HODGKIN S DISEASE Description:

o o o a type of lymphoma it is a cancer of the lymph tissue found in the lymph nodes, spleen, liver, and bone marrow unicentric in origin in that it initiates in a single node Reed-Sternberg cell the malignant gigantic tumor cell that is morphologically unique and is the pathologic hallmark and essential diagnostic criterion

Etiologic factors:
o o UNKNOWN Past infection with the Epstein-Barr virus (EBV) (thought to contribute to its cause)

Manifestations:
o Swollen lymph nodes (that do not hurt) in the neck, underarms, or groin o Becoming more sensitive to the effects of alcohol or having painful lymph nodes after drinking alcohol o Weight loss for no known reason o Fever that does not go away o Soaking night sweats o Itchy skin o Coughing, trouble breathing, or chest pain o Weakness and tiredness that don't go away Infections or other health problems may also cause these symptoms. Types: 4 pathologic subtypes based upon Reed-Sternberg cell morphology and the composition of the reactive cell infiltrate seen in the lymph node biopsy specimen (the cell composition around the Reed-Sternberg cell(s) Name Description

Is the most common subtype and is composed of large tumor nodules showing Nodular sclerosing scattered lacunar classical RS cells set in a background of HL reactivelymphocytes, eosinophils and plasma cells with varying degrees of collagen fibrosis/sclerosis. Mixed-cellularity subtype Is a common subtype and is composed of numerous classic RS cells admixed with numerous inflammatory cells including lymphocytes, histiocytes, eosinophils, and plasma cells without sclerosis. This type is most often associated with EBV infection

and may be confused with the early, so-called 'cellular' phase of nodular sclerosing CHL. Lymphocyte-rich or Lymphocytic predominance Lymphocyte depleted Unspecified Is a rare subtype, show many features which may cause diagnostic confusion with nodular lymphocyte predominant B-cell Non-Hodgkin's Lymphoma (B-NHL). This form also has the most favorable prognosis. Is a rare subtype, composed of large numbers of often pleomorphic RS cells with only few reactive lymphocytes which may easily be confused withdiffuse large cell lymphoma. Many cases previously classified within this category would now be reclassified under anaplastic large cell lymphoma.[5]

Staging: Ann Arbor staging is the staging system for lymphomas The principal stage is determined by location of the tumor:  Stage I indicates that the cancer is located in a single region, usually one lymph node and the surrounding area. Stage I often will not have outward symptoms.  Stage II indicates that the cancer is located in two separate regions, an affected lymph node or organ and a second affected area, and that both affected areas are confined to one side of the diaphragm - that is, both are above the diaphragm, or both are below the diaphragm.  Stage III indicates that the cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen.  Stage IV indicates diffuse or disseminated involvement of one or more extralymphatic organs, including any involvement of the liver, bone marrow, or nodular involvement of the lungs.

Modifiers (these letters can be appended to some stages):  A or B: the absence of constitutional (B-type) symptoms is denoted by adding an "A" to the stage; the presence is denoted by adding a "B" to the stage.  E: is used if the disease is "extranodal" (not in the lymph nodes) or has spread from lymph nodes to adjacent tissue.  X: is used if the largest deposit is >10 cm large ("bulky disease"), or whether the mediastinum is wider than 1/3 of the chest on a chest X-ray.  S: is used if the disease has spread to the spleen. Type of staging: (the nature of the staging is (occasionally) expressed with):  CS - clinical stage as obtained by doctor's examinations and tests.  PS - pathological stage as obtained by exploratory laparotomy (surgery performed through an abdominal incision) with splenectomy (surgical removal of the spleen). Note: exploratory laparotomy has fallen out of favor for lymphoma staging.

Complications:
People with Hodgkin's lymphoma may be at an increased risk of the following conditions, mainly because of the effects of treatment. However, with advances in treatment, the risk of developing these complications may decline: o o o o o o o o o Cardiovascular disease Vascular disease, including stroke Thyroid dysfunction Sterility Airway compression Spread of the cancer:Brain cancer, Spinal cord tumor Sepsis Superior vena cava syndrome Second malignancy, such as leukemia, non-Hodgkin's lymphoma and tumors in the lungs, breasts or gastrointestinal system

Collaborative Management:
Diagnostics: o excisional lymph node biopsy and the finding of Reed-Sternberg cell o chest x-ray & CT scan of chest, abdomen and pelvis identify extent of lymphadenopathy o PET scan most sensitive imaging test in identifying residual disease o CBC, platelet count, ESR, liver and renal function studies o Bone marrow biopsy Treatment primarily depends on the following: o The type of Hodgkin's lymphoma (most people have classic Hodgkin's) o The stage (where the disease has spread) o Whether the tumor is more than 4 inches (10 cm) wide o The patient's age and other medical issues o Other factors, including weight loss, night sweats, and fever Treatment depends on your age and stage of the cancer. o Stages I and II (limited disease) - radiation therapy, chemotherapy, or both o Stages III - chemotherapy alone or a combination of radiation therapy and chemotherapy o Stage IV (extensive disease) - most often treated with chemotherapy alone o Advanced or refractory disease - may receive high-dose chemotherapy followed by an autologous bone marrow transplant Chemotherapy: o ABVD (standard treatment of Hodgkin's disease in the US) doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velban), dacarbazine (DTIC) o Stanford V (includes radiation therapy) doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, prednisone

o o

BEACOPP (usually with involved-field radiation therapy added, a form of treatment for stages > II) bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone MOPP (mostly replaced by ABVD; may be used if there are lung or heart conditions present or allergies to any of the medications in the ABVD combination) mustargen (mechlorethamine, nitrogen mustard), oncovin (Vincristine, VCR), procarbazine (Matulane), prednisone (Deltasone, Orasone)

Additional treatments depend on other symptoms. They may include: Transfusion of blood products, such as platelets or red blood cells, to fight low platelet counts and anemia o Antibiotics to fight infection, especially if a fever occurs Support Groups ease the stress of illness through support groups, of people who share common experiences and problems

Nursing Management:
o o o o o o o o o o o protect the skin receiving radiation, avoid rubbing, powders, deodorants, lotions, or ointments (unless prescribed) or application of heat or cold encourage patient to keep clean and dry, and to bathe the area affected by radiation gently with tepid water and mild soap encourage wearing loose-fitting clothes and to protect skin from exposure to sun, chlorine, and temperature extremes protect oral and gastro-intestinal tract mucous membranes, encourage frequent, small meals, using bland and soft diet at mild temperatures teach the patients to avoid irritants such as alcohol, tobacco, spices, and extremely hot or cold foods administer or teach self-administration of pain medication or antiemetic before eating or drinking, if needed encourage mouth care at least twice per day and after meals using a soft toothbrush or toothete and mild mouth rinse assess for ulcers, plaques, or discharge that may be indicative of superimposed infection for diarrhea, switch to low-residue diet and administer anti-diarrheals as ordered teach patient about risk of infection; advice patient to monitor temperature and report any fever or other sign of infection promptly explain to patient that radiation therapy may cause sterility

Sources: Smeltzer et al. Textbook of Medical-Surgical Nursing.12th ed. Philadelphia, 2010. http://en.wikipedia.org/wiki/Hodgkin's_lymphoma

http://www.nlm.nih.gov/medlineplus/ency/article/000580.htm http://nursingcrib.com/nursing-notes-reviewer/hodgkin%E2%80%99s-disease/