Question

Mr. Hampton is a 65-year-old male who has been admitted to the hospital with abdominal swelling, night sweats, and shortness of breath that has been getting progressively worse over the last 4 weeks. He reports having lost 10 pounds over this time, being itchy, and being constantly tired. His past medical history is clear of any medical problems. His family history reveals that his mother had breast cancer and his father had prostate cancer. He is a chemist by profession, and exposed to hazardous chemicals on a regular basis. He reports as a non-smoker and drinks alcohol about once a week.

Upon physical exam, the following was found:

-Decreased breath sounds on the right lung

-Fluid build-up in the abdominal cavity causing swelling

-Enlarged lymph node in the groin region and in the cervical region near his neck that are not painful upon touch

The lab test revealed:

-Decreased white blood cell count

-Decreased red blood cell count

-Decreased platelet count

-Decreased lymphocyte count

Instructions

In order to complete this discussion, please be sure you have read the Case Study on Mr. Hampton in Module 1's Exploration. In a post that is a minimum of 300 words, respond to the following:

• What are your initial observations of the patient in this case?

• What do you think the diagnosis may be? Identify if you think the diagnosis is benign or malignant? What are the associated cellular mechanisms that may be occurring?

• What are the patient's risk factors leading to this diagnosis?

• Are there different stages of his diagnosed condition? What stage may he be in?

• What are the survival rates associated with this diagnosis?

• What may be the treatment options for this patient?

Answer 1

1 A group of .Initial observations include :

• Shortness of breath
• Drenching night sweats
• weight loss(exceeding 10% over past 6 months)

The onset of symptoms is usually insidious. The initial development is enlargement of cervical, axillary or inguinal lymph nodes; a mediastinal node mass is the second most common location(due to this decreased breath sounds on the right lung)

2.The above listed symptoms are known as 'B' symptoms, which are the characteristic feature of Hodgkin's lymphoma. It is a malignant condition characterized by proliferation of abnormal, giant, multi-nucleated cells called Reed Sternberg cells, which are located in the lymph nodes

3.Normally, lymph nodes consist of connective tissues that surround a fine mesh of reticular fibers and cells. In Hodgkin's lymphoma, the normal structure of lymph nodes is destroyed by hyperplasia of monocytes and macrophages. The main diagnostic feature of Hodgkin's lymphoma is the presence of Reed Sternberg cells in lymph node biopsy specimens. The disease is believed to arise in a single location (it orginates in cervical lymph nodes in 70% of patients) and then spreads along the adjacent lymphatics. It eventually infiltrates other organs, especially lungs, spleen and liver. When the disease begins above the diaphram, it remains confined to lymph nodes for a variable time. Disease orginating below the diaphram frequently spreads to extra lymphoid sites such as the liver

3.

Risk factors for Hodgkin's lymphoma

Etiology	Patient risk factors
Ebstein-Barr virus infection Genetic predisposition Exposure to occupatonal toxins Patients who have HIV infection	Genetic predisposition Mother had breast cancer Father had prostate cancer Occupational exposure

4. The presence of 'B' symptoms correlate with a worse prognosis. After the ingestion of even small amounts of alcohol, individual's with Hodgkin's lymphoma, may complain of rapid onset of pain at the site of the disease . The cause for alcohol induced pain is unknown. Generalized pruritus without skin lesions may develop. Cough, dypnea, stridor and dyphagia may all reflect mediastinal node involvement

In more advanced disease, there may be hepatomegaly and spleenomegaly. Anemia results from increased destruction and decreased production of erythrocytes

How stages are diagnosed in Hodgkin's Lymhoma?

Radiologic evaluation can help define all sites and determine the clinical stage of the disease. Positron Emission Tomography with or without CT is used to stage and then assess response to therapy and to differentiate residual tumor from the fibrotic massess after treatment.

This patient is in the final stage of the disease due to the presence of 'B" symptoms. Treatment depends on the nature and the extent of the disease. The nomenclature used in staging involves an A or B classification depending on whether symptoms are present when the disease is found, and a Roman numeral(I-IV) that reflects the location and the extent of the disease. Additional features that may move an early stage (I-II) to an unfavourable prognosis warranting more aggressive therapy, include and elevated ESR; age of 45 years or older; male gender; presence of large mediastinal mass and low serum albumin, hemoglobin; and low or high lymphocyte count

5.Once the stage of hodgkin's lymphoma is established management focuses on selecting a treatment plan.

The standard for chemotherapy is the ABVD regimen:

A- Adriyamycin or doxarubacin

B-Bleomycin

V-Vinblastin

D-Dacarbazine

Advanced-stage Hodgkin's lymphoma is treated aggresively with 6-8 cycles of chemotherapy. A common regimen is BEACOPP

B-Bleomycin

E-Etoposide

A-Adriyamycin

C-cyclophosphamide

0- vinvcristine(Oncovin)

P-procarbazine

P-prednisone

The role of radiation supplement to chemotherapy varies depending on the sites of the disease and the presence of resistant disease after chemotherapy

Hematopoetic Stem Cell transplantation (HSCT) has allowed patients to recieve higher potential curative doses of chemotherapy while reducing life-threatening leukopenia