A.S. was recently diagnosed with Hodgkin disease and scheduled for a staging procedure. His previous axillary lymph node biopsy result was positive for Reed-Sternberg cells. The surgeon charted the results of the staging procedure as “stage I.”
1. What is the purpose of the staging procedure for A.S.?
Staging system establishes a correlation between anatomic extent of disease and prognosis. Staging is used to determine the most appropriate type of treatment: local, regional, or disseminated. 2. How does Hodgkin lymphoma spread in the body, and what does “stage I” signify for A.S.? Hodgkin disease arises in a single mutant cell located in a single node or chain of nodes and spreads characteristically to anatomically contiguous nodes. Stage I: Involvement of a single lymph node region is associated with a high cure rate. 3. What is the difference between Hodgkin disease and non-Hodgkin lymphoma? The primary difference between Hodgkin disease and non-Hodgkin lymphoma is the presence or absence of Reed-Sternberg cells. These large malignant cells are found in Hodgkin disease and are thought to be a type of malignant B lymphocyte. Non-Hodgkin lymphoma also usually develops in the lymph nodes, but can originate in any lymphatic tissue or organ.
It is commonly found in older adult, and in general there is a greater incidence in males than females. It is increasingly seen in AIDS patients. It involves T, B, or NK cells and has a poorer long-term survival than HD because most patients have advanced disease at the time of diagnosis. It does not spread in an orderly fashion along a lymphatic series of nodes and is not usually localized. The GI tract, liver, and bone marrow are more likely to be involved. The B symptoms of Hodgkin disease are not commonly seen.
Hodgkin disease is usually localized at a single axial group of nodes (cervical, mediastinal, paraaortic), and continuous spread along the string of nodes is the norm. B symptoms (fever, weight loss, night sweats) are common. It is common in persons older than 50 years and in those ages 15 to 35 years, and there is a greater occurrence in males.
4. What is the prognosis and predicted therapy for A.S. now that he has been diagnosed with stage I Hodgkin disease? Overall 10-year survival rate is 90%.
Stages I and II: may be managed with radiation therapy alone unless a large mediastinal mass is present (not seen in this case), when a combination of chemotherapy and radiation therapy is indicated.
5. What side effects might A.S. expect from this therapy?
Radiation, like chemotherapy, may result in bone marrow suppression leading to anemia, thrombocytopenia, and leukopenia. Anemia produces a decrease in oxygen carrying capacity, reducing activity tolerance. There is an increased risk of bleeding with thrombocytopenia, and of infection with leucopenia. Both chemotherapy and radiation therapy increase risk of developing later malignancies.
Example (only) of reference
Banasik, Jacquelyn L. and Lee-Ellen C. Copstead. 4th ed. St. Louis, MO: Saunders Elsevier, 2010. Pathophysiology. http://www.mayoclinic.com/health/type-1-diabetes-in-children/DS00931/DSECTION=tests-and-diagnosis