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Hodgkin's Disease

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Mallory Joyner

on 10 March 2014

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Transcript of Hodgkin's Disease

Hodgkin Lymphoma Staging Procedure

Stage IIIA and Stage IIIB
IIIA: Disease ex
What is Hodgkin's disease?
It is a cancer affecting the immune system. Its originates from lymphocytes and usually moves from one lymph node group to another. It can also spread to organs such as the liver, spleen, and lungs.
Testing
Hodgkin's Lymphoma

Stage I
Involves a single lymph node region or localized involvement of a single extra lymphatic organ or site.


Stage II
Involves two or more lymph node regions on same side of diaphragm or localized involvement of a single associated extra lymphatic organ or site and its regional lymph node(s), with or without involvement of other lymph node regions on same side of diaphragm.
Case Study
A.S. was recently diagnosed with Hodgkin disease and scheduled for a staging procedure. His previous axillary lymph node biopsy result was positive for Reed-Sternberg cells. The surgeon charted the results of the staging procedure as “stage I.”
Signs and Symptoms
Painless enlargement of immune tissues such as the spleen
Fever
Unexplained weight loss
Fatigue
Night sweats
Unexplained itching
Chest pain
Stage III
Involves lymph node regions on both sides of diaphragm, which may also be accompanied by localized involvement of an associated extralymphatic organ or site by involvement of spleen, or by both.
Stage IV
Disease is present in many body areas, including in one or more non-nodal tissues and organs.
CT Scan: Shows any lymph node affected by lymphoma
Lymph Biopsy: A lymph node is removed and examined under a microscope for the presence of multi-nucleated Reed-Sternberg cells which indicate Hodgkin disease
Further Testing
After being diagnosed with Hodgkin Disease:
Blood Test: Will determine which treatment will work best and how much treatment is needed based on the patient and stage of disease
Bone Marrow Test: This will reveal if the patient has cancer in their bone marrow because this is a common problem with Hodgkin disease
Treatments
Hodgkin vs Non-Hodgkin lymphoma
What is the purpose of the staging procedure for A.S?
Determines the extent of disease
Determines Prognosis of Disease
Based on
Clinical Stage
Histologic Type
Tumor cell concentration
Tumor burden
Constitutional symptoms
Age
Based on
Medical History
Presence of symptoms and palpable lymph nodes
Radiologic and hematologic results
Type and amount of treatment depend on the stage of Hodgkin's disease; some patients may need a combination of treatments


Some treatments include: Radiation therapy, Chemotherapy, steroids,bone marrow/stem cell transplant, complementary and alternative therapies.
Since A.S. is diagnosed as a Stage I he will receive radiation therapy
Radiation Therapy

X-ray waves destroy cancer cells or slow their growth
It treats the tumor and a small amount of surrounding tissue
Generally used for stages 1 and 2 of Hodgkin’s disease
Used to relieve pain

External Beam Radiation Procedure
Radiation therapy machine aims a beam of high-energy rays toward the target site.
Dosage calculated as accurately as possible to reduce side effects.
Lead blocks or shields further protect non target areas of the body from radiation.
Padding and other devices keep the person’s body in the right position.

Setting up for each treatment take from 15-30 minutes.
Treatment itself less than one minute.
Radiation usually given daily.
Therapy goes on for 3-6 months with rest periods
Person generally goes to a hospital radiology department for treatment
Long-Term Effects
A second cancer can develop months, years after treatment.
Leukemia, lung cancer, and thyroid cancer are sometimes found among people who have been treated.
Therapy to the head and neck can cause hypothyroidism.
Short-Term Side Effects
Increased risk for infection, anemia, and bleeding
Fatigue and lack of energy.
Skin in the target area may become red, dry, tender, and itchy.
Radiation near chest or neck: dry, sore throat, trouble swallowing, shortness of breath, and a dry cough
Radiation to abdomen: nausea, vomiting, diarrhea, and urinary problems.
Side Effects of Radiation Therapy
Both cancers originate in the lymphocytes which affects the immune system, however Non-Hodgkin is much more common. The major difference is the lack of Reed-Sternberg cells in non-Hodgkin lymphoma
Higher survival rate higher for Hodgkin Lymphoma
References
Bucher, L., Camera, I., Dirksen, S., & Heitkemper, M. (2011). Medical-Surgical Nursing. Missouri: Elsevier Mosby.
Banasik, J. & Copstead, L. (2010). Pathophysiology. Missouri: Saunders Elsevier.
http://www.cancerresearchuk.org/cancer-help/type/hodgkins-lymphoma
http://www.cancer.org/cancer/hodgkindisease/detailedguide/hodgkin-disease-after-follow-up
http://www.cancer.gov/cancertopics/pdq/treatment/adulthodgkins/Patient/page2
Peacock, J. (2002). Chapter #3: Treatment for Hodgkin's Disease. In, Hodgkin's Disease (0-7368-1027-7) (p.22). Capstone Press.
Patient and Family Education
Skin in the path of radiation becomes very dry and may break down.
Teaching patients about skin care needs during radiation therapy is a priority nursing intervention


Wash the irradiated area gently each day with either water or a mild soap
Use hands rather than a washcloth to be gentler
Rinse soap thoroughly from your skin
If ink or dye markings are present to identify exactly where the beam of radiation is to be focused, take care not to remove them

Dry the irradiated area with patting motions rather than rubbing motions.
Use only powders, ointments, lotions, or creams on on skin at radiation site that are prescribed by the radiation oncology department
Wear soft clothing over the skin at the radiation site
Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site
Avoid exposure of the irradiated area to the sun
Protect this area by wearing clothing over it
Try to go outdoors in the early morning or evening to avoid the more intense sun rays
When outdoors, stay under awnings, umbrellas, and other forms of shade during the times when the sun's rays are most intense
Avoid heat exposure
Follow-Up Care
Important to keep follow-up appointments.
During visits, the doctors will ask about symptoms, do physical exams, and may order blood tests or imagining tests such as CT scans or chest x-rays.
Needed to check for cancer recurrence or spread
This is the time to ask question and express concerns.

Questions Comments Concerns?
Created by Mandy Castillo and Mallory Joyner
Etiology
Reed-Sternberg (RS) cells are derived from a B cell in the germinal center that has not undergone successful immunoglobulin gene rearrangement that would normally undergo apoptosis
The survival of these RS cells secrete and release cytokines that result in the accumulation of inflammatory cells that produces local and systemic effects.

Triggering mechanism for the malignant transformation of RS cells are unknown, however, many people with HL have a high Epstein-Barr virus titer.
Genetic Susceptibility suggested
HL more common in males. In childhood, 60% of all cases occur in males.
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