Date: [Date of encounter]
Patient: [Patient Name]
Chief Complaint:
Document the patient’s main concerns, such as fatigue, weight loss, lymphadenopathy (swollen lymph nodes), fever, night sweats, or skin lesions.
History of Present Illness:
Onset and duration of symptoms.
Progression of symptoms over time.
Any constitutional symptoms (e.g., fatigue, fever, night sweats, weight loss).
Specific location and characteristics of lymphadenopathy (if present).
Presence of skin lesions (describe location, appearance, and duration).
Prior infections or exposures (e.g., Epstein-Barr virus [EBV])
Recent travel history (particularly to Asia for extranodal NK/T-cell lymphoma)
Past Medical History:
Underlying medical conditions (e.g., autoimmune disorders, immunosuppression)
Prior malignancies
History of Epstein-Barr virus (EBV) infection
Medications:
List of current medications and any potential interactions with planned treatment.
Social History:
Tobacco use
Alcohol intake
Family History:
Family history of lymphoma or other cancers
Physical Exam:
Vital signs (e.g., fever may indicate infection or active lymphoma)
General examination (e.g., lymphadenopathy, weight loss, pallor)
Head and neck examination (e.g., enlarged lymph nodes)
Skin examination (presence and characteristics of skin lesions)
Laboratory Tests:
Complete blood count (CBC) with differential to assess for anemia or cytopenias.
Lactate dehydrogenase (LDH) levels (often elevated in lymphoma)
Liver function tests
Electrolytes
Coagulation studies
Epstein-Barr virus (EBV) serology (EBV positivity common in NK/T-cell lymphoma)
Human T-cell lymphotropic virus (HTLV) serology (may be considered depending on risk factors)
Bone marrow biopsy (may be indicated depending on clinical suspicion)
Imaging Studies (as indicated):
Chest X-ray or CT scan to assess for lymphadenopathy or other organ involvement.
PET scan (positron emission tomography) to evaluate for metabolic activity of lymphoma cells and disease spread.
Other imaging studies (e.g., CT scan of abdomen/pelvis, MRI) depending on suspected location of lymphoma involvement.
Biopsy:
Site and type of biopsy performed (e.g., lymph node biopsy, skin biopsy)
Pathology results confirming diagnosis of T-cell/natural killer-cell lymphoma and specific subtype (e.g., peripheral T-cell lymphoma, nasal NK/T-cell lymphoma)
Assessment:
Confirmed diagnosis of T-cell/natural killer-cell lymphoma and specific subtype based on pathology results.
Stage of disease based on extent of involvement (localized, advanced)
Prognostic factors (e.g., age, performance status, LDH level)
Performance status (patient’s ability to perform daily activities)
Plan:
Treatment: Discuss treatment options based on diagnosis, stage, and prognostic factors. This may include chemotherapy, immunotherapy, radiation therapy, or a combination of these.
Clinical Trial Enrollment: Discuss the possibility of participation in clinical trials for new treatment options.
Supportive Care: Address supportive care needs to manage side effects of treatment and improve quality of life (e.g., pain management, nutrition, emotional support)
Referral: Consider referral to an oncologist specializing in lymphoma treatment.
Follow-up:
Schedule follow-up appointments to monitor response to treatment, manage side effects, and detect potential recurrence.
Additional Notes:
Document any additional relevant information not covered above (e.g., patient education provided).
Disclaimer: This template is for informational purposes only and should be adapted to fit the specific needs of each patient. It is important to follow established guidelines for the diagnosis, staging, and treatment of T-cell/natural killer-cell lymphoma