HODGKINS DISEASE

FAMADOR O. GENALDO, RN, MD

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The Lymph Nodes

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Definition
Hodgkins disease is a lymphoma
Lymphomas are malignant disorders of
the reticuloendothelial system that results
in an accumulation of dysfunctional,
immature lymphoid-derived cells
It originates in the lymphoid system and
involves predominantly lymph nodes

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 They are classified according to the

predominant cell type and by the degree
of cell maturity:
Well differentiated
Poorly differentiated
Undifferentiated

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Pathophysiology and Etiology

Etiology is unknown
Characterized by appearance of ReedSternberg multinucleated giant cell in
tumor
Generally spreads via lymphatic
channels, involving lymph nodes, spleen,
and ultimately extralymphatic sites

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 May also spread via bloodstream to sites

such as GIT, bone marrow, skin, upper air
passages, and other organs
Incidence demonstrates two peaks, at
ages 20 - 40 and after age 60

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FOUR STAGES
Stage I
Hodgkin's disease is found in only 1 lymph
node area, or has extended locally into
adjacent tissue (IE).
Stage II
Hodgkin's disease is found in 2 or more
lymph node areas on the same side of the
diaphragm (muscle beneath the lungs that
moves up and down to help you breathe).
The cancer extends locally from the lymph
node(s) to adjacent tissue (IIE).

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Stage III
Either of the following means that the disease is a
Stage III:
Hodgkin's disease is found in lymph node areas
on both sides of the diaphragm.
The cancer may also have extended to an area
or organ adjacent to the lymph node and/or to the
spleen (IIIE/IIISE).
Stage IV
Hodgkin's disease has spread to 1 or more
organs outside the lymphatic system such as the
bone marrow or liver.
Progressive or Recurrent Hodgkin's Disease:
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 Progressive disease is the term used when

the disease progresses while you are still
being treated.
Recurrent disease means that Hodgkin's
disease has come back after it has been
treated.
It may return in the area where it first
started or in another part of the body.
This may occur shortly after treatment or
years later.
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Clinical Manifestations
Common symptoms include:
Painless enlargement of lymph nodes
(generally unilateral)
Fever and chills
Night sweats
Weight loss
Pruritus
Various symptoms may occur with
pulmonary involvement, superior vena
cava obstruction, hepatic or bone
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Diagnostic Evaluation
Tests are used to determine extent of
disease involvement before treatment
and followed at regular intervals to
assess response to treatment
CBC: determines abnormal cells
Lymph node biopsy: determines type of
lymphoma
Bilateral bone marrow aspirate and
biopsy: determine whether bone marrow
is involved

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 Radiographic tests: to detect deep nodal

involvement
X-ray, CT scanning, MRI

Gallium-67 scan: detects areas of active

disease and may be used to determine
aggressive of disease
Liver function tests and scan: determine
hepatic involvement
Liver biopsy: done if results are abnormal
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 Lymphangiogram: detects size and

location of deep nodes involved, including
abdominal nodes, which may not be
readily seen via CT scan
Surgical staging: laparotomy with
splenectomy, liver biopsy, multiple lymph
node biopsies
Lumbar puncture: to obtain spinal fluid for
cytopathology if meningeal lymphoma is
suspected
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Medical Management
Choice of treatment depends on extent of
disease, histopathologic findings, and
prognostic indicators
Hodgkins disease is more readily cured
than other lymphomas
5-year survival: 80%

More than one treatment strategy is

available
Combination of radiation and chemotherapy
are commonly used
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 Radiation Therapy
Treatment of choice for localized disease
Areas of body where lymph node chains
are located can generally tolerate high
radiation doses
High-energy rays are used (or particles) to
destroy cancer cells or slow their rate of
growth.
Vital organs are protected with lead
shielding during radiation treatment
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 External Beam radiation.

Hodgkin's disease is usually treated with a
carefully focused beam of radiation,
delivered from a machine outside the body.
This is known as external beam radiation
It is most useful when the disease is
localized to one part of the body or is so
bulky that even if chemotherapy is used, it
won't get rid of all the cancer in the area.

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 Involved Field Radiation

Treating only the known areas of disease
with radiation
The preferred form of radiation therapy.
It is often combined with chemotherapy,
although they are not given at the same
time.
After 3 to 4 courses of chemotherapy,
involved field radiation will be given to
areas that have clinically obvious disease.

