Hodgkin’s Disease

Hodgkin’s disease is a rare cancer of unknown cause that is unicentric in origin and spreads along the lymphatic system. There is a familial pattern associated with Hodkin’s as well as an association with the Epstein-Barr virus (found 40% to 50% of patients). It is more common in men and tends to peak in the early 20s and after 50 years of age.  The Reed-Sternberg cell, a gigantic morphologically unique tumor cell that is thought to be  of immature lymphoid origin, is the pathologic hallmark and essential diagnostic criterion of Hodgkin’s disease. Most patients with Hodgkin’ disease have the types currently designated “nodular sclerosis” or “mixed cellularity”. The nodular sclerosis type tends to occur more often in young women ans at an earlier stage but has a worse prognosis than the  mixed cellularity subgroup. which occurs more commonly in men and causes more constitutional symptoms but has a better prognosis.

CLINICAL MANIFESTATIONS

  • Painless enlargement of the lymph nodes on one side of the neck. Individual nodes are firm and painless; common sites are the cervical, supraclavicular, and mediastinal nodes.
  • Mediastinal lymh nodes may be visible on x-ray films and large enough to cause severe pressure symptoms (eg. dyspnea from pressure against the trachea; dysphagia from pressure against the esophagus).
  • Symptoms may result from the tumor compressing other organs, causing cough and pulmonary effusion (from pulmonary infiltrates); jaundice (from hepatic involvement or bile duct obstruction); abdominal pain (from splenomegaly or retroperitoneal adenopathy); or bone pain (due to skeletal involvement).
  • Pruritus is common and can be distressing; unclear etiology Herpes zoster  infection is common.
  • Some patients (20%) experience brief but severe pain after drinking alcohol, usually at the site of the tumor.
  • Mild anemia develops; the white blood cell count may be elevated or decreased; and energy (an absence of or decreased response to skin sensitivity tests such as candidal infection, mumps) may be noted.
  • Constitutional symptoms for prognostic purpose referred to as B symptoms, include fever (without chills), drenching sweats (particularly at night), and unintentional loss of more than 10% of body weight (found in 40% of patients and more common in advanced disease).

ASSESSMENT AND DIAGNOSTIC METHODS

Diagnostic depends on identification of characteristic histologic features in an excised lymph node. After the diagnosis is confirmed, the total extent of tumor involvement is assessed and its distribution is defined.

  • Laboratory studies: complete blood count; platelet count, sedimentation rate, liver and renal function studies, RBC sedimentation rate and serum copper levels are used by some clinicians to assess disease activity.
  • Excisional  lymph node biopsy, bone marrow biopsy, characteristic presence of Reed-sternberg cell; staging of node.
  • Chest x-ray and computed tomography (CT) of chest, abdomen, and pelvis; positron emission tomography (PET) to detect residual disease.

MEDICAL MANAGEMENT

Treatment id determined by the stage of the disease instead of the histologic type.

  • Chemotherapy followed by radiation therapy is used in early-stage disease.
  • Combination chemotherapy alone is now the standard treatment for more advanced disease.
  • When Hodgkin;s does recur, the use of high doses of chemotherapeutic medications, followed by autologous bone marrow or stem-cell transplantation, can be very effective.

NURSING MANAGEMENT

  • Help patients to cope with undesirable effects of radiation therapy including esophagitis, anorexia, loss of taste, dry mouth, nausea and vomiting, diarrhea, skin reactions, and lethargy.
  • Serve bland, soft foods at mild temperature.
  • Teach patient about proper dental hygiene.
  • Administer antiemetics during peak times of nausea.
  • Teach patient that skin reactions are common; rubbing the area and applying heat, cold or lotion should be avoided.
  • Encourage patient to rest and sleep to maintain a  reasonable energy level; lethargy accompanies radiation.
  • Help patient to prepare for alopecia by encouraging him or her to purchase a wig before hair loss.
  • Encourage patient to report any sign of infection for immediate treatment.
  • Instruct patient to use contraception during chemotherapy to prevent cytotoxic effects on the fetus.
  • Encourage patient to keep all follow-up appointments.

 

Reference:

Handbook for Brunner & Suddarth’s textbook of Medical-Surgical Nursing 11th edition by Joyce Young Johnson

Lippincott Williams & Wilkins pp.447-450

 

 

 

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