Diagnosis

Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. Your doctor may consider these factors when choosing a diagnostic test:

• Age and medical condition
  
  
• The type of cancer suspected
  
  
• Severity of symptoms
  
  
• Previous test results

The following tests may be used to diagnose an HIV/AIDS-related cancer or determine if or where it has spread:

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. CT scans of the chest and abdomen can help find cancer that has spread to the lungs, lymph nodes, or liver.

KAPOSI’S SARCOMA

Endoscopy. This test allows the doctor to see the inside the body with a thin, lighted, flexible tube called an endoscope. The person may be sedated as the tube is inserted through the mouth, down the esophagus, and into the stomach and small bowel. If abnormal areas are found, the doctor can remove a sample of tissue and check it for evidence of cancer. The doctor can examine the large intestine with a specific endoscopic procedure called a colonoscopy.

Bronchoscopy. This endoscopic test allows the doctor to see the inside the lungs with a thin, lighted, flexible tube called a bronchoscope. The person is sedated as the tube is inserted through the mouth or nose, down through the windpipe, and into the breathing passages of the lungs. This procedure may be performed by a surgeon or a pulmonologist (a medical doctor who specializes in the diagnosis and treatment of lung disease). Tiny tools inside the tube can gather samples of fluid and tissue and remove them, so the pathologist can examine the samples.

X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs.

Photography. Because multiple and scattered skin lesions can develop, doctors regularly photograph parts of the skin (called mapping) in order to determine whether new lesions have developed over time.

NON-HODGKIN LYMPHOMA

Blood tests. Many different blood tests provide information about the diagnosis of lymphoma, its effect on the body, and how the disease is responding to treatment.

Bone marrow aspiration and biopsy. Lymphoma often spreads to the bone marrow, the spongy material in the center of bones where blood cells are produced. Looking at a sample of the bone marrow can be important for doctors to diagnose lymphoma and to determine if it has spread.

The most common site to biopsy the bone marrow is the back of the pelvic (hip) bone. The skin is numbed, and a needle is inserted into a bone in the hip until it reaches the marrow. A small amount of bone marrow is removed and examined under a microscope.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the brain and spinal column. MRIs create more detailed pictures of soft tissues and nerves than CT scans. A contrast medium may be injected into a patient’s vein to create a clearer picture.

Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images. The exact accuracy and role of PET scanning in NHL is not yet clear, although aggressive subtypes of lymphomas often show up on PET scans. Many oncologists will obtain a PET scan as part of the initial evaluation, especially for the aggressive lymphomas. In the future, a PET scan may help monitor the disease’s response to treatment. There is also some evidence that using a PET scan after one or two cycles of treatment may be a useful way of predicting whether that treatment is likely to completely eliminate the lymphoma. This is not yet proven, but it is being evaluated in many studies around the world.

CERVICAL CANCER

Pap test. The doctor gently scrapes the outside of the cervix and vagina and takes samples of the cells for testing. Learn more about what to expect when having a pap test.

Colposcopy. The doctor may do a colposcopy to check the cervix for abnormal areas. A special instrument called a colposcope (an instrument that magnifies the cells of the cervix and vagina, similar to a microscope) is used. The colposcope gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix. The colposcope is not inserted into the woman’s body, and the examination is not painful, can be done in the doctor's office, and has no side effects. It can even be done on pregnant women.

Learn more about what to expect when having common tests, procedures, and scans.

Find out more about common terms used during a diagnosis of cancer.