeted therapy 

• Bruton tyrosine kinase (BTK) inhibitors (e.g., ibrutinib): Used for specific subtypes of non-Hodgkin lymphoma, targeting molecules involved in cancer cell growth. 

Stem cell transplantation 

• Stem cell or bone marrow transplantation may be considered for patients with aggressive lymphomas or those who relapse after initial treatment. It involves high-dose chemotherapy followed by the infusion of healthy stem cells to regenerate bone marrow. 

Preventive measures: 

• Regular follow-ups: Patients in remission should attend regular follow-up appointments to monitor for recurrence or late effects of treatment. 
• Infection prevention: Patients with lymphoma, especially those undergoing chemotherapy or immunosuppressive treatments, are at increased risk of infections. Vaccinations, good hygiene, and avoiding exposure to sick individuals are important. 

Lymphoma nursing care plan 

Nursing considerations 

Nurses play a critical role in the care of lymphoma patients by managing symptoms, administering treatments, monitoring side effects, and providing emotional support. 

Assessment 

• Physical assessment: Monitor for signs of infection, bleeding, anemia, and other complications related to lymphoma or its treatment. 
• Pain and fatigue assessment: Evaluate for pain, fatigue, and other side effects from chemotherapy or radiation. 
• Psychosocial assessment: Assess the patient’s emotional and mental health, as a lymphoma diagnosis can cause anxiety, depression, and fear. 

Nursing diagnosis/risk for 

• Risk for infection related to immunosuppressive treatment 
• Fatigue related to chemotherapy and disease burden 
• Anxiety related to diagnosis and prognosis 
• Risk for impaired skin integrity related to radiation therapy 

Interventions 

• Administer medications: Ensure timely administration of chemotherapy, immunotherapy, or radiation therapy. Monitor for side effects, including nausea, vomiting, hair loss, or neutropenia. 
• Pain management: Provide analgesics or non-pharmacologic interventions like relaxation techniques or heat therapy for pain relief. 
• Infection control: Teach patients about the importance of infection prevention, including hand hygiene, avoiding crowds, and vaccination. 
• Emotional support: Offer counseling, support groups, or referrals to mental health professionals to help patients cope with the emotional aspects of their diagnosis. 

Expected outcomes 

• The patient will maintain adequate infection control with no signs of infection during treatment. 
• The patient will demonstrate effective coping strategies to manage anxiety and stress. 
• The patient will report reduced pain and fatigue with appropriate interventions. 
• The patient will adhere to follow-up appointments and treatments as scheduled. 

Individual/caregiver education 

Patient and caregiver education is vital in managing lymphoma, minimizing treatment side effects, and promoting a positive quality of life: 

• Medication adherence: Teach patients about the importance of completing chemotherapy regimens and taking medications as prescribed. 
• Infection prevention: Educate on avoiding exposure to infections, maintaining good hygiene, and recognizing early signs of infection (fever, chills). 
• Managing side effects: Instruct patients on how to manage common side effects such as nausea, fatigue, and hair loss. 
• Follow-up care: Emphasize the importance of attending regular follow-up appointments to monitor for recurrence and long-term side effects. 

References

• Lymphoma Research Foundation. (2023). Lymphoma. Retrieved from https://www.lymphoma.org 
• ICD-10 Data. (2023). C81.9 - Hodgkin lymphoma, unspecified. Retrieved from https://www.icd10data.com/ICD10CM/Codes/C00-D49/C81-C96/C81-/C81.9 
• American Cancer Society. (2023). Lymphoma. Retrieved from https://www.cancer.org 
• Lymphoma - StatPearls - NCBI Bookshelf (nih.gov)