Assessment

HISTORY. Note any history of infection with HIV, acquired immunodeficiency syndrome (AIDS), organ transplant, congenital immunodeficiency, autioimmune diseases, or other treatment with immunosuppressive drugs. Patients often have complaints of painless enlarged lymph nodes (commonly in the neck, mediastinum, or chest wall), fevers, night sweats, weight loss, weakness, and malaise. Because nodes and extranodal sites are more likely to be involved in NHL, the patient may also report vague abdominal distress (bleeding, bowel obstruction, cramping, ascites), symptoms of spinal cord compression, or back pain. Cough, dyspnea, and chest pain occur about 20% of the time and are indicative of lung involvement.

PHYSICAL EXAMINATION. Carefully inspect all the locations for lymph nodes and the abdomen for signs of hepatosplenomegaly and ascites. Skin lesions that look like nodules or papules with a tendency to ulcerate appear in about 20% of cases. When palpating lymph node chains, examine the submental, infraclavicular, epitrochlear, iliac, femoral, and popliteal nodes. Involved nodes are characteristically painless, firm, and rubbery in consistency; they are in contrast to the rock-hard nodes of carcinoma because they are freely movable and of varying size. Palpate the liver or spleen, which may be enlarged. The patient may also have weight loss and fever.

PSYCHOSOCIAL. The diagnosis of cancer is devastating at any time of life. Because the disease is most common in the older adult, the patient may be planning retirement. The diagnosis of NHL throws all retirement plans into disarray and may lead to feelings of loss, grief, and anger.

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