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Chemotherapy
Chemotherapy is systemic therapy, which
means the drug enters the bloodstream
and circulates throughout the body to reach
and destroy cancer cells.
Is the use of drugs for killing cancer cells.
The drugs can be taken by mouth in pill or
liquid form, or they can be injected into a
vein under the skin or in a muscle.

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 Multiple drugs are always used in

chemotherapy for Hodgkin's disease ,
MEDICALdrugs
MANAGEMENT
because different
kill cancer cells in
different ways.
The many drugs used in combination to
treat Hodgkin's disease are often referred
to by abbreviations that are easier to
remember.

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 Two common examples are MOPP and

ABVD.
a) MOPP refers to Mechlorethamine
(nitrogen mustard), vincristine (Oncovin),
Procarbazine, and Prednisone.
b) ABVD refers to doxorubicin (Adriamycin),
Bleomycin, Vinblastine, and Dacarbazine.

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 Autologous or Allogeneic Bone

Marrow Transplant
The patient's own bone marrow is taken
out and stored (frozen).
Then very high doses of chemotherapy,
with or without radiation therapy, are given
to kill the cancer.
These high doses of chemotherapy will
destroy bone marrow, too.

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 After the high-dose chemotherapy

treatments, the stored marrow is thawed
and given back through a vein where it
enters the bloodstream and returns to the
bone
This will replace the marrow that was
destroyed and the blood cells needed to
fight infection and carry oxygen throughout
the body.
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Bone Marrow Aspiration

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 Peripheral Blood Stem Cell Transplant

Another type of autologous transplant is
called peripheral blood stem cell transplant
(PBSCT).
A machine removes the patient's blood a
little at a time, takes out only the stem cells
(immature cells from which all blood cells
develop), and returns the rest of the blood
to the body.
This procedure is called leukapheresis and
usually takes a few hours.
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 The stem cells that are collected are then

frozen until they are returned to the patient.
The chances for recovery are greater if these
procedures take place in a hospital that has
done many bone marrow transplantations.
It is better to do these earlier in treatment
rather than later.
If the first set of treatments doesn't get rid of
the cancer, then many doctors would
recommend transplantation right away.
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 On the other hand, if the disease comes

back after it had gone away for a long
time with the first treatment, most doctors
would favor a second course of standard
treatment.
They would wait to see if the patient gets
better with the standard treatment before
recommending the transplant.
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Complications
Side effects of radiation:
Acute side effects: during treatment to 6
months after treatment

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Fatigue and malaise

Erythema at the site, dry-to-wet desquamation
Nausea and vomiting, diarrhea, esophagitis
Changes in taste, mucositis, xerostomia
Dyspnea, pneumonitis
Cystitis, urethritis
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 Chronic side effects: after 6 months with a

variability of in time of expression
Fibrosis, telangiectasia, atrophy, permanent
darkening of skin
Fibrosis, adhesions, obstruction, ulcerations
Permanent xerostomia, permanent taste
alteration, dental caries
Radiation nephritis

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Nursing Management
Nursing Diagnosis
Impaired Skin Integrity related to high-dose
radiation therapy
Altered Oral Mucous Membranes related to
high-dose ration therapy

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Nursing Interventions
Maintaining Tissue Integrity
Avoid rubbing, powders, deodorants,
lotions, or ointments (unless prescribed) or
application of heat/cold to treated area
Encourage client to keep treated area
clean and dry, bathing gently with tepid
water and mild soap
Encourage wearing loose-fitting clothes
Advise the client to protect skin from
exposure to sun, chlorine, temperature
extremes
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 Preserving Oral and GIT Mucous

Membrane
Encourage frequent small meals, using
bland and soft diet at mild temperature
Avoid irritants such as alcohol, tobacco,
spices, extreme food temperatures
Administer pain medications or anti-emetic
before eating or drinking, if needed
Encourage mouth care at least twice a day
and after meals using soft toothbrush and
mild mouth rinse
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 Patient Education and Health Maintenance

Teach the client about the risk of infection
Teach clients how to take medications as
ordered
Explain that radiation therapy may cause
sterility
Sperm banking before treatment should be
done
Women may develop ovarian failure and
require hormonal replacement therapy
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Daghang Salamat

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