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HIV and AIDS-Related Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find some basic information about these diseases and the parts of the body they may affect. This is the first page of Cancer.Net’s Guide to HIV/AIDS-Related Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

About HIV/AIDS

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.

About HIV/AIDS-related cancer

People with HIV/AIDS have a high risk of developing certain cancers, such as Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer (see below). For people with HIV, these three cancers are often called “AIDS-defining conditions,” meaning that if a person with an HIV infection has one of these cancers it can signify the development of AIDS.

The connection between HIV/AIDS and certain cancers is not completely understood, but the link likely depends on a weakened immune system. Most types of cancer begin when normal cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). The types of cancer most common for people with HIV/AIDS are described in more detail below.

Kaposi sarcoma

Kaposi sarcoma is a type of skin cancer 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 found most often 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 often called epidemic Kaposi sarcoma.

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

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) is a cancer of the lymphatic system. Lymphoma begins when cells in the lymphatic system change and grow uncontrollably, 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; and the tonsils, located in the throat.

There are many different subtypes of NHL. The most common subtypes of NHL in people with HIV/AIDS are primary central nervous system lymphoma (affecting the brain and spinal fluid), primary effusion lymphoma (causing fluid to build up around the lungs or in the abdomen), or intermediate and high-grade lymphoma. Learn more about non-Hodgkin lymphoma.

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. Learn more about cervical cancer.

Other types of cancer

Other, less common types of cancer that may develop in people with HIV/AIDS are Hodgkin lymphoma, angiosarcoma (a type of cancer that begins in the lining of the blood vessels), anal cancer, liver cancermouth cancer, throat cancer, lung cancer, testicular cancer, colorectal cancer, and types of skin cancer including basal cell carcinoma, squamous cell carcinoma, and melanoma.

Looking for More of an Overview?

If you would like additional introductory information about sarcoma, NHL, and cervical cancer, explore these related items. Please note these links take you to other sections on Cancer.Net:

  • ASCO Answers Fact Sheet: Read one-page fact sheets (available in PDF) that offer an easy-to-print introduction to these types of cancer.

To continue reading this guide, use the menu on the side of your screen to select another section.  

HIV and AIDS-Related Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find information about how many people learn they have an HIV/AIDS-related cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

Kaposi sarcoma is the most common HIV/AIDS-related cancer, and it is more common in men than women. Due to improved HIV treatment, Kaposi sarcoma rates have decreased, with about 6 new cases per million people in the United States each year. Better treatments have also improved survival rates for people with Kaposi sarcoma. The five-year survival rate is the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases. When HIV and AIDS first became widespread, the five-year survival rate of people with Kaposi sarcoma was less than 10%. Now the most recent data from the National Cancer Institute shows five-year survival rates of about 68%. Often people with Kaposi sarcoma die from other diseases related to HIV and AIDS, not Kaposi sarcoma.

NHL is the second most common cancer associated with HIV/AIDS. About 57% of people diagnosed with NHL have already been diagnosed with AIDS; however, 30% of people are diagnosed with NHL and AIDS at the same time. People with HIV/AIDS are also much more likely to develop central nervous system lymphoma than people without HIV/AIDS. Primary central nervous system lymphoma accounts for 20% of all NHL cases in people with AIDS. For people with NHL and HIV/AIDS, the chance of recover depends on a number of factors, including the stage of the lymphoma, the person’s age, the strength of the person’s immune system, and his or her health history.

Women with HIV/AIDS have a high risk of developing cervical intraepithelial neoplasia (CIN). Over time, CIN can eventually become invasive cervical cancer.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of each type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with HIV/AIDS-related cancer. Because the survival statistics are measured in multi-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the National Cancer Institute and the American Cancer Society.

To continue reading this guide, use the menu on the side of your screen to select another section.

HIV and AIDS-Related Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find out more about factors that increase the chance of developing an HIV/AIDS-related cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing an HIV/AIDS-related cancer:

Human papillomavirus infection. Research indicates that infection with this virus is a risk factor for cervical cancer. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of cancers. Factors that raise the risk of becoming infected with HPV include becoming sexually active at an early age, having many partners (or having sex with a person who has had many partners), and having sex with a man who has penile warts. HPV vaccines protect against certain strains of the virus.

HHV-8 infection. HHV-8 is related to other herpes viruses, such as the viruses that cause cold sores and genital herpes, as well as cytomegalovirus (CMV). Other herpes viruses, however, are not the same as HHV-8 and are not thought to be risk factors for cancer. HHV-8 infection is associated with Kaposi sarcoma and primary effusion lymphoma (see Overview).

