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Hodgkin diseaseAbbreviation: HD
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.
The goal of therapy is cure, not only 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), although 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 (e.g., serum protein levels, transferrin levels) and, as necessary, using anergy panels. A well-balanced, high-calorie, high-protein diet is provided. The patient is observed for complications during chemotherapy, including anorexia, nausea, vomiting, mouth ulcers, alopecia, fatigue, and bone marrow depression as well as for adverse reactions to radiation therapy, such as hair loss, anorexia, nausea, vomiting, and fatigue. Supportive care is given as indicated for adverse reactions to chemotherapy or radiation therapy. Comfort 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 any person 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 and provide emotional 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. As necessary, both patient and family are referred for respite or hospice care. 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.)