Hodgkin's disease (Hodgkin lymphoma)
Definition
Epidemiology and risk factors
Bimodal age distribution – peaks at 15–35 years and over 55 years; slightly commoner in males. Associated with Epstein–Barr virus (EBV), HIV infection, immunosuppression, family history.
Clinical features
Painless, rubbery, enlarged lymph nodes, most often cervical/supraclavicular, then axillary, mediastinal (cough, breathlessness, superior vena cava obstruction).
"B" symptoms (poorer prognosis): unexplained fever >38 °C (sometimes cyclical – Pel–Ebstein fever), drenching night sweats, weight loss >10% in 6 months.
Pruritus (generalised itching); alcohol-induced pain in affected nodes (rare but characteristic).
Fatigue, splenomegaly, hepatomegaly, anaemia; later bone marrow involvement.
Investigations
Excision lymph node biopsy (diagnostic – Reed–Sternberg cells; fine-needle aspiration is insufficient).
FBC, ESR (prognostic), LDH, liver and renal function, HIV test.
Staging: chest X-ray, CT/PET-CT of chest, abdomen, pelvis; bone marrow biopsy in selected cases.
Ann Arbor staging
Stage | Extent |
|---|---|
I | One lymph node region |
II | Two or more regions on the same side of the diaphragm |
III | Node regions on both sides of the diaphragm |
IV | Diffuse involvement of extralymphatic organs (liver, bone marrow, lungs) |
Suffix A = no B symptoms; B = B symptoms present.
Medical management
Chemotherapy – ABVD regimen: Adriamycin (doxorubicin), Bleomycin, Vinblastine, Dacarbazine, every 2 weeks for 2–6 cycles depending on stage (BEACOPP for advanced high-risk disease) – at the Uganda Cancer Institute.
Radiotherapy to involved fields for early-stage or bulky disease.
Supportive: antiemetics, allopurinol and hydration (tumour lysis), blood transfusion, infection prophylaxis, fertility counselling (sperm banking).
Relapse – high-dose chemotherapy with stem cell transplant, brentuximab.
Key toxicities: bleomycin – pulmonary fibrosis (cough, breathlessness; avoid high oxygen concentrations); doxorubicin – cardiotoxicity; vinblastine – myelosuppression; long-term – infertility, secondary cancers, hypothyroidism (neck radiotherapy).
Cure rates are high – over 80–90% for early-stage disease.
Nursing management – nursing process
Assessment
Lymph nodes, B symptoms, weight, temperature, breathing (mediastinal mass), skin (itching), FBC results, chemotherapy side effects, emotional state, fertility concerns.
Nursing care plan
Nursing diagnosis | Goal | Interventions | Rationale |
|---|---|---|---|
Risk for infection (disease and neutropenia) | No infection | Hand hygiene, protective measures, monitor temperature and FBC, report fever ≥38 °C immediately | Neutropenic sepsis is fatal if delayed |
Imbalanced nutrition (weight loss, nausea, mucositis) | Stable weight | Antiemetics before chemo, small frequent nutritious meals, mouth care | Supports recovery |
Impaired comfort (pruritus, night sweats) | Patient comfortable | Cool environment, change damp linen, emollients, antihistamines | Symptom relief |
Fear/anxiety and disturbed body image (alopecia) | Copes, completes treatment | Information about good prognosis, counselling, wigs/scarves, fertility advice | Adherence and wellbeing |
Evaluation
Completes chemotherapy, no serious infection, nutrition maintained, disease in remission, regular follow-up.