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recent lymphoma diagnosis -- Help
Mar 2, 2001

Dear Dr. Thanks for all of your work with this column. I was diagnosed yesterday with lymphoma from a biopsy of a lymph node under my arm. We are still awaiting further pathology reports as the the exact nature. How does one tell how it may have spread? They did a CT scan of my neck and chest, but the technician said they can only tell if lymph nodes are swollen, not whether they are cancerous. Just because nodes are swollen doesn't necessarily mean they are cancerous, correct? How important is it to have an oncologist who works a lot with HIV? How can I go about finding one in the New York / New Haven are?

Response from Dr. Dezube

My heart goes out to you with your new diagnosis; certainly an unwelcome guest. Lymphoma is typically very treatable and even curable (this depends a bit on your CD4 count, where it has spread, final pathology reports, and so on). Here are the answers to your questions 1) How does one tell where it's spread? -- Typically your health provider will order a CT scan of the chest, abdomen and pelvis; a gallium scan; perform a bone marrow biopsy; and perform a spinal tap. All these tests are pretty important to know the exact extent of the disease. They can usually be performed in one week or less.

2) How can you tell if swollen lymph nodes are cancer? -- The technician is correct. Although most of the enlarged lymph nodes in lymphoma patients are due to lymphoma, it is possible that they just may be due to your HIV disease. This is the purpose of the gallium scan. It lights up the lymph nodes which contain lymphoma. So if a lymph node is seen on the CT scan and if that node lights up with gallium, then most likely that lymph node contains cancer.

3) In terms of the need for expertise, obviously the more familiar your doctor is with lymphoma, and particularly AIDS lymphoma, the better. Fortunately the treatment of lymphoma is quite straight-forward from the physician standpoint (I imagine that from your standpoint, you would not consider it straight-forward). Most oncologists, even if they do not have a large HIV practice, should be able to handle your case. It is very important that (s)he maintain a tight link with your HIV doctor. TEAM WORK is the buzz word.

The standard treatment for lymphoma is a regimen called CHOP; some HIV oncologists use CDE. Either one should be okay. Please tell your oncologist that he should feel free to contact me to discuss your case. I'm listed with all the oncology services or he can always use thebody.com. The AIDS Malignancy Consortium's website has a list of HIV oncologists (about 20 or so sites scattered in the US). This consortium has been set up by the National Cancer Institute.

GOOD LUCK. Keep me posted with your progress.


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