Question

Ms. Y is a 31-year-old woman who reported to her physician that she has recently lost weight, always seems tired, and has experienced night sweats. A few months ago, she had noticed a small firm lump on her neck that was painless and not tender, so she ignored it. Closer physical examination revealed a swelling of several lymph nodes in the neck and throat region. A blood test indicated a decreased lymphocyte count and a lymph node biopsy revealed the presence of Reed-Sternberg cells, confirming the diagnosis of Hodgkin’s lymphoma.

1. Relate the pathophysiologic changes to the manifestations and lab results. (See Hodgkin's Disease/Lymphoma—Pathophysiology, Signs and Symptoms.)

2. Discuss the four stages of the disease based on the Ann Arbor staging system, and determine which stage the patient is probably in. Discuss the prognosis. (See Pathophysiology—Staging Systems.)

3. Discuss the treatment options for this patient. (See Treatment.)

4. Discuss the differences between Hodgkin’s and non-Hodgkin’s Lymphomas. (See Non-Hodgkin’s Lymphoma.)

Answer 1

1. HODGKIN LYMPHOMA - is a type of cancer in the lymphatic system.

FUNCTIONS: The main two function of the lymphatic system is to drain fluid and waste products from the body and to produce white blood cells called lymphocytes in the blood to protect against infections.

PATHOPHYSIOLOGY: Lymphoma occurs when the lymph node cells (lymphocytes) begin to multiply uncontrollably resulting in the production of malignant cells that have abnormal ability to invade other tissues throughout the body.

TYPES: 2 types 1. HODGKIN LYMPHOMA (HL) 2. NON-HODGKIN LYMPHOMA (NHL)

SIGNS AND SYMPTOMS OF HODGKIN LYMPHOMA:

a) Painless enlargement of one or more lymph nodes or lymphadenopathy ( most common sign) b) Itchy skin c) Night sweats d) Unexplained weight loss e) Splenomegaly f) Hepatomegaly g) Hepatosplenomegaly h) Bleeding and Petechiae ( due to low platelet count).

2. STAGES: It has 4 stages

STAGE 1 : Hodgkin Lymphoma (HL)  is found only in 1 lymph node area or in the lymph node organ such as the thymus.

STAGE 2 : HL is found in 2 or more lymph node areas on the same side of (above or below) the diaphragm ( which is the thin muscle beneath the lungs that separates the chest and the abdomen)

STAGE 3 : HL is found in lymph node areas on both sides of ( above and below) the diaphragm.

STAGE 4 : HL has spread widely into at least one organ outside of the lymph system ( liver, bone marrow or lungs).

From the physical examination, it is clearly identified that she is on the STAGE 2 of HL (swelling of several lymph nodes in the neck and throat region) which means the cancer has extends locally from one lymph node area into an nearby organ.

PROGNOSIS: The treatment of the disease has been improving from the past. A new type of chemotherapy had shown a greater effect on the treatment plan of HL. The recent 5-year survival rate of those patients with favorable prognosis was 98% while the patients with worse outlooks was at least 85%. In this case, the patient have 90-95% prognosis rate on stage 2 Hodgkin's disease.

3. TREATMENT OPTIONS: The treatment options include

a) Chemotherapy ( most commonly used)

b) Radiation therapy

c) Stem cell transplant (is used to that patient who is resistant to treatment or returns after initial treatment).

4. DIFFERENCE BETWEEN HODGKIN'S AND NON-HODGKIN'S LYMPHOMA:

a) While examining the cancer cells of Hodgkin Lymphoma, a specific type of abnormal cell called a Reed-Sternberg found while in non-Hodgkin lymphoma it is absent.

b) Non-Hodgkin's Lymphoma are more common than Hodgkin's disease. In the United States, the Non-Hodgkin's lymphoma is the sixth most common cause of cancer among males and females while only about 1% with Hodgkin's disease.

c) The main risk factors of Hodgkin's and Non-Hodgkin's lymphoma can occur in people of any age, but the former seen more commonly in younger people ( 15 to 40 years of age) and people with 55 or older at the time of diagnosis while the latter seen in many people in their 60s.

d) The prognosis rate of Hodgkin's lymphoma with 5-year survival rates have steadily increased to about 88% ( 2000-2010) whereas the Non-Hodgkin's survival rate was about to 72% (2004-2010).