Hodgkin`s Disease

A Lymphoma, tumours arising in the lymph nodes

Hodgkins is a malignant lymphoma, can involve any lymphoid tissue, spleen and bone marrow.

Lymphomas are classified according to the malignant cell type eg. lymphocytic lymphoma

May be viral, a malignant condition

Clinical features

Painless enlargement of lymph nodes

General malaise, weakness

Anaemia

Weight loss

Pruritus

Evening fever and night sweats

Pain after any alcohol

Spleen and liver enlargement

Any organ can be infiltrated with Hodgkin tissue, eg. spine, bone, nervous system, skin

Usually effects young or middle aged adults

Relapses and remissions

Diagnosis

Biopsy of lymph gland, presence of Reed-Sternberg cells.

The malignant cells are morphologically unique and of uncertain lineage.

FBC, LFTs, Bone marrow, X rays, IVP

Stages

1. One lymph node site

2. More than one lymph node site, either below or above the diaphragm

3. Nodes on both sides of the diaphragm

4. Sites involved outside the lymphatic system

A symptom free

B with symptoms

Treatment

DXT in 1, 2, 3A

Cytotoxics

Nursing Interventions

Compensate for ADL deficiencies

Health education for early reporting

Support during the diagnostic and staging process

Explanation of procedures

Mouth and tooth care to prevent complications of Radiation, (it reduces saliva production)

Extra fluoride may be given

Teach good oral hygiene

Treat anorexia, nausea and vomiting from radiation

Maintain nutrition and hydration

Treat diarrhoea from radiation, constipation from cytotoxics

Keep DXT areas clean and dry

Treat for side effects of cytotoxics

Involve patient and significant others in care, they should go home soon

Prevention of opportunist infection, (defective cellular immunity, T cell disease), ie. immunosupression

Join Hodgkin`s Disease Society

Prognosis is reasonably good

Advise on possible sterility from radiation

Possible pressure on the trachea from tumour tissue

Pre-op care as required

Patient outcomes/evaluation

Feeling comfortable

Symptom free

Adheres to therapeutic programme

Skin breakdown from scratching is minimal

Knows,

- Nature of the disorder

- Therapeutic regimen

- Community services

Achieves cure/remission

ee

B with symptoms

Treatment