TAILIEUCHUNG - Chapter 105. Malignancies of Lymphoid Cells (Part 8)

Chapter 105. Malignancies of Lymphoid Cells (Part 8) Approach to the Patient: Lymphoid Cell Malignancies Regardless of the type of lymphoid malignancy, the initial evaluation of the patient should include performance of a careful history and physical examination. These will help confirm the diagnosis, identify those manifestations of the disease that might require prompt attention, and aid in the selection of further studies to optimally characterize the patient's status to allow the best choice of therapy. It is difficult to overemphasize the importance of a carefully done history and physical examination. They might provide observations that lead to reconsidering the diagnosis, provide. | Chapter 105. Malignancies of Lymphoid Cells Part 8 Approach to the Patient Lymphoid Cell Malignancies Regardless of the type of lymphoid malignancy the initial evaluation of the patient should include performance of a careful history and physical examination. These will help confirm the diagnosis identify those manifestations of the disease that might require prompt attention and aid in the selection of further studies to optimally characterize the patient s status to allow the best choice of therapy. It is difficult to overemphasize the importance of a carefully done history and physical examination. They might provide observations that lead to reconsidering the diagnosis provide hints at etiology clarify the stage and allow the physician to establish rapport with the patient that will make it possible to develop and carry out a therapeutic plan. For patients with ALL evaluation is usually completed after a complete blood count chemistry studies reflecting major organ function a bone marrow biopsy with genetic and immunologic studies and a lumbar puncture. The latter is necessary to rule out occult CNS involvement. At this point most patients would be ready to begin therapy. In ALL prognosis is dependent upon the genetic characteristics of the tumor the patient s age the white cell count and the patient s overall clinical status and major organ function. In CLL the patient evaluation should include a complete blood count chemistry tests to measure major organ function serum protein electrophoresis and a bone marrow biopsy. However some physicians believe that the diagnosis would not always require a bone marrow biopsy. Patients often have imaging studies of the chest and abdomen looking for pathologic lymphadenopathy. Patients with typical B cell CLL can be subdivided into three major prognostic groups. Those patients with only blood and bone marrow involvement by leukemia but no lymphadenopathy organomegaly or signs of bone marrow failure have the best prognosis.

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• Malignancies of Lymphoid Cells
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