Hodgkin's Disease is twice as common in men as in women. It may occur in any decade of life, but is rarely found at puberty. The cause is unknown.

It is sometimes difficult for even the pathologist to differentiate Hodgkin's Disease from lymphosarcoma or other diseases of the lymph nodes. For this reason Hodgkin's Disease and lymphosarcoma are often discussed as one disease entity.

The first symptom of Hodgkin's Disease is usually the painless enlargement of a peripheral lymph node, often in the neck region. The cervical, axillary, inguinal, and retroperitoneal nodes are most commonly affected-others only rarely. The nodes may grow slowly or may very suddenly increase in size. Symptoms vary with the location of the enlarged nodes. Backache may be caused by enlargement of the retroperitoneal nodes; edema or pain of the lower extremities may result from involvement of the pelvic and inguinal nodes; dyspnea usually results from involvement in the lungs. Other symptoms which occur as the disease progresses include lassitude, loss of weight, anemia, fever, and in the late stages intractable itching.

The prognosis of this disease is decidedly variable. Many patients have been known to live for years in relative comfort, while in others the disease progresses very rapidly.

Treatment

X-ray, applied locally to the involved nodes or to regional infiltrations, is considered the treatment of choice because of the extended remissions and relief of symptoms which can be achieved. In recent years a valuable adjunct has been added in nitrogen mustard and related alkylating agents, such as triethylene mela-mine (TEM) and triethylene phosphorylamide (thio-tepa). These drugs are given intravenously and must be used with extreme caution since they are caustic to the skin. In some clinics the nurse may be asked to assist in giving these drugs and she should remember that damage will occur if any of the drug is accidentally spilled on the skin. If this occurs, the area must be immediately bathed with copious amounts of water to prevent blistering. Adrenal corticosteroids are sometimes used in advanced Hodgkin's Disease; in this case careful observation of fluid balance is necessary. Edema or hypertension must also be watched for. Additional therapy may include transfusions for anemia, analgesics for bone pain, and antibiotics for intercurrent infections.

Nursing Care

General supportive measures to build up and maintain the patient's resistance are an important part of the nursing care for these patients. Nutritionally balanced meals, sufficient rest, and avoidance of infection are important. Special problems may arise as a result of the therapeutic regimen. X-ray treatment may produce nausea, anorexia, and vomiting, and adjustments in the diet may be necessary. Skin reactions during or following X-ray treatment may occur. Petechiae and bruising may indicate approaching drug toxicity and should be reported to the physician. The drugs used in the treatment of the leukemia and lymphomas are, in general, highly toxic, and one of the most important contributions of the nurse is her intelligent observation of the patient's appearance, behavior, and reactions. This will often be significant to the physician in his total management of this disease, which requires the most judicious use of a variety of very specific treatments.