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Kaposi's sarcoma, non-Hodgkin lymphoma, and cervical cancer are AIDS-defining neoplasms in HIV-infected patients. Other cancers that appear to be increased in incidence or severity include Hodgkin lymphoma (especially the mixed cellularity and lymphocyte-depleted subtypes), primary CNS lymphoma, anal cancer, testicular cancer, melanoma and other skin cancers, and lung cancer. Leiomyosarcoma is a rare complication of HIV infection in children. For full discussion of Kaposi's sarcoma, see Cancers of the Skin: Kaposi's Sarcoma.
Non-Hodgkin
lymphoma:
Non-Hodgkin lymphoma (see also Lymphomas: Non-Hodgkin Lymphomas) incidence increases 50- to 200-fold in HIV-infected patients. Most are B-cell, aggressive, high-grade histologic subtype lymphomas. At diagnosis, extranodal sites are usually involved, such as bone marrow, GI tract, and other sites that are unusual in non–HIV-associated non-Hodgkin lymphoma, eg, the CNS and body cavities (eg, pleural, pericardial, peritoneal).
Common presentations include rapidly enlarging lymph nodes or extranodal masses or systemic symptoms such as weight loss, night sweats, or fevers. Diagnosis is by biopsy with histopathologic and immunochemical analysis of tumor cells. Abnormal circulating lymphocytes or unexpected cytopenias suggest involvement of the bone marrow, mandating marrow biopsy. Tumor staging may require CSF examination and CT or MRI of the chest, abdomen, and other areas where tumor is suspected. Poor prognosis is predicted by CD4+ count < 100, age > 35 yr, poor functional status, bone marrow involvement, a history of opportunistic infections, and a high-grade histologic subtype.
Non-Hodgkin lymphoma is treated with systemic, multidrug chemotherapy (eg, with cyclophosphamide , doxorubicin , vincristine , and prednisone ), usually combined with antiretrovirals, prophylactic antibiotics and antifungals, and hematologic growth factors. Therapy may be limited by profound myelosuppression, particularly when using combinations of myelosuppressive antitumor or antiretroviral drugs. Another possible treatment is IV anti-CD20 monoclonal antibody ( rituximab ), which is effective for non-Hodgkin lymphoma in patients without HIV. Radiation therapy may debulk large tumors and control pain or bleeding.
Primary
central nervous system lymphoma:
Primary CNS lymphomas (PCNSLs) occur with increased frequency in HIV-infected patients (see also Intracranial and Spinal Tumors: Primary Brain Lymphomas). PCNSLs consist of intermediate- or high-grade malignant B-cells, originating in CNS tissue. Presenting symptoms include headache, seizures, neurologic deficits (eg, cranial nerve palsies), and mental status change.
Acute treatment requires control of cerebral edema and whole-brain radiation therapy. Radiographic response is common, but median survival is < 6 mo. The role of antitumor chemotherapy is unclear, but survival is improved by highly active antiretroviral therapy (HAART).
Cervical
cancer:
Cervical cancer (see also Gynecologic Tumors: Cervical Cancer) is difficult to cure in HIV-infected patients. HIV-infected women have increased human papillomavirus (HPV) infection rates, persistence of oncogenic subtypes (types 16, 18, 31, 33, 35, and 39), and cervical intraepithelial dysplasia (CIN, incidence of up to 60%), but no proven increase in cervical cancer rates. However, cervical cancers are more extensive, are more difficult to cure, and have higher recurrence rates after treatment. Confirmed risk factors in HIV-infected women include infection with HPV subtype 16 or 18, CD4+ counts < 200/μL, and age > 34 yr. HIV infection does not affect management of CIN or cervical cancer. Frequent Papanicolaou smears are important to monitor for progression. HAART may produce resolution of HPV infection and regression of CIN but has no clear effects on cancer.
Squamous
cell cancer of the anus and vulva:
Squamous cell cancers of the anus (see also Tumors of the GI Tract: Anorectal Cancer) and vulva (see also Gynecologic Tumors: Vulvar Cancer) are caused by HPV and occur more commonly in HIV-infected patients. The reason for the increased incidence in HIV appears to be the increased rate of high-risk behaviors, eg, anal-receptive intercourse, rather than HIV itself. Anal dysplasia is common, and squamous cell cancers can be very aggressive. Treatments include surgical extirpation, radiation therapy, and combined modality chemotherapy with mitomycin or cisplatin and 5- fluorouracil .
Last full review/revision November 2005
Content last modified November 2005
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