Hodgkin's lymphoma, previously known as Hodgkin's disease, is a type of lymphoma, which is a cancer originating from white blood cells

called lymphocytes. It was named after Thomas Hodgkin, who first described abnormalities in the lymph system in 1832.[1][2] Hodgkin's lymphoma is characterized by the orderly spread of disease from one lymph node group to another and by the development of systemic symptoms with advanced disease. When Hodgkins cells are examined microscopically, multinucleated Reed-Sternberg cells (RS cells) are the characteristic histopathologic finding. Hodgkin's lymphoma may be treated with radiation therapy, chemotherapy or hematopoietic stem cell transplantation, the choice of treatment depending on the age and sex of the patient and the stage, bulk and histological subtype of the disease. Staging The staging is the same for both Hodgkin's as well as non-Hodgkin's lymphomas. After Hodgkin's lymphoma is diagnosed, a patient will be staged: that is, they will undergo a series of tests and procedures that will determine what areas of the body are affected. These procedures will include documentation of their histology, a physical examination, blood tests, chest X-ray radiographs, computed tomography (CT) scans or magnetic resonance imaging (MRI) scans of the chest, abdomen and pelvis, and a bone marrow biopsy. Positron emission tomography (PET) scan is now used instead of the gallium scan for staging. In the past, a lymphangiogram or surgical laparotomy (which involves opening the abdominal cavity and visually inspecting for tumors) were performed. Lymphangiograms or laparotomies are very rarely performed, having been supplanted by improvements in imaging with the CT scan and PET scan. On the basis of this staging, the patient will be classified according to a staging classification (the Ann Arbor staging classification scheme is a common one):

Stage I is involvement of a single lymph node region (I) (mostly the cervical region) or single extralymphatic site (Ie); Stage II is involvement of two or more lymph node regions on the same side of the diaphragm (II) or of one lymph node region and a contiguous extralymphatic site (IIe); Stage III is involvement of lymph node regions on both sides of the diaphragm, which may include the spleen (IIIs) and/or limited contiguous extralymphatic organ or site (IIIe, IIIes); Stage IV is disseminated involvement of one or more extralymphatic organs. Staging Hodgkin's disease Once the diagnosis is confirmed, doctors "stage" the disease. Staging is how doctors judge the extent of the disease, which will likely affect your treatment options. Stage I. The cancer is limited to one lymph node region or a single organ. Stage II. In this stage, the cancer is in two different lymph nodes, but is limited to a section of the body either above or below the diaphragm.

Stage III. When the cancer moves to lymph nodes both above and below the diaphragm, but hasn't spread from the lymph nodes to other organs, it's considered stage III. Stage IV. This is the most advanced stage of Hodgkin's disease. Stage IV Hodgkin's disease affects not only the lymph nodes but also other parts of your body, such as the bone marrow or your liver

The absence of systemic symptoms is signified by adding 'A' to the stage; the presence of systemic symptoms is signified by adding 'B' to the stage. For localized extranodal extension from mass of nodes that does not advance the stage, subscript 'E' is added.

Signs and symptoms

Patients with Hodgkin's lymphoma may present with the following symptoms:

