Hodgkin's Lymphoma

  1. General information
    1. Malignant neoplasm of lymphoid tissue, usually originating in localized group of lymph nodes; a proliferation of lymphocytes
    2. Metastasizes first to adjacent lymph nodes
    3. Cause unknown
    4. Most prevalent in adolescents; accounts for 5% of all malignancies
    5. Prognosis now greatly improved for these children; influenced by stage of disease and histologic type
    6. Long-term treatment effects include increased incidence of second malignancies, especially leukemia and infertility
  2. Medical management
    1. Diagnosis: extensive testing to determine stage, which dictates treatment modality
      1. Lymphangiogram determines involvement of all lymph nodes (reliable in 90% of clients); is helpful in determining radiation fields
      2. Staging via laparotomy and biopsy
        1. stage I: single lymph node involved; usually in neck; 90%-98% survival
        2. stage II: involvement of 2 or more lymph nodes on same side of diaphragm; 70%-80% survival
        3. stage III: involvement of nodes on both sides of diaphragm; 50% survival
        4. stage IV: metastasis to other organs
      3. Laparotomy and splenectomy
      4. Lymph node biopsy to identify presence of Reed-Sternberg cells and for histologic classification
    2. Radiation: used alone for localized disease
    3. Chemotherapy: used in conjunction with radiation therapy for advanced disease
  3. Assessment findings
    1. Major presenting symptom is enlarged nodes in lower cervical region; nodes are nontender, firm, and movable
    2. Recurrent, intermittent fever
    3. Night sweats
    4. Weight loss, malaise, lethargy
    5. Pruritus
    6. Diagnostic test: presence of Reed-Sternberg cells
  4. Nursing interventions
    1. Provide care for child receiving radiation therapy.
    2. Administer chemotherapy as ordered and monitor/alleviate side effects.
    3. Protect client from infection, especially if splenectomy performed.
    4. Provide support for child/parents; specific needs of adolescent client must be considered.