CASE STUDY

 A 65-year-old man with background retroviral disease on ART ( Antiretroviral therapy) presented with histological diagnosis of Prostate adenocarcinoma. He initially had symptoms of occasional dysuria (pain on passing urine), weight loss and constipation.

The digital rectal exam ( manual examination of the prostate) at the time revealed a large volume prostate with induration along the left side of the gland.

Prostate specific antigen was 289.98ng/ml which was beyond the normal range and deemed abnormal.

Trans rectal ultrasound revealed a prostate volume of 67.3g while PET scan showed locally advanced prostate cancer and prostate biopsy ( tissue sample from the prostate) diagnosed Ductal adenocarcinoma.

His treatment has been as follows: Orchiectomy (surgical removal of one or both testicles to stop testosterone production which can feed the prostate cancer cells) – Bicalutamide( an antiandrogen drug) – Abiraterone( hormone therapy drug) – Enzalutamide( hormone therapy).

However, despite the above stated treatment the disease progressed and recent imaging showed skeletal metastasis with PSA:117.37ngmL.

He is currently on single agent Docetaxel and been scheduled for radiotherapy to the spine.

Three months after commencement of chemotherapy, he was admitted with features of Septicemia  blood infection). CD-4 count was 350 cells/mm2.

He was later discharged and counselled adequately on the need to be compliant with his anti-retroviral medications.

Acquired immune deficiency syndrome (AIDS); is a disease of the immune system caused by infection with the human immunodeficiency virus (HIV).

HIV is transmitted from person to person most commonly in blood and bodily secretions, such as semen. A person with HIV is highly vulnerable to life-threatening conditions because HIV severely weakens the body’s immune system. When HIV infection causes symptoms and specific disease syndromes, the disease is called AIDS.

People with HIV/AIDS have an increased risk of developing the following cancers:

  • Kaposi sarcoma
  • Non-Hodgkin lymphoma (NHL)
  • Cervical cancer

For people with HIV, these 3 cancers are often called “AIDS-defining conditions.” This means that if a person with an HIV infection has 1 of these cancers, it can mean that AIDS has developed.

The connection between HIV/AIDS and certain cancers is not completely understood, but the link likely depends on a weakened immune system.

Kaposi sarcoma

Kaposi sarcoma is a type of soft-tissue sarcoma that has traditionally occurred in older men of Jewish or Mediterranean descent, young men in Africa, or people who have had organ transplantation. Today, Kaposi sarcoma is often found in homosexual men with HIV/AIDS and is related to an infection with the human herpesvirus 8 (HHV-8). Kaposi sarcoma in people with HIV is also called epidemic Kaposi sarcoma.

HIV/AIDS-related Kaposi sarcoma causes lesions to arise in more than 1 area of the body, including the skin, lymph nodes, and organs such as the liver, spleen, lungs, and digestive tract.

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) is a cancer of the lymphatic system. Lymphoma begins when healthy cells in the lymphatic system change and grow out of control, which may form a tumor. The lymphatic system is made up of thin tubes that branch to all parts of the body. Its job is to fight infection. The lymphatic system carries lymph, a colorless fluid containing white blood cells called lymphocytes. Lymphocytes fight germs in the body. Groups of tiny, bean-shaped organs called lymph nodes are located throughout the body at different sites in the lymphatic system. Lymph nodes are found in clusters in the abdomen, groin, pelvis, underarms, and neck. Other parts of the lymphatic system include the spleen, which makes lymphocytes and filters blood; the thymus, an organ under the breastbone; the tonsils, located in the throat; and bone marrow, the spongy red tissue inside bones that makes blood cells and platelets.

There are many different subtypes of NHL. The most common NHL subtypes in people with advanced HIV/AIDS include:

  • Aggressive B-cell lymphomas, most commonly the diffuse large B-cell or Burkitt subtypes
  • Primary central nervous system lymphoma, which affects the brain
  • Primary effusion lymphoma, which causes fluid to build up around the lungs or heart or in the abdomen

Recently, doctors have found that even people with well-controlled HIV/AIDS can develop NHL.

Cervical cancer

Cervical cancer starts in a woman’s cervix, the lower, narrow part of the uterus. The uterus holds the growing fetus during pregnancy. The cervix connects the lower part of the uterus to the vagina and, with the vagina, forms the birth canal. Cervical cancer is also called cancer of the cervix.

Women with HIV/AIDS have a higher risk of developing cervical intraepithelial neoplasia (CIN), a precancerous growth of cells in the cervix that is associated with human papillomavirus (HPV) infection. High-grade CIN can turn into invasive cervical cancer.

