Hodgkin Disease Case Study
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. The stage of the disease guides treatment. Banasik and Copstead (2019) state there are two parts to
staging: clinical stage (CS) and pathologic stage (PS). CS is based off non-invasive imaging (such as a CT
scan), patient history and physical examination, while PS comes from invasive procedures (such as
biopsy and surgery). In earlier stages, when the disease is localized, radiation works well. If the disease is
more advanced, chemotherapy is found to work better. Banasik and Copstead (2019) refer to the Ann
Arbor Staging System with Cotswald Modifications.
NIH National Cancer Institute (2022) states that CT and PET scans are the current standard imaging for
CS, and that laparotomy is no longer recommended except for certain circumstances. NIH refers to
Lugano Classification, which replaced the Ann Arbor classification system.
When I compare the Ann Arbor and Lugano classification systems, they are very similar. One significant
change is that the Lugano does not use the A/B designation to denote presence of symptoms. The
Lugano system uses “bulky” in the stage, while Ann Arbor uses “X” to indicate bulky disease.
Additionally, stage III does not have subgroups in the Lugano system (subscripts 1 and 2) denoting
where node involvement is located. (NIH National Cancer Institute, 2022)
2. Hodgkin lymphoma spreads on a predictable pattern along contiguous lymphatic pathways (Banasik &
Copstead, 2019). Reed-Sternberg cells develop in a lymph node, then spread down that chain of lymph
nodes (Banasik & Copstead, 2019). Stage I is “Involvement of a single lymph node region or lymphoid
structure (e.g., spleen, thymus, Waldeyer ring)” (Banasik & Copstead, 2019).
3. The Leukemia & Lymphoma Society writes that “the World Health Organization (WHO) divides
Hodgkin lymphoma into two main subtypes: classical Hodgkin lymphoma, and nodular lymphocytepredominant Hodgkin lymphoma” (Hodgkin Lymphoma Subtypes, n.d.). Banasik and Copstead (2019)
state that non-Hodgkin lymphoma refers to lymphomas comprised of B- cell, T-cell and NK (natural
killer) cell origin.
4. I am going to assume that A.S. has stage IA, meaning that A.S. has no symptoms. Banasik and
Copstead (2019) state that the typical treatment is radiation therapy, though limited-field radiation and
combined chemotherapy is often used to minimize the rate of relapse. The typical disease-free survival
rate for early-stage treatment is 90% for 10 years.
The NIH National Cancer Institute (2022) classifies A.S. in the early favorable group. This is based on
stage I with no adverse prognostic factors (large mediastinal mass, extranodal involvement, elevated
ESR, involvement of ≥3 lymph node areas, presence of symptoms). This web page does not include early
stage favorable group survivability estimates.
5. The NIH National Cancer Institute (2022) lists fatigue, hair loss, skin changes (dry, peeling, itchy skin;
red skin; edema), throat problems (difficulty swallowing related to lack of saliva production from
damaged salivary glands), cough and shortness of breath as potential side effects for radiation of the
chest. As this is an axillary lymph node, radiation may also include the neck and head. If this is the case,
additional side effects may include mouth problems (dry mouth, dysphagia) taste changes, and a less
active thyroid gland. These side effects may subside after a few months, or even come on months or
years after radiation therapy is completed (Radiation Therapy Side Effects, 2022).
References
Banasik, J.L., & Copstead, L.C. (2019). Pathophysiology (6th ed.). Elsevier.
National Cancer Institute (2022, July 15). Adult Hodgkin Lymphoma Treatment (PDQ) - Health
Professional Version. National Institutes of Health. Retrieved February 20, 2022, from
https://www.cancer.gov/types/lymphoma/hp/adult-hodgkin-treatment-pdq#
National Cancer Institute (2022, January 11). Radiation Therapy Side Effects. National Institutes of
Health. Retrieved February 20, 2022, from https://www.cancer.gov/aboutcancer/treatment/types/radiation-therapy/side-effects