Epstein Barr virus (EBV) infection. EBV is a herpes-related virus that causes mononucleosis. It is also associated with primary central nervous system lymphoma, high-grade B-cell lymphoma, and primary effusion lymphoma.

Research continues to look into the factors that cause an HIV/AIDS-related cancer and what people can do to lower their personal risk. There is no proven way to completely prevent these cancers, but there may be steps you can take to lower your cancer risk. Talk with your doctor if you have concerns about your personal risk of developing cancer.

To continue reading this guide, use the menu on the side of your screen to select another section.  

HIV and AIDS-Related Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with an HIV/AIDS-related cancer may experience the following symptoms or signs. Sometimes, people with an HIV/AIDS-related cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor.

Kaposi sarcoma

  • Slightly elevated purple, pink, brown, or red lesions in the mouth and/or throat or anywhere on the skin, most commonly on the upper body and face.
  • Lymphedema (swelling caused by blockage of the lymphatic system, often in an arm or leg)
  • Unexplained cough or chest pain
  • Unexplained stomach or intestinal pain
  • Unexplained bleeding from the mouth or rectum
  • Diarrhea and/or blockage of the digestive tract, caused by Kaposi sarcoma lesions that have developed in the gastrointestinal system

Non-Hodgkin lymphoma

The symptoms of NHL depend on where the cancer began and the organ that is involved.

General symptoms:

  • Enlarged lymph nodes in the abdomen, groin, neck, or underarms
  • Enlarged spleen or liver
  • Fever that cannot be explained by an infection or other illness
  • Weight loss with no known cause
  • Sweating and chills

Examples of symptoms related to tumor location:

  • A tumor in the abdomen can cause a distended (stretched) belly or pain.
  • A tumor in the center of the chest can press on the windpipe and cause difficulty breathing or other respiratory problems.
  • A tumor in the brain can cause headaches, seizures, or changes in vision and memory

Cervical cancer

  • Bloody spots or light bleeding between or following menstrual periods
  • Menstrual bleeding that is longer and heavier than usual
  • Bleeding after sexual intercourse, douching, or a pelvic examination
  • Pain during sexual intercourse
  • Bleeding after menopause
  • Increased vaginal discharge

Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often.

If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.

HIV and AIDS-Related Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out 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. This list describes options for diagnosing an HIV/AIDS-related cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and 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. A CT scan can also be used to measure the tumor’s size. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein or given orally (by mouth) 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 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 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 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 lung disease). Tiny tools inside the tube can collect samples of fluid and tissue, so the pathologist can examine the samples.

X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation.

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

Non-Hodgkin Lymphoma

Blood tests. Many different blood tests provide information about a lymphoma diagnosis, the disease’s effect on the body, and how well treatment is working.

Bone marrow aspiration and biopsy. Lymphoma often spreads to the bone marrow, and looking at a sample of the bone marrow can be important for doctors to diagnose lymphoma and to find out if it has spread. A bone marrow biopsy and aspiration are similar procedures and often done at the same time. Bone marrow has both a solid and a liquid part. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle. An aspiration removes a sample of fluid with a needle. The sample(s) are then analyzed by a pathologist. A common site for a bone marrow biopsy and aspiration is the pelvic bone, which is located in the lower back by the hip. The skin in that area is usually numbed with medication beforehand, and other types of anesthesia (medication to block the awareness of pain) may be used.

Molecular testing of the lymphoma cells. Your doctor may recommend running laboratory tests on a sample of the lymphoma cells to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy (see Treatment).

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 or given orally 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 sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. The exact accuracy and role of PET scanning in NHL is not yet clear, although aggressive subtypes of lymphoma often show up on PET scans. Many oncologists will recommend a PET scan as part of the initial evaluation, especially for the types of lymphoma that are more likely to grow quickly. A PET scan may also help doctors monitor how well treatment is working. There is some evidence that using a PET scan after one or two cycles of treatment may be a useful way to predict if that treatment is likely to completely get rid of the lymphoma. This is not yet proven, but it is being evaluated in many research studies.

Cervical Cancer

Pap test. The doctor gently scrapes the outside of the cervix and vagina and takes samples of the cells for testing.

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.

After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.

HIV and AIDS-Related Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancers.

