Pregnancy: Lymphoma or the Baby? A Case Report

Öz

Mediastinal Large B-Cell Lymphoma disease is usually seen in young women between the ages of 30-35 years. Disease symptoms include cough, chest pain, dyspnea, venous obstruction. Superior Vena Cava Syndrome occurs in 30% of cases and it may cause dysphagia, hoarseness, phrenic nerve paralysis. Optimal disease management and care in pregnant cases with Non-Hodgkin Lymphoma are important for maternal and fetal health. Successful results can be obtained with a multidisciplinary teamwork involving physicians and nurses working in the fields of obstetrics, hematology, pediatrics, and psychiatry in patients who are under chemotherapy due to lymphoma diagnosis during their pregnancy. The case was hospitalized for examination and treatment with a preliminary diagnosis of lymphoma at the 34th week of her pregnancy. The baby was evaluated by the Department of Obstetrics and Gynecology. The pregnancy processes were managed with the cooperation of the Division of Hematology, and the Department of Obstetrics and Gynecology. This case study was prepared with the aim of drawing attention to the importance of nursing care of a pregnant case diagnosed with lymphoma during her pregnancy and to raise awareness about a more effective nursing.

Anahtar Kelimeler

• Pregnancy
• cancer
• chemotherapy
• nursing care

Gebelik: Lenfoma mı, Bebek mi? Bir Olgu Sunumu

Öz

Mediastinal Büyük B Hücreli Lenfoma hastalığı genellikle, 30-35 yaş arası genç kadınlarda görülmektedir. Hastalık semptomları arasında öksürük, göğüs ağrısı, dispne, venöz obstruksiyon bulunur. Vena Kava Superior Sendromu olguların %30’unda görülür ve disfaji, ses kısıklığı, frenik sinir paralizisine neden olabilir. Non-Hodgkin Lenfoma gebe olgularda optimal hastalık yönetimi ve bakım, anne ve fetüs sağlığı açısından önemlidir. Gebelikleri sırasında lenfoma tanısına bağlı kemoterapi alan hastalarda, kadın doğum, hematoloji, pediatri, psikiyatri alanlarında çalışan hekim ve hemşirelerin yer aldığı multidispliner bir ekip çalışması ile başarılı sonuçlar alınabilir. Olgu, gebeliğinin 34. haftasında lenfoma ön tanısı ile tetkik ve tedavi için yatırıldı. Bebek Kadın Doğum Anabilim Dalı tarafından değerlendirildi. Gebelik süreçleri Hematoloji Bilim Dalı ve Kadın Doğum Anabilim Dalı ve iş birliği ile yönetildi. Bu olgu sunumu, gebelik sırasında lenfoma tanısı almış gebe bir olgunun hemşirelik bakımının önemine dikkat çekmek ve daha etkin bir hemşirelik bakımına ilişkin farkındalık oluşturmak amacı ile hazırlandı.

Anahtar Kelimeler

• Gebelik
• kanser
• kemoterapi
• hemşirelik bakımı

Kaynakça

1. Boussios S, Pentheroudakis G, Pavlidis N. Cancer management during pregnancy [Internet]. 2021 Apr [cited 2021 Dec 5]. Available from: http:// www.cancer-pregnancy-Pavlidis-Boussios-Pentheroudakis.pdf.
2. Triunfo S, Scambia G. Cancer in pregnancy: diagnosis, treatment and neonatal outcome. Minerva Ginecol. 2014;66(3):325–34.
3. Johnson PWM, Davies AJ. Primary mediastinal B-cell lymphoma. American Society of Hematology [Internet]. 2008 [cited 2021 Dec 7]. P: 349–58 Available from: https://watermark.silverchair.com/349_358ash. pdf?tokenDOI: 10.1182/asheducation-2008.1.349
4. Avivi I, Farbstein D, Brenner B, Horowitz NA. Non-Hodgkin lymphomas in pregnancy: tackling therapeutic quandaries. Blood Rev. 2014 Sep;28(5):213–20.
5. Fiascone S, Datkhaeva I, Winer ES, Rizack T. Primary mediastinal large B-cell lymphoma in pregnancy. Leukemia and Lymphoma. 2016 Jan; 57(1): 240–43.
6. Perez CA, Amin J, Aguina LM, Cioffi-Lavina M, Santos ES. Primary mediastinal large B-Cell lymphoma during pregnancy. Case Rep Hematol. 2012 Oct 31;2012:1–3.
7. Ferhanoglu B. Diffüz büyük B hücreli lenfomalar-Klinik ve Tedavi. 2007;(3):54–62.
8. Botha MH, Rajaram S, Karunaratne K. Cancer in pregnancy. Int J Gynecol Obstet. 2018 Oct 11;143(2):137–42.

