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Overview

AIDS-related cancers occur with greater frequency among people with HIV/AIDS than in the general population. Kaposi's sarcoma (KS) is the most common AIDS-related cancer, followed by non-Hodgkin's lymphoma (NHL).

Rates for many other cancers are rising among people with HIV/AIDS. Antiretroviral therapy has made it possible for people with HIV/AIDS to live longer, healthier lives, which gives other cancers more time to develop.

Types of cancer that are known to be associated with HIV/AIDS include the following:

• Kaposi's sarcoma
• Non-Hodgkin's lymphoma
• Hodgkin's disease
• Cervical cancer
• Anal squamous cell carcinoma
• Primary CNS lymphoma
• Multiple myeloma (type of bone marrow cancer)
• Testicular cancer
• Oral cancers

Some common cancers that not usually associated with HIV/AIDS, such as melanoma, breast cancer, and lung cancer, also may have a higher incidence among people with HIV/AIDS.

Kaposi's Sarcoma (KS)
Kaposi's sarcoma was one of the first signs of the AIDS epidemic in the United States in the early 1980s. Even though antiretroviral therapy has greatly reduced the number of new cases, KS remains the most common AIDS-related cancer. It appears in gay and bisexual men much more frequently than in women or heterosexual men.

KS is one of the most noticeable signs of AIDS because it produces spots, or lesions, on the skin that look purplish on light skin and brownish black or bluish on dark skin. The lesions usually appear on the face, arms, or legs. They may be small and flat, or they may look like lumps of bubble gum stuck on the skin. KS is diagnosed by examining the lesions, visually and/or with a biopsy (evaluation of cells under a microscope).

Like all cancers, KS can spread and cause serious life-threatening problems. It can spread into the mouth (where it can cause difficulty swallowing and digesting), the lymph nodes, the lungs, and throughout the digestive system.

Fortunately, the number of new KS cases has decreased dramatically since antiretroviral therapy was introduced in the mid-1990s. Antiretrovirals are often the only treatment necessary. Small, flat lesions can be removed with laser surgery or liquid nitrogen. Treatment may also include radiation or small doses of chemotherapy injected directly into the lesions. Larger lesions may require systemic chemotherapy.

Treating patients who are infected with human herpesvirus (HHV-8) using an anti-herpes medication, such as ganciclovir, may decrease the risk for AIDS-related KS. AIDS-related KS is associated with this virus.

Lymphoma
The term "lymphoma" refers to about a dozen different types of cancer that are characterized by abnormal, rapidly growing white blood cells in the lymphatic system. Lymphoma can spread through the lymphatic system to almost any part of the body, including the intestines, liver, and brain. Lymphomas generally grow and spread more quickly in patients who have HIV/AIDS than in those who are not infected.

The many different types of lymphoma are generally categorized as either Hodgkin's lymphoma or non-Hodgkin's lymphoma (NHL). Both of these types are considered AIDS-related cancers, although NHL is much more common among patients who have HIV/AIDS. Indeed, it is the second most common AIDS-related cancer. Lymphoma that affects the brain is known as primary CNS (central nervous system) lymphoma.

Lymphatic System
The lymphatic system is a network of thin tubes that, like blood vessels, branch and extend throughout the entire body. A transparent, watery fluid (lymph) flows through the tubes and supplies the body with various disease- and infection-fighting cells. The network is dotted with clusters of lymph nodes, which are small organs where the cells are made and stored.

Other tissues and organs that play a role in making, storing, or filtering the infection-fighting cells include the bone marrow (spongy tissue inside the bones), the spleen (organ in the upper abdomen), the thymus (organ in the chest, beneath the breastbone), and the tonsils.

Non-Hodgkin's Lymphoma
The Epstein-Barr virus (EBV) likely plays a causal role in the development of some types of lymphoma, including NHL. NHL occurs more frequently in gay and bisexual men than in other patients who are infected with HIV.

NHL is the second most common AIDS-associated cancer. Some researchers suspect that it may become the most common AIDS-related cancer. NHL takes several years to spread and develop tumors large enough to detect. More patients who have HIV/AIDS now are developing NHL, because antiretroviral therapy is helping them live longer, healthier lives. People on antiretroviral therapy who have normal CD4+ counts and undetectable viral loads can develop NHL.

