Hodgkin's+Disease+(adult+and+child)


 * **Epidemiolgy:** || Erin

Hodgkin's lymphoma account for less than 1% of newly diagnosed cancers each year.1 There is a slight male predominance as about 1000 more cases are diagnosed in men than women per year. Approximately half of the Hodgkin's lymphomas are diagnosed in patients under 40 years of age and it is very rare in childen younger than 10 years old. It is unknown why, but the incidence of Hodgkin's lymphoma is higher in developed countries than in undeveloped ones. ||
 * **Etiology:** || Spencer

Although there is no absolute evidence to what causes Hodgkin’s disease, there are some things linked with the condition.
 * Hodgkin’s disease has a bimodal age distribution: 2
 * First Peak – age 25-30 years
 * Second Peak – 75-80 years
 * Epstein- Barr Virus – Infection 2 ||
 * **Signs & Symptoms:** || Pablo

Signs and symptoms of Hodgkin lymphoma can vary and they often share their characteristics with other illnesses such as the common cold and the flu. These symptoms include:
 * Swollen lymph nodes in the neck, underarms or groin
 * Intermittent fevers
 * Drenching night sweats
 * Feeling tired all the time
 * Unexplained weight loss
 * Decreased appetite
 * Generalized itching
 * Abdominal pain or swelling, feeling of fullness
 * Coughing, shortness of breath, chest discomfort 3 ||
 * **Diagnostic Procedures:** || Becky

__Physical examination__: 2 --palpable nodes or viscera

__Laboratory test__: --complete blood count --platelet count --liver and renal function --blood chemistry profile --erythrocyte sedimentation rate

__Radiologic test__: --Chest x-ray --CT scan of chest, abdomen, pelvis and neck (if needed) --FDG-PET scan

__Special test__: --Cytologic examination of effusions --Bone marrow, needle biopsy (if symptoms correlate) --percutaneous liver biopsy (optional) ||
 * **Histology:** || Adam

Hodgkin's disease is characterized by Reed-Sternberg cells. These cells are abnormal lymphocytes (B cells) that, while making up less than 1% of the cells in an HD-infiltrated lymph node, still make for a tell-tale sign of the disease. HD is divided into five histologic subtypes: 2
 * Nodular Sclerosis - Most common. Mediastinal involvement typical.
 * Lymphocyte Rich - Often diagnosed in young people, usually early stage disease, uncommon systemic symptoms, most favorable of the first four "classical" subtypes
 * Mixed Cellularity - More commonly advanced disease, less favorable outcome
 * Lymphocyte Depeleted - Tends to occur in older patients and associated with advanced disease, worst prognosis
 * Nodular Lymphocyte Predominance - Usually early stage disease, uncommon systemic symptoms, best overall survival ||
 * **Lymph node drainage:** || Megan

Since Hodgkin's Disease is disease of the lymphatic tissue, it is understandable that most of the bodies lymph chains become of interest. Hodgkin's Disease nearly always begins in the lymph nodes, and nearly 80% of those diagnosed present with cervical node involvement. Mediastinal involvement is found with 50% of cases. This figure depicts the areas of interest for drainage, potential involvement, and staging. 5  ||
 * **Metastatic spread:** || Kevin

Nearly all patients with hepatic or bone marrow involvement by Hodgkin’s lymphoma have extensive involvement of the spleen. Hodgkin’s lymphoma rarely involves Waldeyer’s ring, Peyer’s patches, the upper aerodigestive tract, central nervous system, or skin. 2 || There is no grading system used for Hodgkin's Lymphoma, only a staging system is used. ||  || Ann Arbor Staging System 2 This staging system has been used since 1971. || Anytime a patient gets treated with radiation therapy there are possible side effects that might be experienced by the patient. When treating Hodgkin's lymphoma the following are the most common side effects experienced: Age, gender, albumin, white cell count, lymphocyte count, hemoglobin, and Ann Arbor staging are prognosis factors that are used for Hodgkin’s disease. 2 Ann Arbor staging is the most important factor || Radiation therapy combined with chemo is the most effective treatment option for HD. Usually, treatment will begin with chemotherapy, which helps to reduce the size of bulky disease and results in less normal tissue being treated (particularly in cases with mediastinal involvement). 2 Radiation doses range from 20 Gy to 36 Gy, with the use of combined therapy having the added benefit of requiring less cycles of chemo and reduced irradiation fields. Full mantle fields were the classic radiation therapy approach in the past, but this approach is more uncommon today. Typical setups are evenly weighted opposed-fields between 6MV and 15MV with daily fractions of 1.5 to 1.8 Gy. 1 || Due to the fact that Hodgkin's Disease effects so many areas of the body, I decided to include a general Emami table that encompasses the majority of the body. More in depth and specific tables can be found, but this is a great overall address of the body's TD 5/5. 6 The power point referenced for this material (6) is an interesting address of the evolution of tissue tolerance doses. I highly recommend glancing through it if you have time. || Back to Week 6
 * **Grading:** || Erin
 * **Staging:** || Spencer
 * **Radiation side effects:** || Pablo
 * Skin irritation
 * Hair loss
 * Nausea
 * Vomiting
 * Loose bowel movement
 * Sore throat
 * Fatigue 4 ||
 * **Prognosis:** || Becky
 * **Treatments:** || Adam
 * **TD 5/5:** || Megan
 * **References:** || Kevin
 * 1) Washington CM, Leaver D. //Principles and Practice of Radiation Therapy//. 3rd ec. St Louis, MO: Mosby Inc; 2010:610.
 * 2) Chao C, Perez C, Brady L. //Radiation Oncology Management Decisions//. 3rd ed. PA: Lippincott Williams and Wilkins; 2011:639-658.
 * 3) Cancer treatment Centers of America. Web site. __ http://ww2.cancercenter.com/hodgkin-lymphoma/symptoms/?source=ROOGLESE __ . June 27, 2013.
 * 4) Radiation Oncology. Web site. __ http://cancer.wehealny.org/radonc/treatment/disease/hodgkins.htm __ . Accessed June 27, 2013.
 * 5) Chao KS, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002:575 & 577.
 * 6) Marks LB. Predicting Normal Tissue Injury in the Modern Era: A Review of QUANTEC. []. Accessed July 5, 2013. ||