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Course: Pediatric Nursing

Topic: Nursing Care of Child with

Neoplastic Disorders Part II b

The Nurses International Community

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Module Goals

Learners will be able to:

Identify types of lymphoma in children including signs and symptoms.
Identify risk factors for development of lymphoma in children.
Describe common laboratory and diagnostic procedure.
Explain common medical treatments / therapies.
Explain the role of the nurse management of child with lymphoma.

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Hodgkin Lymphoma (Hodgkin Disease)

Affects lymphocytes, which are a type of white blood cell.
Can start anywhere in the lymphatic system.
Often starts in the lymph nodes in the upper body, such as in the chest, neck or underarms.
More common in older children and teenagers than in young children
Two main types:

Classic Hodgkin lymphoma.
Nodular lymphocyte predominant Hodgkin lymphoma.

Australian Government Cancer Australia, 2022

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

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Types

Two main types of childhood Hodgkin lymphoma:

Classic Hodgkin lymphoma:

The most common type
Occurs most often in adolescents
Hodgkin lymphoma cancer cells, called Reed-Sternberg cells, may be present
Further subdivided into:

Nodular-sclerosing Hodgkin lymphoma
Mixed cellularity Hodgkin lymphoma
Lymphocyte-rich classic Hodgkin lymphoma
Lymphocyte-depleted Hodgkin lymphoma

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

Nodular-sclerosing Hodgkin lymphoma

occurs most often in older children and adolescents. It is common to have a chest mass at diagnosis.

Mixed cellularity Hodgkin lymphoma

most often occurs in children younger than 10 years of age. It is linked to a history of Epstein-Barr virus (EBV) infection and often occurs in the lymph nodes of the neck.

Lymphocyte-rich classic Hodgkin lymphoma:

is rare in children. When a sample of lymph node tissue is looked at under a microscope, there are Reed-Sternberg cells and many normal lymphocytes and other blood cells.

Lymphocyte-depleted Hodgkin lymphoma

is rare in children and occurs most often in adults or adults with the human immunodeficiency virus (HIV). When a sample of lymph node tissue is looked at under a microscope, there are many large, oddly shaped cancer cells and few normal lymphocytes and other blood cell

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Types (Continued)

Nodular lymphocyte-predominant:

Less common than classic Hodgkin lymphoma.
Most often occurs in children younger than 10 years of age.
The cancer cells look like "popcorn".
Often occurs as a swollen lymph node in the neck, underarm, or groin.

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

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Critical Thinking Question

During a physical assessment, a nurse discovers a child’s groin and underarm has popcorn like nodules.

What condition would the nurse suspect ?

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Risk Factors

Epstein-Barr virus infection
A family history of Hodgkin lymphoma
Infection with the human immunodeficiency virus (HIV)
An autoimmune lymphoproliferative syndrome
A weakened immune system after an organ transplant

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

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Symptoms

Swollen lymph nodes
Fever
Drenching night sweats
Weight loss
Feeling very tired
Anorexia
Itchy skin
Coughing
Trouble breathing, especially when lying down

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

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Diagnosis

Medical history and physical exam
Blood tests
Medical imaging, such as:

Chest X-ray
Computed tomography (CT) scan
Magnetic resonance imaging (MRI)
Positron emission tomography (PET) scan

Lymph node biopsy

Australian Government Cancer Australia,2022

Contact info: info@nursesinternational.org

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Staging

Often describe in four stages:

Stage I:

Cancer in one lymph node area or lymphoid organ ( thymus) Or in one organ outside the lymphatic system.

Stage II:

Cancer in two or more lymph node areas on the same side of the body either both above or both below the diaphragm.
May spread from one lymph node area into a nearby organ.

Australian Government Cancer Australia,2022

Contact info: info@nursesinternational.org

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Staging (Continued)

Stage III:

Occurs in more than one lymph node area on both sides of the diaphragm (above and below).
May spread to a nearby organ and/or the spleen.

Stage IV:

Has spread to one or more organs outside the lymphatic system.
Alternatively, occurs in two organs in distant parts of the body, but not in the nearby lymph nodes Or, in the liver, bone marrow, lungs or cerebrospinal fluid.

Australian Government Cancer Australia,2022

Contact info: info@nursesinternational.org

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Critical Thinking Question

A child who has been diagnosed with hodgkin's lymphoma has cancer in two or more lymph node areas on the same side of the body.

What stage of the disease is this?

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Treatment

Types of standard treatment:

Chemotherapy
Radiation therapy
Targeted therapy
Immunotherapy
Surgery
High-dose chemotherapy with stem cell transplant

New types of treatment are being tested in clinical trials.

Proton beam radiation therapy

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

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Nursing Management

Education of the child and family
Psychosocial support for the child and family
Preparation of the child for procedures
Management of pain
Prevention and management of infection
Management of fever and neutropenia
Management of nausea and vomiting
Management of central venous access devices (CVADs)
Health promotion (dental care, immunization)
Monitoring of long-term effects of treatment

Australian Government Cancer Australia, 2022

Contact info: info@nursesinternational.org

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Case Study

Which of the following is true for the treatment and management of a child diagnosed with lymphoma? (Select all that apply)

Chemotherapy, radiation therapy, targeted therapy are some of the available treatment options
Proton beam radiation therapy is found to be most effective in hodgkin's lymphoma
Education and psychological support has to be provided to the child and the family
Pain management is another most important aspect of the nursing care

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

Contact info: info@nursesinternational.org

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Cultural Considerations (Continued):

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

Contact info: info@nursesinternational.org

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References:

National Cancer Institute. (2021 August 13). Childhood Hodgkin Lymphoma Treatment (PDQ®)–Patient Version. https://www.cancer.gov/types/lymphoma/patient/child-hodgkin-treatment-pdq

Australian Government Cancer Australia. (2022). Hodgkin lymphoma (Hodgkin disease). https://childrenscancer.canceraustralia.gov.au/types-childrens-cancers/hodgkin-lymphoma

American Cancer Society. (2018). What Is Hodgkin Lymphoma?. https://www.cancer.org/cancer/hodgkin-lymphoma/about/what-is-hodgkin-disease.html

Australian Government Cancer Australia. (2022). Supportive care needs of the child with ALL. https://www.edcan.org.au/edcan-learning-resources/case-based-learning-resources/acute-lymphoblastic-leukaemia/active-treatment/supportive-care-needs

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