Lymphoma Case Study

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Topics: Cancer
Case Study
Hodgkin’s Disease

Setting: Outpatient clinic

Index Words: Hodgkin’s disease, cancer, assessment, radiation therapy, diagnostic tests, symptom management

Scenario

A.T. is a 21-year-old college student. He works part-time as a manual laborer, uses half a can of smokeless tobacco each week, and drinks a six-pack of beer on the weekend. A year ago in September, he discovered a small, painless lump in his lower left neck. Over the quarter, he experienced increasing fatigue and a 10-pound weight loss that he attributed to “working and studying too hard.” In the spring he saw a nurse practitioner at the student health center who immediately referred him to an oncologist. A lymph node biopsy revealed Hodgkin’s disease. The gallium scan, bone scan, and CT scan of the chest, abdomen, and pelvis all came back negative. A staging laparotomy was conducted a month later to confirm the diagnosis. His diagnosis was Hodgkin’s disease, stage IA, mixed cellularity. You are a staff nurse in the outpatient oncology services when
A.T. comes in.

1. A.T. wants to know what Hodgkin’s disease is and how he “caught” it. What will you tell him?

I would tell him that it is cancer of the lymphocytes, which leads to an enlargement of the lymph nodes. A patient will usually have a swollen lymph node and its usually painless. To diagnose Hodgkin’s Lymphoma, there must be a biopsy. It is the presence of Reed-Sterngerg cells that differentiate it from non-Hodgkin’s. It is binucleated or multi-nucleated in a background of inflammatory cells. There are no guidelines for preventing Hodgkin’s lymphoma; the cause is unknown or multifactorial.

Some risk factors for Hodgkin’s Lymphoma include: * Sex: male * Ages: 15-40 and over 55 * Family history * History of infectious mononucleosis or infection with Epstein-Barr virus, a causative agent of mono * Weakened immune system, including infection with HIV or the presence of AIDS * Prolonged use of



References: American Cancer Society www.cancer.org National Cancer Institute www.cancer.gov Medical-Surgical Nursing: Critical Thinking in Patient Care, 5th edition. Priscilla LeMone, Karen Burke, and Gerene Bauldoff

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