HODGKIN DISEASE

 

Definition of Hodgkin disease

 Hodgkin disease is a type of lymphoma. Lymphoma is cancer of lymph tissue found in the lymph nodes, spleen, liver, and bone marrow.

Unknown

Classification of Hodgkin disease

·         Nodular Sclerosis (NS). Nodular Sclerosis (NS) accounts for 60-80% of all Hodgkin's disease cases. It almost always appears in people between the ages of 15 and 35, and is much more common in women than in men. Most people with NS don't have any initial symptoms. When the disease is found, it is usually at Stage I or II.

·         Lymphocyte Rich (LR) or Lymphoid Proliferative (LP). LP Hodgkin's disease is usually found in people in their 30s and 40s. It accounts for about 5% of all cases. More men than women get LP Hodgkin's disease, and the cure rate is very high. B symptoms are very uncommon in LP Hodgkin's.

·         Mixed-Cellularity (MC). Mixed-Cellularity (MC) Hodgkin's can be found in all age groups, but is most common in people in their 30s and 40s. It is more common in men, and most people aren't diagnosed until the disease is in stage III or IV. B symptoms are very common, and often help the doctor diagnose the disease.

·         Lymphocyte Depleted (LD). Lymphocyte Depleted (LD) Hodgkin's disease is the most aggressive Hodgkin's disease. This sub-type is very rare, accounting for only about 1% of Hodgkin's disease cases. More Reed-Sternberg cells are present in the lymph nodes of someone with LD Hodgkin's disease than in any other type. There are two types of LD Hodgkin's disease: reticular and diffuse fibrosis. People with reticular LD usually have some cancer invading their bone marrow. Those with diffuse fibrosis usually have more cancer in the lymph nodes themselves, and in surrounding body tissue. LD Hodgkin's disease is more common in older men. Most people with this form of Hodgkin's disease are diagnosed at an advanced stage.

·         Nodular Lymphocyte Predominant Hodgkin's disease (NLPHD), makes up about 5% of all Hodgkin's disease cases. It is three times more common in men than in women, and it usually affects young adults between their 30s-50s. Most patients are diagnosed at an early stage and a majority respond to therapy with a complete response. Classic Reed-Sternberg cells are not seen or are very uncommon in patients' tissue samples. Instead, large, circular meshworks of cells take over the lymph nodes. Late relapses are common, but they usually do not affect survival. The survival rate is favorable even among patients with recurrent disease

Causes and Pathophysiology of Hodgkin Disease

Cause of this disease is Unknown. Hodgkin lymphoma is unicentric in origin in that it initiates in a single node It is different from other lymphomas because of the presence of a special cell, the Reed-Sternberg cell. In most lymphomas, cancer cells make up most of a tumor. In this disease the Reed-Sternberg cells only make up a small part of the cells in a cancerous lymph node. The rest of the cells are normal.

Symptoms of Hodgkin disease

·          painless  enlargement of one or more lymph nodes in the neck, armpits, or groin

·         fever and chills

·         night sweats

·         weight loss

·         loss of appetite

·         itchy skin – pruritus is common

·         Mild anaemia

Diagnosis

·        Biopsy of lymph nodes

·        Leukocytes count may be elevated or decreased.

·        Bone marrow aspirate and biopsy

·        Radiographic tests (X-ray, CT, and Magnetic Resonance Imaging (MRI), to detect deep nodal involvement.

·        Gallium-67 scan- detects areas of active disease.

·        Liver function test

·        Lymphangiogram to detect size and location of deep nodes involved.

·        Surgical staging( laparatomy with splenectomy, liver biopsy)

·        Lumber puncture to obtains  spinal fluid for cytopathology

 

Medical Management of Hodgkin disease

·        The treatment is determined primarly by the stage of disease, not the histologic type

·        Chemotherapy Short course 2 to 4 months  followed by

·        Radiation to the specific involved area.

·        Chemotheraphy  initial treatment often with:

·        MOPP regimen of nitrogen mustard ( Mustargen), vincristine(oncovin), procarbazine(Matulane), and predinisolone or

·        ABVD regimen of doxorubincin(Adriamycin), bleomycin(Blenoxane), vinblstine(Valban), and dacarbazine(DTIC)

o   Three or four drugs may be given in intermittent or cyclical courses with periods off treatment to allow recovery from toxicities.

Nursing Management

Nursing Diagnosis

·        Impaired tissue intergrity related to high doses radiation therapy

·        Altered oral mucous membranes related to high doses of radiation therapy

o   Avoid rubbing, powders, deodorants, lotions or ointments (unless prescribed) or application of heat/cold to treated area.

o   Encourage patient to keep treated area clean and dry, bathing area gently with warm water and mild soap.

o   Encourage wearing loose-fitting clothes.

o   Advice patient to protect skin from exposure to sun shine, chlorine, temperature extremes.

o   Encourage frequent small meals, bland and soft diet at mild temperature.

o   Teach patient to avoid irritants such as alcohol, tobacco, spices

o   Administer or teach self-administration of pain medication or antemetic before eating or drinking if needed.

o   Encourage mouth care at least twice a day and after meals using soft toothbrush and mild mouth rinse.

o   Assess for ulcers, plaques, or discharge that may be indicative of superimposed infection.

o   If diarrhea,  give low residue diet and administer antidiarrhoea

·        Patient Education

o   Teach patient about risk of infection

o   Teach patient about how to take medication as ordered

o   Teach patient about side effects of chemotherapy

o   Explain to patients that radiation therapy may cause sterility

o   Reassure the patient that fatigue will decrease after treatment is completed.

Complications

·        Side effects of radiation or chemotherapy