Other types of cancer

Less commonly, people with HIV/AIDS may develop the following cancers:

Hodgkin lymphoma, Angiosarcoma (which begins in the lining of the blood vessels), Anal cancer, Liver cancer, Mouth cancer and throat cancer, Lung cancer, Testicular cancer, Penile cancer, Colorectal cancer and Skin cancer (basal cell carcinoma, squamous cell carcinoma, and melanoma).

Two Ways to Beat Cancer: Healthy Living and Early Detection

You can lower your cancer risk a lot, and manage your HIV at the same time, by making healthy choices. Finding cancer in its early stages (early detection) and treating it right away can raise your chances of living longer with HIV. Cancer treatments can also be very hard on the immune systems of people with HIV. Education and Awareness must be part of cancer and HIV/AIDS management.

Healthy Living to Prevent Cancer

Quitting smoking is the biggest step to protecting yourself from cancer. If you quit smoking, you can greatly lower your risk of cancer of the mouth, throat, lungs, stomach, kidneys, liver, pancreas, and bladder. As soon as you stop smoking, your body starts to heal and your cancer risk drops. Ask your doctor about treatment and counseling to help you quit.

Take all your HIV medications on schedule. A stronger immune system is your best protection against many types of cancer. Take all your medications on schedule and try not to skip doses. HIV medications have helped to greatly reduce Kaposi’s Sarcoma.

Protect yourself and others from HIV and other viruses. HIV, HPV, hepatitis and herpes are passed through sex or sharing needles or other equipment used to inject drugs. Use a condom the right way every time you have sex. Never share needles or drug works.

Eat healthy foods. You can lower your risk of cancers of the breast, prostate, stomach, colon, and rectum with a healthy diet.

  • Fruits and vegetables have lots of minerals, vitamins and fiber. Try to eat them five times a day – as part of every meal and as snacks.
  • Eat whole wheat bread, pasta, rice, and beans.
  • Eat lean meats like chicken and fish and low-fat dairy products, such as skim milk and cottage cheese.
  • Cook with canola oil or olive oil instead of butter.
  • Try to get your vitamins and minerals from healthy foods – not from pills, drinks, and powders.
  • Talk with your doctor or a nutritionist about what foods are right for you.

Get plenty of exercise, stay at a healthy weight. Regular exercise can lower your risk of getting some types of cancer.

  • Try walking, jogging, or riding a bike four or five days a week. A lot of things can count as exercise – as long as you move your body on a regular basis.
  • Do something you enjoy. That will make it easier to stick with it.
  • People with HIV or AIDS sometimes have trouble keeping enough weight on. Ask your doctor about how to exercise enough and eat enough to stay at a healthy weight.

Avoid drugs and alcohol. Drugs are not a direct cancer risk, but they can hurt your immune system and make it harder to stay healthy with HIV. You can lower your risk of mouth, throat, liver, and breast cancer (in women) by not drinking alcohol. If you have chronic hepatitis C and liver disease, don’t drink at all.

Protect yourself from the sun. Wear sunscreen that is rated SPF 15 or higher. Wear a hat, sunglasses and clothing to protect you from the sun.

Finding cancer in its early stages (early detection)

Have regular medical check-ups. Talk with your doctor or health care provider about your cancer risk and problems to watch for. Ask about tests you can get even if you have no signs of cancer:

  • Cervical screening ( Liquid based cytology/Pap smear)for cervical cancer.
  • Mammogram for female breast cancer.
  • Colon/rectal exam and Colonoscopy for men and women from mid-40’s.
  • Prostate exam for men from mid-40’s.
  • Dental and Oral exam by a dentist every six months.

Know the warning signs of cancer and do self-exams. If you notice any of these warning signs, tell your doctor or dentist right away:

  • A sore that does not heal. Look for new growths on your skin or any changes in the size, color, or shape of moles or warts.
  • A lump or hardness in the skin, especially in female breasts and in the male testicles and groin area.
  • Oral exam: check the inside of your mouth, lips, gums, and tongue for sores, swelling or bleeding, white patches, scabs, or cracks.
  • Bleeding or loss of body fluids that is not normal.
  • Changes in your bowel or bladder habits.
  • A cough or a sore throat that lasts for a long time.
  • Heartburn or trouble swallowing that does not go away.

Staying Healthy and Preventing Cancer

HIV weakens the immune system and allows the growth of other viruses that can cause cancer. Scientists are working hard to figure out the links between HIV, other viruses, and cancer and to make medications that prevent and treat these diseases. In the meantime, do what you can to stay healthy and prevent cancer.

https://www.health.ny.gov/diseases/aids/consumers/hiv_basics/hiv_cancer.htm

https://www.health.ny.gov/diseases/aids/consumers/hiv_basics/hiv_cancer.htm

www.lakeshorecancercenter.org