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"The accumulation of these malignant and reactive cells, that's what causes the lymph nodes to get big. That's why they grow. And that's why the classic presentation is persistent, painless, enlarged lymph nodes. So when we think of the pathophysiology of Hodgkin lymphoma, there are really two processes contributing to the presentation: One is the physical effects of enlarging lymph nodes or the involved organs. The second is the systemic inflammatory response generated by it and its surrounding immune environment," ONS member Victoria Krogg, DNP, APRN-CNP, AOCNP®, nurse practitioner at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus, OH, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about an overview of Hodgkin lymphoma for oncology nurses.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
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Learning outcome: Learners will report an increase in knowledge related to the pathophysiology and diagnosis of Hodgkin lymphoma.
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Highlights From This Episode"Hodgkin lymphoma can be diagnosed at virtually any age but is more common in younger patients as well as older adults. It kind of skips middle-aged people, but it occurs in our geriatric population as well. There are different prognostic implications depending on the group of patients that are diagnosed with Hodgkin lymphoma. As far as risk factors ... Hodgkin lymphoma is not considered a hereditary disease. There's not a specific gene we know of today that can be passed down to children and put them at risk. But if there is a first-degree relative affected by a lymphoma, we do find that noteworthy. We do consider it a risk factor. But that risk factor isn't necessarily a hereditary component so much as it is having that same genetic susceptibility to Hodgkin's or perhaps sharing common environmental exposures." TS 5:46
"Sometimes the subtypes of Hodgkin lymphoma can vary in terms of presentation. It's certainly not textbook how someone can present. But generally, we worry about enlarged lymph nodes, especially if they are notably enlarged to the point where someone can even see them when they're standing a few feet away from that individual. ... We also worry about what we call B symptoms, related to B lymphocytes, such as unexplained and persistent fevers, drenching night sweats, unexplained weight loss, and new progressive fatigue. ... Interestingly, there is a phenomenon where sometimes people who have an underlying Hodgkin lymphoma will experience lymph node pain or tenderness when they drink alcohol. It's kind of a unique presenting symptom. But I also want to point out that you don't have to have all of these symptoms. A lot of patients are relatively asymptomatic, meaning without symptoms." TS 8:37
"It's always important to consider if there is any very obvious infectious or inflammatory correlate that could explain the enlarged lymph node. Something I've seen in my practice is someone gets a flu vaccine in their right arm and then a couple of days later they notice a lump in their right armpit. And yeah, it might be a flared lymph node, but they also had a vaccine in their arm recently, which would stimulate your lymph node, because the purpose of the vaccine is to have an effect on the immune system. So I always want to make sure—is there something really obvious that could explain these lymph nodes being abnormal? A recent tattoo, recent injury, or infection proximal to where that enlarged lymph node is? So, you have to think of all of that when you're thinking of the differential diagnoses that come to mind." TS 19:19
"Nurses can be monumentally helpful with the education role with any patients who may have lymphoma. It would be helpful if nurses guide patients on the diagnostic process, providing support, guidance and encouragement, and of course, advocating for patients. Also, when you think of Hodgkin lymphoma and you think of the younger patients that are diagnosed with it, there's some additional supportive care that we need to consider, and we may need to refer them for fertility preservation. That can be very daunting for our young patients, so it's helpful to have nursing support in those situations." TS 22:55
"People think of Hodgkin lymphoma as a very treatable disease—and it can be very curable for certain patient populations—but it's not a 100% success rate. We do still have fatalities, so it's a very serious thing. I try to always educate my patients about seeking out care if they notice new lumps or bumps on their bodies. We can observe enlarged lymph nodes most easily on the neck, under the armpit, and in the groin area. If someone were to notice a lump in that area, short-term observation—keeping an eye on it for two weeks is fine—but if it persists past that, they should definitely seek care to get it evaluated." TS 33:18
