Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
Follow-up for marginal zone lymphoma (MZL) / New or worsening symptoms (specify)
(e.g., fatigue, lymphadenopathy, abdominal pain, weight loss)
History of Present Illness:
For follow-up visits, inquire about any new or worsening symptoms since the last encounter.
Describe the character, duration, and severity of new symptoms.
Mention any recent changes in medications, lifestyle habits, or exposures that may affect MZL (e.g., new medications, weight changes, infections).
Past Medical History:
Date of MZL diagnosis and the specific subtype (e.g., extranodal MZL of the spleen, MALT lymphoma).
Previous treatments for MZL (e.g., surgery, radiation therapy, chemotherapy).
Presence of underlying conditions associated with MZL (e.g., autoimmune disease, chronic infections like H. pylori).
Other relevant medical history.
Medications:
List all current medications, including any medications for MZL treatment or supportive care.
Social History:
Inquire about tobacco use (may worsen prognosis).
Family History:
Presence of lymphoma or other cancers in first-degree relatives.
Physical Exam:
General observation: Assess for signs of:
Fatigue
Lymphadenopathy (swollen lymph nodes) – depending on the subtype of MZL
Abdominal pain or distension (more common with extranodal MZL of the spleen)
Palpable splenomegaly (enlarged spleen)
Consider a focused examination based on the specific subtype of MZL (e.g., ENT exam for MALT lymphoma).
Laboratory Tests:
Complete blood count (CBC): May reveal anemia or lymphocytosis.
Lactate dehydrogenase (LDH): May be elevated in some MZL cases.
Other laboratory tests may be indicated based on specific concerns (e.g., autoimmune workup, H. pylori testing for MALT lymphoma).
Imaging Studies (as indicated):
Chest X-ray: May reveal enlarged lymph nodes in the chest.
CT scan or PET scan: Can help assess the extent of disease involvement, including lymph nodes, spleen, and other organs.
Endoscopy (upper or lower) with biopsy: May be used to diagnose MALT lymphoma involving the stomach or intestines.
Ultrasound: Can be used to assess the size and appearance of the spleen.
Bone Marrow Biopsy (if indicated): May be performed in some cases to rule out other types of lymphoma.
Assessment:
Marginal zone lymphoma status: Confirm or rule out MZL based on clinical presentation, laboratory findings, imaging studies, and biopsy results.
Specific subtype of MZL: Identify the specific subtype of MZL based on the location of the primary tumor.
Stage of disease (if applicable): Depending on the subtype, staging may be used to determine the extent of disease spread.
Prognosis: Discuss the patient’s prognosis based on the specific subtype, stage, and other factors.
Plan:
Treatment (depends on factors like subtype, stage, symptoms, and patient preferences):
Observation (watch and wait): May be appropriate for patients with early-stage, asymptomatic MZL.
Surgery: May be curative for some patients with localized MZL of the spleen or other organs.
Radiation therapy: May be used for localized disease or to control symptoms.
Chemotherapy: Typically not the first-line treatment, but may be used in some cases.
Targeted therapies: Newer targeted therapies are being investigated for MZL.
Eradication of H. pylori infection (if present with MALT lymphoma).
Monitoring: Schedule regular follow-up visits with physical exams, blood tests, and imaging studies as needed to monitor disease progression and treatment response.
Education: Educate the patient about MZL, specific subtype, treatment options, potential side effects, and the importance of regular follow-up. Provide resources for support groups or patient advocacy organizations.
Disclaimer: This template is for informational purposes only and should be adapted to the specific needs of each patient. Marginal zone lymphoma is a heterogeneous group of lymphomas with varying clinical presentations and treatment approaches. It is recommended to consult with relevant medical resources and MZL