9. GLOBOCAN. [Internet]. Non-Hodgkin lymphoma; 2021 Apr [cited 2022 Aug 15]. Available from: https://gco.iarc.fr/today/data/factsheets/ cancers/34-Non-hodgkin-lymphoma-fact-sheet.pdf
10. Çetin O. Non- Hodgkin lymphoma diagnosed during pregnancy: a case report. Perinat J. 2011 Aug;19(2):94–8.
11. Klink DT, Van Elburg RM, Schreurs MWJ, Van Well GTJ. Rituximab administration in third trimester of pregnancy suppresses neonatal B-cell development. Clin Dev Immunol. 2008 May 5;2008:1-6.
12. Pescovitz D, Greenbaum CJ, Krause-Steinrauf H, Becker DJ, Gitelman ST, Goland R, Gottlieb PA et al. Rituximab, B-lymphocyte depletion, and preservation of beta-cell function. N Engl J Med. 2009 Nov 26;361(22):2143–52.
13. Lee EJ, Ahn KH, Hong SC, Lee EH, Park Y, Kim BS. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy for diffuse large B-cell lymphoma in pregnancy may be associated with preterm birth. Obstet Gynecol Sci. 2014 Nov 20;57(6):526-29.
14. Evens AM, Advani R, Press OW, Lossos IS, Vose JM, Hernandez- Ilizaliturri FJ, et al. Lymphoma occurring during pregnancy: Antenatal therapy, complications, and maternal survival in a multicenter analysis. J Clin Oncol. 2013 Nov 10;31(32):4132–9. 1
15. Güner Ö, Kavlak O. Care patient with endometrial cancer according to neuman systems model: a case report. Balıkesır Heal Sci J. 2015 Feb 10;4(2):94–102.
16. Cangöl E, Şahin NH. Emzirmeyi etkileyen faktörler ve emzirme danışmanlığı. Zeynep Kamil Tıp Bülteni. 2014;45(3):100.
17. Nurseslabs. Cancer. Nurse study guides. [Internet]. 2021 Feb 11 [cited 2022 Jun 8]. Available from: https://nurseslabs.com/cancer/
18. Koyuncu A, Canbay E. Gebelik ve laktasyon döneminde meme kanseri breast cancer in pregnant and postpartum women. C. Ü. Tıp Fakültesi Derg. 2002; 24(1):53–6.
19. Mete S. Stres, Hormonlar ve doğum arasındaki ilişki. DEUHYO ED [Internet]. 2013 Apr [cited 2022 Sep 17]; 6(2):93–8. Available from: http://www.deuhyoedergi.org/
20. Lennan E, Roe H. Role of nurses in the assessment and management of chemotherapy-related side effects in cancer patients. Nurs Res Rev. 2014 Aug 28;4:103–15.
21. Jia Y, Du H, Yao M, Cui X, Shi Q, Wang Y, Yang Y. Chinese herbal medicine for myelosuppression induced by chemotherapy or radiotherapy: A systematic review of randomized controlled trials. Evidence-based Complement Altern Med. 2015 Jan 21; 2015: 1-12.
22. McSorley ST, Horgan PG, McMillan DC. The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: A systematic review and meta-analysis. Critical Reviews in Oncology/Hematology. 2016 Mar 8;101:139–50.
23. Orell-Kotikangas H, Österlund P, Saarilahti K, Ravasco P, Schwab U, Mäkitie AA. NRS-2002 for pre-treatment nutritional risk screening and nutritional status assessment in head and neck cancer patients. Support Care Cancer. 2014 Oct 24;23(6):1495–502.
24. Aksu G, Dolaşik I, Ensaroğlu F, Şener SY, Aydin FH, Temiz S, et al. Evaluation of the efficacy of aprepitant on the prevention of chemotherapy-induced nausea and vomiting and quality of life with functional living index emesis. Balkan Med J. 2012 Sep 11;30(1):64–7.
25. Özkan M, Akın S. Evaluation of the effect of fatigue on functional quality of life in cancer patients. Florence Nightingale Hemşirelik Derg. 2017 Jul 31;25(3):177–92.
26. Ryan JL, Bole C, Hickok JT, Figueroa-Moseley C, Colman L, Khanna et al. Post-treatment skin reactions reported by cancer patients differ by race, not by treatment or expectations. Br J Cancer. 2007 June 12;97(1):14–21.
27. Özveren H. Ağrı kontrolünde farmakolojik olmayan yöntemler nonpharmacological methods at pain management. HÜ Sağ Bil Fak Hem Der. 2011;83–92.
28. Karakut Ş, Bucak FK. Türkiye’de ve dünyada kadın sağlığı hemşireliğine bakış. Gevher Nesibe J Med Heal Sci. 2021;6(13):46–51.
29. Gunes EF. Anne sütündeki biyoaktif bileşenler. Türkiye Klin Beslenme ve Diyetetik Özel Konular [Internet]. 2017 Mar 22;3(2):101–10. Available from: https://www.researchgate.net/publication/315716309