Hodgkin, Thomas
(hoj'kĭn 
)
Brit. physician, 1798–1866.
ABBR: HD
A malignant lymphoma whose pathological hallmark is the Reed-Sternberg (RS) cell. SYN: Hodgkin lymphoma.SEE: non-Hodgkin lymphoma; Reed-Sternberg cell.
In 2024, the American Cancer Society estimated that 8,570 Americans would be diagnosed with Hodgkin lymphoma, and that 930 would die of the disease. The disease may affect people of any age, but it occurs most often in adults in their early 30s. Its incidence is higher in males than in females. It is slightly more common in Caucasians than in other racial groups. The disease has a bimodal age distribution: it is common in people between the ages of 15 and 35 and in another group of patients older than 50.
Epstein-Barr virus has been found in the cells of nearly half of all patients with Hodgkin disease.
Early-stage patients may have no symptoms other than a painless lump or enlarged gland in the armpit or neck. Others may develop fevers, night sweats, loss of appetite, and weight loss.
The presence of the giant, multinucleated RS cell in tissue obtained for biopsy is diagnostic.
This lymphoma typically begins in a single lymph node (esp. in the neck, axillae, groin, or near the aorta) and spreads to adjacent nodes if it is not recognized and treated early. It may metastasize gradually to lymphatic tissue on both sides of the diaphragm or disseminate widely to tissues outside the lymph nodes. The degree of metastasis defines the stage of the disease; early disease (stage I or II) is present in one or a few lymph nodes; widespread disease has disseminated to both sides of the diaphragm (stage III) or throughout the body (stage IV). The lower the stage of the disease, the better the prognosis. Patients with stage I Hodgkin lymphoma have a 90% survival rate 5 years after diagnosis. Although many childhood Hodgkin's survivors are concerned that treatment may adversely affect fertility, most treated patients under 40 who have not had pelvic radiation do not have problems with infertility.
The goal of therapy is cure, not merely palliation of symptoms. Treatment depends on accurate staging. Combinations of radiation therapy with chemotherapy have been traditionally used (radiation alone for stages I and II, radiation and chemotherapy for stage III, and chemotherapy for stage IV); chemotherapies that rely on multiple agents may be as effective. Autologous bone marrow transplant or autologous peripheral blood stem cell transfusion (along with high-dose chemotherapy) also has been used in treatment, esp. among younger patients. Antiemetics, sedatives, antidiarrheals, and antipyretic drugs are given for patient comfort.
All procedures and treatments associated with the plan of care are explained. The patient is assessed for nutritional deficiencies and malnutrition by obtaining regular weight readings, checking anthropomorphic measurements, and monitoring appropriate laboratory studies (such as serum protein levels, transferrin levels). A well-balanced, high-calorie, high-protein diet is provided. The patient is observed for complications during chemotherapy (anorexia, nausea, vomiting, mouth ulcers, alopecia, fatigue, and bone marrow depression) and for adverse reactions to radiation therapy (hair loss, anorexia, nausea, vomiting, and fatigue). Supportive care is given as indicated for adverse reactions to chemotherapy or radiation therapy. Pallaitive measures are provided to promote relaxation, and periods of rest are planned because the patient tires easily. Hematological studies are followed closely during treatment, and colony-stimulating factors are administered as necessary to stimulate red and white blood cell production. Antiemetic drugs are administered as prescribed. The importance of gentle but thorough oral hygiene to prevent stomatitis is stressed. To control pain and bleeding, a soft toothbrush or sponge-stick (toothette), cotton swabs, and a soothing or anesthetic mouthwash, such as a sodium bicarbonate mixture or viscous lidocaine, are used as prescribed. The patient can apply petroleum jelly to the lips and should avoid astringent mouthwashes. He or she is advised to pace activities to counteract therapy-induced fatigue and is taught relaxation techniques to promote comfort and rest and reduce anxiety. The patient should avoid crowds and anyone with a known infection and notify the health care provider if any signs or symptoms of infection develop. Health care providers should stay with the patient during periods of stress and anxiety, if possible, and provide support to the patient and family. Referral to local support groups may be helpful. Women of childbearing age should delay pregnancy until long-term remission occurs. Follow-up care includes regular examinations with an oncologist and blood tests or radiographic studies to assess for disease recurrence. Both patient and family are referred for respite or hospice care if necessary. The American Cancer Society (through local chapters) provides information and counseling and can assist in obtaining financial assistance if needed. (800-ACS-2345; www.cancer.org)