First, health-care providers will look for the source of any symptoms. Blood tests can be helpful (e.g., uric acid and LDH levels), as can an MRI, PET scans, computed tomography (CT), or gallium scanning. If a tumor is suspected, a biopsy will then be performed. During a biopsy, a sample of the tumor will be collected as a part of a surgical procedure and sent to a lab for analysis. A biopsy of the bone marrow and a spinal tap are often necessary to determine if the cancer has spread beyond the tumor. Treating the lymphoma depends on this information.
Both Hodgkin's disease and NHL are classified by the same categories of stages. Most lymphomas in HIV-positive people involve B-cells, as opposed to T-cells.
The stage of the lymphoma is very important and can help determine prognosis and the course of treatment. The four stages are:
The 4 Stages of Lymphoma
Stage I: There is one cancer site. No bone marrow involvement.
Stage II: There are two sites; both are either above or below the diaphragm. No bone marrow involvement.
Stage III: There are sites above and below the diaphragm. No bone marrow involvement.
Stage IV: The bone marrow is effected or the cancer cells have spread outside the lymphatic system.
In Hodgkin's disease, staging is further classified by letters which indicate:
Hodgkin's Disease Classifications
B: the presence of fever, weight loss or night sweats
A: the absence of fever, weight loss or night sweats
E: the disease has spread to organs outside the lymph system
As for CNS lymphoma, brain biopsies are the best way to diagnose suspected cancer. However, these surgical procedures are risky and are not routinely performed on HIV-positive men and women. Nonetheless, CNS lymphoma can look a lot like toxoplasmosis, so it's important to determine the true source of the lesion in the brain. Spinal taps, bone marrow biopsies, and careful inspection of scans can do this in most cases.
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