Itchy Skin Night sweats Unexplained weight loss Lymph nodes: the most common symptom of Hodgkin's is the painless enlargement of one or more lymph nodes. The nodes may also feel rubbery and swollen when examined. The nodes of the neck and shoulders (cervical and supraclavicular) are most frequently involved (8090% of the time, on average). The lymph nodes of the chest are often affected, and these may be noticed on a chest radiograph. Splenomegaly: enlargement of the spleen occurs in about 30% of people with Hodgkin's lymphoma. The enlargement, however, is seldom massive and the size of the spleen may fluctuate during the course of treatment. Hepatomegaly: enlargement of the liver, due to liver involvement, is present in about 5% of cases. Hepatosplenomegaly: the enlargement of both the liver and spleen caused by the same disease. Pain following alcohol consumption: classically, involved nodes are painful after alcohol consumption, though this phenomenon is very uncommon.[11] Back pain: nonspecific back pain (pain that cannot be localized or its cause determined by examination or scanning techniques) has been reported in some cases of Hodgkin's lymphoma. The lower back is most often affected.[citation needed] Red-coloured patches on the skin, easy bleeding and petechiae due to low platelet count (as a result of bone marrow infiltration, increased trapping in the spleen etc. i.e. decreased production, increased removal) Systemic symptoms: about one-third of patients with Hodgkin's disease may also present with systemic symptoms, including low-grade fever; night sweats; unexplained weight loss of at least 10% of the patient's total body mass in six months or less, itchy skin (pruritus) due to increased levels of eosinophils in the bloodstream; or fatigue (lassitude). Systemic symptoms such as fever, night sweats, and weight loss are known as B symptoms; thus, presence of fever, weight loss, and night sweats indicate that the patient's stage is, for example, 2B instead of 2A.[12]

Cyclical fever: patients may also present with a cyclical high-grade fever known as the PelEbstein fever,[13] or more simply "P-E fever". However, there is debate as to whether or not the P-E fever truly exists.[14]

Cause
There are no guidelines for preventing Hodgkin's lymphoma; this is because the cause is unknown or multifactorial. A risk factor is something that statistically increases one's chance of contracting a disease or condition. Risk factors for Hodgkin's lymphoma include:

Sex: male[15] Ages: 1540 and over 55[15] Family history[15] History of infectious mononucleosis or infection with Epstein-Barr virus, a causative agent of mononucleosis[15] Weakened immune system, including infection with HIV or the presence of AIDS[15] Prolonged use of human growth hormone[15] Exposure to exotoxins, such as Agent Orange

Estimated new cases and deaths from Hodgkin lymphoma in the United States in 2011: New cases: 8,830 Deaths: 1,300
CAuse

The exact cause of Hodgkin's disease is unknown. There are five types of Hodgkin's disease all among a group of cancers called lymphomas cancers of the lymphatic system. The lymphatic system includes the lymph nodes (lymph glands), which are located throughout your body and are connected by small vessels called lymphatics. The spleen, thymus gland and bone marrow also are part of the lymphatic system. Hodgkin's disease commonly begins in lymph nodes located in the upper part of your body. Some lymph nodes are in areas more readily noticed, such as in your neck, above your collarbone, under your arms or in your groin area. Enlarged lymph nodes in the chest cavity also are common. Eventually, Hodgkin's disease may spread outside your lymph nodes to virtually any part of your body.
Abnormal B cells

A key step in Hodgkin's disease involves the development of abnormal B cells, a type of lymph cell that's an important part of your immune system's response to foreign invaders. B cells normally work with T cells, which derive from the thymus, to fight infection. T cells kill foreign invaders directly. B cells become plasma cells, which in turn produce antibodies that neutralize foreign invaders.

When B cells develop into large abnormal cells, these abnormal, cancerous cells are called Reed-Sternberg cells, after the two pathologists who first discovered them. Instead of undergoing the normal cell cycle of life and death, these Reed-Sternberg cells don't die, and they continue to produce abnormal B cells in a malignant process.

Risk factors
The following are risk factors for Hodgkin's disease:
Age. People between the ages of 15 and 40, as well as those older than 55, are

most at risk of Hodgkin's disease.

Family history. Anyone with a brother or a sister who has the disease faces an

increased risk of developing Hodgkin's, though this may be due to similar environmental exposures rather than genetic factors.
Sex. Males are slightly more likely to develop Hodgkin's. Past Epstein-Barr infection. People who have had illnesses caused by the

Epstein-Barr virus, such as infectious mononucleosis, are more likely to develop Hodgkin's disease than people who haven't had a past Epstein-Barr infection.
Compromised immune system. Having a compromised immune system,

such as from HIV/AIDS or from having an organ transplant requiring medications to suppress your immune response, also appears to put you at a greater risk of Hodgkin's disease.

