world cancer report - iarc

TUMOURS ASSOCIATED WITH
HIV/AIDS
Approximately 30-40% of patients with
HIV infection are likely to develop malignancies.
Kaposi sarcoma is the most common
malignancy in patients with HIV infection.
Since no current therapies have proven
curative, both delivery of effective treatment
and maintenance of adequate control
of HIV and other infections remain the
goals of current treatment. Several studies
have shown benefits of highly active
anti-retroviral treatment (HAART) on
Kaposi sarcoma lesions. HAART might be
a useful alternative both to immune
response modifiers during less aggressive
stages of this disease and to systemic
cytotoxic drugs in the long term
maintenance therapy of advanced Kaposi
sarcoma (Tavio M et al., Ann Oncol, 9: 923,
1998; Tirelli U and Bernardi D, Eur J
Cancer, 37: 1320-24, 2001). Liposomal
anthracyclines are considered the standard
treatment for patients with
advanced stages of AIDS-related Kaposi
sarcoma. Concomitant use of both HAART
and haematological growth factors is
needed, with the aim of reducing opportunistic
infections and myelotoxicity.
Non-Hodgkin lymphoma in patients with
HIV infection is about two hundred-fold
more frequent than expected. One feature
of AIDS-non-Hodgkin lymphoma is the
widespread extent of the disease at initial
presentation and the frequency of systemic
B-symptoms (general symptoms
such as night sweats, weight loss, temperature
change). Whether intensive or
conservative chemotherapy regimens are
appropriate is still a matter of controver-
alter gastric acid secretion, elevating gastric
pH, changing the gastric flora and
allowing anaerobic bacteria to colonize
the stomach. These bacteria produce
60 The causes of cancer
sy. In fact, the poor bone marrow reserve
and underlying HIV immunodeficiency
make the management of systemic non-
Hodgkin lymphoma very difficult. Intensive
chemotherapy regimens may be given to
low or intermediate risk category patients
and conservative chemotherapy regimens
to high or poor risk patients (Spina M et al.,
Ann Oncol, 10: 1271-1286, 1999). The prognosis
of AIDS-non-Hodgkin lymphoma is
very poor.
Hodgkin disease in patients with AIDS carries
a relative risk much lower than that for
non-Hodgkin lymphoma but the histological
subtypes tend to be those with
unfavourable prognosis and the response
rate remains poorer than that of the general
population. Outcome may be improved
by an optimal combination of anti-neoplastic
and HAART to improve control of the
underlying HIV infection. The inclusion of
growth factors may allow the use of higher
doses of the drugs (Vaccher E et al., Eur J
Cancer, 37: 1306-15, 2001)
Cervical intraepithelial neoplasia (CIN) has
been increasingly diagnosed in HIV-infected
women; invasive cervical cancer is currently
an AIDS-defining condition. CIN in
HIV-infected women is associated with high
grade histology, more extensive and/or
multifocal disease and disseminated lower
genital tract HPV-related lesions
(Mandelblatt JS et al., AIDS, 6: 173-178,
1992; Robinson W 3 rd, Semin Oncol, 27:
463-470, 2000). Therapeutic recommendations
are the same as for non-HIV-infected
women, because most HIV-infected women
will die from cervical cancer rather than
other AIDS-related diseases.
Testicular cancer appears to be more frequent
in HIV-seropositive homosexual men
but the risk is not directly related to the
active reductase enzymes that transform
food nitrate into nitrite, an active molecule
capable of reacting with amines, amides
and ureas to produce carcinogenic
Fig. 2.51 Kaposi sarcoma of the skin in a patient
with AIDS. The biopsy (below) reveals the presence
of human herpes virus 8 (HHV-8) in tumour
cell nuclei, demonstrated by immunohistochemistry
(brown colour). Affected individuals are uniformly
co-infected with HIV and HHV-8.
level of immune deficiency. Patients with
HIV infection are offered the standard
chemotherapy, since the majority can be
cured of their tumour and have a good
quality of life (Bernardi D et al., J Clin
Oncol, 13, 2705-2711, 1995).
The spectrum of cancers in patients with
HIV infection may further increase as
these patients survive longer. Based on
advances in current understanding of HIV
viral dynamics and the availability of
newer anti-retroviral therapies, continuation
of HAART with prophylaxis against
opportunistic infections in patients
receiving chemotherapy may significantly
improve treatment outcome.
N-nitroso compounds. H. pylori acts as a
gastric pathogen and thereby mediates a
carcinogenic outcome involving soluble
bacterial products and the inflammatory