Hodgkin's disease
Hodgkin's disease: Excerpt from Handbook of Diseases
A neoplastic disease, Hodgkin’s disease is characterized by painless, progressive enlargement of lymph nodes, spleen, and other lymphoid tissue resulting from proliferation of lymphocytes, histiocytes, eosinophils, and Reed-Sternberg giant cells. The latter cells are its special histologic feature.
Untreated, Hodgkin’s disease follows a variable but relentlessly progressive and ultimately fatal course. Advances in therapy have made Hodgkin’s disease potentially curable, even in advanced stages, and appropriate treatment yields a 5-year survival rate of about 90%.
Causes
The cause of Hodgkin’s disease is unknown. This disease is most common in young adults and occurs more commonly in men than in women. It occurs in all races but is slightly more common in whites. Incidence peaks in two age-groups: ages 15 to 38 and after age 50, except in Japan, where it occurs exclusively among people over age 50.
Signs and symptoms
Symptoms vary, depending on the stage of the disease.
Early signs
The first sign of Hodgkin’s disease is usually a painless swelling of one of the cervical lymph nodes (but sometimes the axillary, mediastinal, or inguinal lymph nodes), occasionally in a patient who has a history of recent upper respiratory tract infection.
In older patients, the first symptoms may be nonspecific, such as persistent fever, night sweats, fatigue, weight loss, and malaise. Rarely, if the mediasti-num is initially involved, Hodgkin’s disease may produce respiratory symptoms.
Another early and characteristic indication of Hodgkin’s disease is pruritus, which, although mild at first, becomes acute as the disease progresses. Other symptoms depend on the degree and location of systemic involvement.
Lymph nodes may enlarge rapidly, producing pain and obstruction, or slowly and painlessly for months or years. It isn’t unusual to see the lymph nodes “wax and wane,” but they usually don’t return to normal.
Late signs
Sooner or later, most patients develop systemic manifestations, including enlargement of retroperitoneal nodes and nodular infiltrations of the spleen, liver, and bones. At this late stage, other symptoms include edema of the face and neck, progressive anemia, possibly jaundice, nerve pain, and increased susceptibility to infection.
Diagnosis
Diagnostic measures for confirming Hodgkin’s disease include a thorough medical history and a complete physical examination, followed by a lymph node biopsy checking for abnormal histiocyte proliferation of Reed-Sternberg cells (a giant atypical tumor cell) and nodular fibrosis and necrosis.
Other appropriate diagnostic tests include bone marrow, liver, mediastinal, lymph node, and spleen biopsies; routine chest X-ray; abdominal computed tomography scan; lung scan; bone scan; and lymphangiography to detect lymph node or organ involvement. Laparoscopy and a lymph node biopsy are performed to complete staging.
Hematologic tests show mild to severe normocytic anemia, normochromic anemia (in 50% of patients), and an elevated, normal, or reduced white blood cell count and differential showing any combination of neutrophilia, lymphocytopenia, monocytosis, and eosinophilia. An elevated serum alkaline phosphatase level indicates liver or bone involvement.
The same diagnostic tests are also used for staging. A staging laparotomy is necessary for patients under age 55 and those without obvious stage III or stage IV disease, lymphocyte predominance subtype histology, or medical contraindications. Diagnosis must rule out other disorders that enlarge the lymph nodes. (See Staging Hodgkin’s disease.)
Treatment
Appropriate therapy (chemotherapy, radiation therapy, or both, depending on the stage of the disease) is based on a careful physical examination with accurate histologic interpretation and proper clinical staging. Correct and timely treatment allows longer survival and even induces an apparent cure in many patients.
Chemotherapy and radiation therapy
Radiation therapy is used alone for stage I and stage II and in combination with chemotherapy for stage III. Chemotherapy, usually in combinations, is used for stage IV, sometimes inducing a complete remission.
These treatments may require concomitant antiemetics, sedatives, or antidiarrheals to combat GI adverse effects.
Other treatments
Treatments include high-dose chemotherapeutic agents with autologous bone marrow transplantation or autologous peripheral blood stem cell transfusions. Biotherapy alone hasn’t proven effective.
Special considerations
Because many patients with Hodgkin’s disease receive radiation therapy or chemotherapy as outpatients, tell the patient to observe the following precautions:
❑ Watch for and promptly report adverse effects of radiation therapy and chemotherapy (particularly anorexia, nausea, vomiting, diarrhea, fever, and bleeding).
❑ Minimize adverse effects of radiation therapy by maintaining good nutrition (aided by eating small, frequent meals of favorite foods), drinking plenty of fluids, pacing activities to counteract therapy-induced fatigue, and keeping the skin in radiated areas dry.
Clinical tip Control pain and bleeding of stomatitis by using a soft toothbrush, cotton swab, or anesthetic mouthwash such as viscous lidocaine; by applying petroleum jelly to the patient’s lips; and by avoiding astringent mouthwashes.
❑ If a female patient is of childbearing age, advise her to delay pregnancy until prolonged remission because radiation therapy and chemotherapy can cause genetic mutations and spontaneous abortions.
❑ Because the patient with Hodgkin’s disease has usually been healthy until this point, he’s likely to be especially distressed. Provide emotional support and offer appropriate reassurance. Ease the patient’s anxiety by sharing your optimism about his prognosis.
❑ Make sure the patient and his family know that the local chapter of the American Cancer Society is available for information, financial assistance, and supportive counseling.
Pictures
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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