Characters Anna Fitzgerald- 13 years old and knows that the reason her parents had her was so that there could be a bone marrow donor for Kate. She hires a lawyer to get medical emancipation from her parents so she will not be forced to donate her kidney. Kate- 16 years old and older sister of Anna's. She was diagnosed with acute promyelocytic leukemia at a very young age. She has basically lived with it almost her entire life. Jesse- Oldest child, brother to Anna and Kate. He is very rebellious, and his parents often don't know where he is at. He likes to play with matches and intentionally burns down old vacant buildings with a friend. Brian- Father of Anna, Kate, and Jesse. His is a firefighter. Although he lives at the firehouse a lot and called away often, he is a very loving and attentive father. Sara- Mother to the three teens. She has desperately cared for Kate since she was diagnosed. Although she clearly loves her other children, the high level of attention she gives to Kate does not give her much time to pay much attention to Anna or Jesse, almost to the point of being callous.

Campbell Alexander- He is the intelligent, savvy attorney Anna hires. Caring little about anyone else, he takes on Anna's case because it will bring him a lot of publicity and he doesn't think he'll have to do much work to win the case. He has a service dog, although we don't find out until the end what it is for. Julia Romano- She is the guardian ad litem for Anna. She dated Campbell when they were both in high school and they both had strong feelings for each other, and those flames are rekindled when they see each other again afters an number of years. Synopsis The book starts off with Anna selling some of her belongings in a pawn shop. After going home she goes to the office of Campbell Alexander in order to hire him to sue her parents "for the right to [her] own body." The reason her parents had her in the first place, she explains, was so that she could donate bone marrow to her older sister. But over the years she has had to go through more and more surgeries. And now, her parents want her to donate a kidney to Kate, Anna has never had to donate a body organ before. Once Campbell realizes that she is very serious about what she is doing, he agrees to be her lawyer, pro bono, knowing he'll get a lot of publicity from the case. He is going to demand medical emancipation for Anna. Anna's parents are shocked when they receive the legal papers informing them of what Anna is doing. When they realize that they are going to need a lawyer, Sara, who is a lawyer, decides to be the lawyer representing the opposing side, not really believing the case will go far and thinking she'll be able to talk Anna out of the suit. She thinks Anna is only doing this for attention. Campbell makes it clear in court that he wants Anna out of the house since her mother is opposing counsel. The judge appoints a guardian ad litem for Anna, Julia Romano, her job is basically to represent the best interests of the minor child. Through out the book we see that Anna feels guilty about the decision she has made and questions it. She doesn't want to hurt her family. Campbell becomes very agitated at Anna's reluctance. He goes through his own turmoil, having to work with an old flame. It comes out during the trial that his service dog is meant to warn him when he is about to have seizures. Turns out that Campbell got into a car accident at 18 and suffered permanent seizures from it. He left Julia because he didn't want to burden her with his affliction. When Julia finds out she begins to forgive Campbell for what he did, and they start a relationship again. Brain finds out that Jesse, his son, has been the person starting all of the recent fires he and his men have been putting out. Confronting Jesse, the boy admits that he feels immense guilt due to the fact he wasn't a donor match for Kate. Brian realizes that Jesse psyche worked to convince him that since he couldn't rescue, he had to destroy. From Sara's perspective, which is told from the past, starting from when Kate was diagnosed, to the