NHL can affect many different organs, including the lungs and bone marrow. Symptoms include the following:

• Painless, swollen lymph nodes in the neck, groin, and armpits
• Itchy skin
• Weight loss
• Fever
• Night sweats

NHL usually is treated with chemotherapy, radiation, or both. Treatment is slightly different for patients who are infected with HIV, and antiretroviral therapy may require some modification during chemotherapy. Anyone with HIV/AIDS who has NHL should be treated by a cancer specialist (oncologist) who is an expert in the care and treatment of people with HIV/AIDS. Antiretrovirals can make treatment for NHL more effective.

Hodgkin's Lymphoma
Symptoms of Hodgkin's lymphoma include the following:

• Painless, swollen lymph nodes in the neck, groin, and armpits
• Itchy skin
• Weight loss
• Fever
• Night sweats

Hodgkin's usually is treated with chemotherapy, radiation, or both. Treatment is slightly different for patients who are infected with HIV, and antiretroviral therapy may require some modification during chemotherapy. Anyone with HIV/AIDS who has Hodgkin's lymphoma should be treated by a cancer specialist (oncologist) who is an expert in the care and treatment of people with HIV/AIDS.

For a more complete description of Hodgkin's lymphoma, visit oncologychannel.com.

Primary (CNS) Lymphoma
Primary CNS (central nervous system) lymphoma occurs in the brain or spinal cord in patients who are HIV-positive and have CD4+ counts below 100 or, more commonly, 50 cells/mL.

One of the symptoms of CNS lymphoma is a persistent headache that does not go away with the usual headache pain relievers. Other symptoms include partial paralysis affecting one side of the body, seizures, and the loss of ability to understand or speak language. The diagnosis usually is based on a microscopic examination of the lymph nodes or other affected tissues (biopsy).

CNS lymphoma is a very aggressive cancer and there is no cure. Radiation can temporarily slow growth of the disease. Patients who are taking antiretroviral drugs rarely develop CNS lymphoma.

Other Cancers
Women who are infected with HIV/AIDS are at increased risk for developing cervical cancer and should receive a Pap smear every 6 months. A Pap smear is a simple test used to detect early precancerous changes in cervical cells and is the single most important step a woman can take to prevent cervical cancer.

Cervical cancer is strongly associated with two types of human papillomavirus (HPV). These types of HPV are sexually transmitted and cause genital warts, which can progress quickly to cancer in people with weakened immune systems. In women, warts can develop on the vulva, anus, vagina, and cervix.

The virus is transmitted through intimate sexual contact. Condoms can provide protection if they are put on before starting sex and worn until the penis is withdrawn.

Treatment for cervical cancer depends on how far the disease has progressed. Early cancer can be removed surgically or treated with radiation. Advanced disease is usually treated with surgery, radiation, and/or chemotherapy. When very advanced cervical cancer is untreatable, radiation can be used to relieve symptoms.

For a more complete description of cervical cancer, visit oncologychannel.com.

Anal Squamous Cell Carcinoma
Men who engage in anal sex are at high risk for anal squamous cell carcinoma, which is associated with human papillomavirus (HPV). The anus, which located at the end of the rectum, is the organ through which stool passes out of the body. Cancer can develop on the outside of the anus or on the inside of the rectum.

Symptoms include the following:

• Bleeding from the rectum
• Lump near the anus
• Pain, pressure, itching, and discharge from the anus

An anal Pap smear is a simple, inexpensive procedure used to detect precancerous changes to cells in the anus. If precancerous changes can be detected before they develop into cancer, they can be treated and the cancer prevented. Regular anal Pap smears may help reduce the incidence of anal cancer.

Although anal cancer occurs more frequently among gay and bisexual men, men and women who are infected with HIV and who regularly engage in anal sex should have routine anal Pap smears.

Anyone with HIV/AIDS who has genital warts or may have been exposed to HPV should contact their physician or other health care provider. Patients with HIV/AIDS who has anal cancer should be treated by a cancer specialist (oncologist) who is an expert in the care and treatment of people with HIV/AIDS.

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