Professional Documents
Culture Documents
DISEASE
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B lymphocytes:
B cells help protect the body from germs
(bacteria and viruses) by making
proteins
called
antibodies.
The
antibodies attach to the germs, marking
them for destruction by other parts of
the immune system.
Almost all cases of Hodgkin disease start
in B lymphocytes.
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Lymph Nodes
and different
Organs
Cervical nodes
Supraclavicular,
Mediastinal nodes
Involvement of the iliac or inguinal
nodes or spleen is much less
common
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Risk Factors?
Factors
What is the Risk
Epstein Barr virus infection (Infectious
Mononucleosis)
1 out of 3 patients with Hodgkins
Age
Any age but higher in ages 15 to 40, and in late adulthood age 55
Gender
Male gender have higher incidence than females
Geography
Most common in US, Canada, Europe
Least common in Asia
Family History
Socioeconomic status
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Stage II:
2 or more lymph node areas in
the same side in the ipsilateral
side
Stage III:
Lymph node areas on both sides
of the diaphragm
Stage IV:
Dissimenated or multiple
involvement of the extranodal
organs
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Other symptoms:
-
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Pathophysiology
PREDISPOSING PRECIPITATING
FACTORS
FACTORS
CONTRIBUTING
FACTORS
-Socioeconomic
Status
(higher
-Epstein-Barr
Virus infection
-Immunosuprres
sed or HIV
infected
-Herpes Zoster
Infection
economic status)
-Geographic
(Most
common
in
US,
Canada, Europe and
Least common in Asia)
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Types
Nodular sclerosing
60%-80% of all cases
Morphology:
Characteristic cell: lacunar-type Reed
Sternberg cell
Types
Mixed-cellularity
15%-30% of cases
Morphology:
Diffused cellularity
Types
Lymphocyte-depleted
Less than 1% of cases
Morphology:
Diffused and hypocellular
Types
Lymphocyte-rich
Less than 5% of cases
Morphology:
Lacunar type Reed sternberg cells with infiltration of
lymhocytes
Diagnosis
History and Physical Examination
Family History
Possible risk factors
Information about symptoms
Other medical conditions
Physical examination particularly to the
lymph nodes, spleen and liver
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Diagnosis
Laboratory
CBC: anemia, lymphopenia, neutrophilia, eosinophilia
ESR
LDH
Serum creatinine
HIV test
Chest x-ray
CT Scan
PET (Positron Emission Tomography)
Biopsy
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Diagnosis
Biopsy
Enlarged lymph nodes are more often caused by
infections than by Hodgkins.
Because of this, doctors often wait a few weeks to
see if they shrink as the infection goes away after
intake of prescribed antibiotics
If it does not, a lymph node is removed to be looked
under the microscope (biopsy)
It is needed to be sure of the diagnosis
The biopsy can also tell what type it is
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Nursing Management
Tell the patient that Hodgkins is curable
Encourage the patient to reduce other
factors that increase risk of developing
second cancers
Provide education about relevant self-care
strategies and disease management
Tell the patient to monitor late effects or
complications of treatments
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Management
Lymphoidectomy
Chemotherapy
Radiation
Stem cell transplantation
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Pharmaceutical Management
Combination with chemotherapy:
doxorubicin (Adriamycin),
bleomycin (Blenoxane),
vinblastine (Velban),
dacarbazine(DTIC),
Referred to as ABVD, is now the standard
treatment for more advanced disease
(stages III and IV and all B stages).
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Takeda,
the
largest
pharmaceutical
company
of
Japan and Asia, has launched the
first new breakthrough treatment
dveloped after 30 years for
Hodgkins Lymphoma
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Infertility
Secondary malignancy (lung, skin, thyroid, breast, NHL)
Cardiac disease
Immune dysfunction
Herpes infections (zoster and varicella)
Pneumococcal sepsis
Acute myeloid leukemia (AML)
Myelodysplastic syndromes (MDS)
Non-Hodgkins lymphoma
Solid tumors
Thyroid cancer
Thymic hyperplasia
Hypothyroidism
Pericarditis (acute or chronic)
Cardiomyopathy
Pneumonitis (acute or chronic)
Avascular necrosis
Growth retardation
Infertility
Impotence
Dental caries
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Revised
treatment
approaches
are
aimed
at
diminishing the risk
for
complications
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