present story. We see throughout her perspective that everything she did was always out of love. However, it seems that she did pay too much attention to Kate to the point of emotionally neglecting her other children. Kate was always her first concern and she didn't think much about that and considered it a given since Kate was dying. Through out the trial and book, Sara realizes where she went wrong in some aspects of her parenting. Though she is frustrated at what Anna is doing, she never hates her or stops loving her for it. Right before the end of the trial, a plot twist: When Anna first found out about the need for a kidney transplant, she was going to do it and had not problem with it. But, Kate convinced her not to. Turns out, she didn't want to go through with the surgery, she was sick of it all. She knew she'd die without the transplant, but she just couldn't go through it all. It was Kate who convinced Anna to get a lawyer. The trial ends with the judge ruling in Anna's favor. She receive medical emancipation from her parents. Everyone is happy that the case is over, and no one is mad at Anna for doing what she did. A sad twist of fate then happens. Campbell is driving in a car with Anna in the passenger seat. The car is struck by a truck. Campbell makes it out okay, but Anna is left brain dead. Everyone is stricken with grief, especially Sara who had always been planning out the death of her other daughter, Kate. The doctor asks about organ donation. Campbell, being the medical power of attorney for Anna, says that Anna would want her kidney donated to her sister. Epilogue Told for the first time from Kate's perspective, she talks about what happened to her family in the few years after Anna's death. The transplant worked and it has been 8 years since her last relapse. Sara suffered from a heavy grieving process. Brain overcame alcoholism. Jesse became a policeman. Julia and Campbell got married. It ends with Kate explaining that with the transplant she takes Anna with her, not matter where she goes.

ACKNOWLEDGEMENT This dissertation would not have been possible without the guidance and the help of several individuals who in one way or another contributed and extended their valuable assistance in the preparation and completion of this study. First and foremost, my utmost gratitude to Dr. Nilo L. Rosas, President of the Philippine Normal University whose sincerity and encouragement I will never forget. Dr. Rosas has been my inspiration as I hurdle all the obstacles in the completion this research work. Dr. Norma J. Manaloto, former Head of the Department of Educational Management, Measurement and Evaluation, who until her day of retirement had kind concern and consideration regarding my academic requirements. Dr. Alice D. Dioquino, for her unselfish and unfailing support as my dissertation adviser; Engr. Alex A. Santos, co-adviser to Dr. Dioquino, for his patience and steadfast encouragement to complete this study; Dr. Danilo K. Villena, Head of the Department of Education Management and Measurement, for the moral support despite his just being newly appointed; Dr. Angelita D. Romero, Dean of the College of Education, for the insights she has shared; Dr. Florentina L. Gorospe, Dr. Jose Rizal Sanchez and Dr. Rebecca C. Nueva-Espa?a for their inputs especially in the curriculum part of this study. They have shared valuable insights in the relevance of the study to basic education not just in the technology sector. The staff of the PNU Presidents Office especially Ms. Didi, Vic and Noel for being accommodating to our queries likewise the secretary of the Educational Management Department Chair and her student assistant for all the help. Dr. Generosa Eligio, Principal of the CLSU Science High School and Engr. Donald Mateo of the Bureau of Post Harvest Research Extension, Nueva Ecija, for their expertise. Despite the distance, they have painstakingly e-mailed the information I needed. The UST ME graduates namely the Andaya group and Emas group for the literature such as catalogues and journals needed that came all the way from Nueva Ecija; Allan Valera of Santo Tomas E-Services Providers for the assistance on how to use the software needed for my presentation; The Administrators of the Faculty of Engineering University of Santo Tomas, for their untiring effort in encouraging the teaching staff to pursue professional growth. Likewise the staff of the Deans Office for their relaying every communication sent in my behalf.

Mr. Edwin G. Antonio of the UST CAD-Engineering for re-editing the electronic version of this dissertation for consistent pagination prior to printing of the required number of hard copies. Alex Roland Realco, Jr. of the Mechanical Engineering Laboratory I for helping out in sorting and compilation of the printed copies. My colleagues and staff in the Mechanical Engineering, Electrical Engineering and Civil Engineering Departments for the use of facilities in the ME Lab, consultations in EE and moral support from CE. Mechanical Engineering students who in one way or another were assistance especially when the system broke down during the course of usage. Last but not the least, my family and the one above all of us, the omnipresent God, for answering my prayers for giving me the strength to plod on despite my constitution wanting to give up and throw in the towel, thank you so much Dear Lord.