Patient care pathways for patients with malignant disease - Hodgkin's lymphoma

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Hodgkins Lymphoma is a malignancy of the lymph nodes and the lymphatic system. It is a primary neoplastic disease of the lymphoid B cells which are named Reed-Sternberg cells (Stevens, Lowe & Scott, 2009). The histological presence is characterised by giant multinucleated cells (Map of Medicine, 2013).  Hodgkin’s Lymphoma causes the cells situated in the lymphatic system to abnormally reproduce (, 2013) .

The change of a normal cell to a malignant one will involve a process that will cause the genes that are involved in normal homeostatic mechanisms to suffer mutational damage. This will result in the activation of genes stimulating proliferation or protection against cell death, the oncogenes, and the inactivation of genes which would normally inhibit proliferation, the tumor suppressor genes (Bertram, 2000).      ??????

A B cell is a type of lymphocyte that produces antibodies to fight infection.  These are the most commonly used lymphocytes in the bloodstream and they are a crucial element in a strong immune system (Lymphomainfo, 2013).

These are categorised in to two groups based on their clinical and pathological findings. Classic Reed- Sternberg cells are binucleate, which are seen in mixed-cellularity and in nodular sclerosis grade 1 Hodgkin’s Lymphoma. Reed-Sternberg cells which are monoclear may be seen in any type of Hodgkin’s Lymphoma but are mainly encountered in mixed celluarity disease (Stevens, Lowe & Scott, 2009).

 The World Health Organisation recognises two histological types of Hodgkin’s Lymphoma.  The nodular lymphocyte and the classic Hodgkin’s Lymphoma.  The latter subdivides into four categories called nodular sclerosis, lymphocyte-rich, mixed cellularity and lymphocyte depletion. (Gobbi, ‘et al’, 2013)

Classical Hodgkin Lymphoma is a B-cell malignancy with a distinctive activated B cell phonotype and absence of immunoglobin production (Laskar et al, 2004).

Risk Factors

Hodgkin’s Lymphoma accounts for a ratio of 1.2:1 in males especially before puberty (Map of Medicine, 2013). Studies undertaken by scientists have determined that Hodgkin’s lymphoma is caused by a variety of factors which include changes to immunity, infections, genetic factors, chemicals and lifestyle factors. (Cancerinfo.nhs,    ) There are certain viruses such as Epstein-Barr Virus (EBV) and the Human Immunodeficiency Virus (HIV) that may increase the risk of developing Hodgkin Lymphoma. Individuals with a weakened immune system after organ transplant or inherited from direct family members. ????????According to the Map of Medicine (2013) the peak age is between 15-54 years and after age 70 years.  

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Hodgkin’s disease involves a transformed B cell.  Disease will present as an enlargement of a single lymph node which may be discovered following an investigation for other symptoms such as weight loss, fever, night sweats or itchy skin. (Stevens, Lowe, Scott, 2009) The symptoms of the tumor mass may include abdominal discomfort or distension, bone pains, neurological symptoms, shortness of breath, coughs and chest pains (Map of Medicine, 2013)

The commonest sites for the disease are the cervical, supraclavicular and the mediastinal lymph nodes, it is stated that sub-diaphragmatic presentations, bone marrow and hepatic involvement are less common. (Gobbi ‘et ...

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