HODGKINS

DISEASE
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What is Hodgkins Disease?

Hodgkin disease (Hodgkin lymphoma) is a cancer
of the lymphatic system that affects the Blymphocytes, causing them to accumulate in the
lymph nodes.
Hodgkins disease is unicentric in origin in that it
initiates in a single node.
It is a potentially curable type lymphoma.
It is named after Thomas Hodgkin who first described
abnormalities in the lymphatic system in 1832.

What is Hodgkins Disease?

The cause of Hodgkins
disease is unknown, but a viral
etiology is suspected. In fact,
fragments of the Epstein- Barr
virus have been found in 40% to
50% of patients; this occurs
more commonly in the younger
patient population

Brief overview of the Lymphatic System

The lymph system is composed mainly of:
Lymphoid tissue: includes the lymph nodes
and related organs that are part of the
immune and blood-forming systems
Lymph: a clear fluid that travels through the
lymph system, carrying waste products and
excess fluid from tissues, as well as
lymphocytes and other immune system cells
Lymphatic vessels: small tubes, similar to
blood vessels, through which lymph travels to
different parts of the lymph system
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Brief overview of the Lymphatic System

Lymphocytes
Lymphocytes, is a type of white blood
cell that has 2 major types; the B
lymphocytes
(B
cells)
and
T
lymphocytes (T cells
T lymphocytes:
There are several types of T cells, and each has a special
job. Some T cells directly destroy certain kinds of bacteria
or cells infected with viruses or fungi.
Other types of T cells play a role in either boosting or
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slowing the activity of other immune system cells.

Brief overview of the Lymphatic System

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

What are the common sites?

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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Higher socioeconomic status, maybe because more exposed to

What is Reed-Sternberg Cell?

The malignant cell of Hodgkins
disease is the Reed-Sternberg cell,
a gigantic tumor cell that is
morphologically unique and is
thought to be of immature lymphoid
origin. It is the pathologic hallmark
and essential diagnostic criterion for
Hodgkins disease. However, the
tumor is very heterogeneous and

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What are the STAGES?

Ann Arbor Classification:
Stage I:
Single lymph node area or single
extranodal side

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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What are the Signs and Symptoms?

Painless enlargement of one of the lymph
nodes
Systemic symptoms (B symptoms)
- Fever
- Night sweats
- Unexplained weight loss (10% per 6 months)

Other symptoms:
-

Fatigue, weakness, pruritus

Cough, chest pains, shortness of breath,
Abdominal pain, bowel disturbances, ascites
Bone pain

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Pathophysiology
PREDISPOSING PRECIPITATING
FACTORS
FACTORS

CONTRIBUTING
FACTORS

- Age (15 to 40;

55 years old or
late adulthood)
- Gender (Male)
- Family History
or Genetics

-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

Frequently observed in adolescents and

young adults
Usually involves the mediastinum
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Types
Mixed-cellularity
15%-30% of cases
Morphology:
Diffused cellularity

Usually affects the abdomial lymph nodes and

spleen
Typically presents with advanced stage disease
with systemic symptoms
Usually observed in patients with HIV infection
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Types
Lymphocyte-depleted
Less than 1% of cases
Morphology:
Diffused and hypocellular

Associated with older age and HIVpositive patients

Usually presents with advanced stage
disease
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Types
Lymphocyte-rich
Less than 5% of cases
Morphology:
Lacunar type Reed sternberg cells with infiltration of
lymhocytes

Usually affects the abdominal lymph nodes and

spleen
Typically presents with advanced stage disease with
systemic symptoms
Usually observed in patients with HIV infection
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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 LAUNCHES NEW TREATMENT FOR HL IN

THE PHILIPPINES?

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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TAKEDA LAUNCHES NEW TREATMENT FOR HL IN

THE PHILIPPINES?

Brentuximab Vedotin is a type

of monoclonal antibody that
targets a protein called CD30
that is found on Hodgkins
lymphoma cells and Anaplastic
large cell lymphoma cells
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TAKEDA LAUNCHES NEW TREATMENT FOR HL IN

THE PHILIPPINES?

Brentuximab Vedotin is a highly

effective drug with an adequate
safety profile that fills an unmet
therapeutic needs in patients with
CD30 positive relapsed or refractory
Hodgkins lymphoma or relapsed
ALCL
- Dr. Anna Sureda, head of Hematology
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Deparment, Barcelona, Spain

Long term outlook for People with Hodgkins

Disease

There is increased survival rate due

to advances in treatment.
1 year: 92%
5 year: 85 %
10 year: 81%

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Long term complications of treatment:

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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