Kaposi sarcoma

There is no officially accepted staging system for HIV/AIDS-related Kaposi sarcoma, although in 1988 the AIDS Clinical Trials Group (ACTG) developed a staging system called the TIS system. The ACTG is the largest HIV clinical trials organization in the world and is funded by the National Institutes of Health. The TIS system evaluates:

  • The size of the tumor (Tumor, T)
  • The status of the immune system, which is measured by the number of a type of white blood cell, called a CD4 cell (Immune System, I).CD4 lymphocytes are a type of white blood cell that have a major regulatory role in the immune system. CD4 lymphocytes are infected with and destroyed by HIV.
  • The spread of the disease or the presence of HIV/AIDS-related systemic (whole body) illness (Systemic Illness, S)

Within each of the three parts of the system, there are two subgroups: good risk (0, zero) or poor risk (1, one).

The following table has been adapted from the original developed by the ACTG to show the TIS system.

 

 

Good Risk (0)  

Poor Risk (1)  

 

(Any of the following)

(Any of the following)

Tumor (T)

Only located on the skin and/or in the lymph nodes and/or minimal oral disease (flat lesions located only on the palate or roof of the mouth) 

Tumor-associated edema (fluid buildup) or ulceration (break in the surface of    the skin)

Extensive oral (mouth) Kaposi sarcoma

Gastrointestinal Kaposi sarcoma

Kaposi sarcoma in other organs in the body

Immune system (I)

CD4 cell count is 200 or more cells per cubic millimeter

CD4 cell count is less than 200 cells per cubic millimeter; a CD4 count lower than 200 indicates that HIV has developed into AIDS

Systemic illness (S)

No systemic illness present

History of systemic illness and/or thrush

No “B” symptoms (Note: “B” symptoms are unexplained fever, night sweats, greater than 10% involuntary weight loss, or diarrhea persisting more than 2 weeks.)

One or more “B” symptoms are present

A Karnofsky performance status score of 70 or higher (The Karnofsky Performance Status scale [see below] measures the ability of people with cancer to perform ordinary tasks. A score of 70 means that a person can take care of himself or herself, but is unable to carry on normal activity or active work.)

A Karnofsky performance status of less than 70

Other HIV-related illness is present (for example, neurological disease or lymphoma)

Karnofsky Performance Score Function

100      Normal, no evidence of disease

90        Able to perform normal activity with only minor symptoms

80        Normal activity with effort, some symptoms

70        Able to care for self, but unable to do normal activities

60        Requires occasional assistance, cares for most needs

50        Requires considerable assistance

40        Disabled, requires special assistance

30        Severely disabled

20        Very sick, requires active supportive treatment

10        Moribund (dying; at the point of death)

0          Dead

Non-Hodgkin lymphoma

Generally, people with HIV/AIDS-related non-Hodgkin lymphoma have advanced disease when they are first diagnosed, and doctors use a staging system called the Ann Arbor system. This is the same system that is used for non-Hodgkin lymphoma in people who do not have HIV/AIDS.

The stage of lymphoma describes how much the tumor has spread. There are four stages: stages I through IV (one through four).

Stage I: Either one of these conditions:

  • The cancer is found in one lymph node region (stage I).
  • The cancer has invaded one extralymphatic organ (organ outside of the lymph node system) or site (identified using the letter “E”) but not any lymph node regions (stage IE).

Stage II: Either one of these conditions:

  • The cancer is in two or more lymph node regions on the same side of the diaphragm (stage II).
  • The cancer involves a single organ and its regional lymph nodes (lymph nodes near the site of the cancer), with or without cancer in other lymph node regions on the same side of the diaphragm (stage IIE).

Stage III: There is cancer in lymph node areas on both sides of the diaphragm (stage III). There may also be involvement of an organ other than the lymph nodes (stage IIIE); the spleen, using the letter “S” (stage IIIS); or both (stage IIIES).

Stage IV: Lymphoma is called stage IV if it has spread throughout the organs beyond the lymph nodes. Common sites for spread are the liver, bone marrow, or lungs.

Progressive: The disease is called progressive if the cancer becomes larger or spreads while the patient is receiving treatment for the original lymphoma. This is also called refractory NHL.

Recurrent: Recurrent lymphoma is lymphoma that has come back after treatment. It may return in the area where it first started or in another part of the body. Recurrence may occur shortly after the first treatment or years later. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Cervical cancer

The staging of HIV/AIDS-related cervical cancer is the same system used for women with cervical cancer who do not have HIV. Doctors look at three factors to determine the stage of cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four).

Stage 0: The tumor is called carcinoma in situ. In other words, the cancer is found only in the first layer of cells lining the cervix, not in the deeper tissues. Carcinoma in situ is not considered an invasive cancer.

Stage I: The cancer has spread from the cervix lining into the deeper tissue but is still just found in the uterus. It has not spread to lymph nodes or other parts of the body.

Stage II: The cancer has spread beyond the cervix to nearby areas, such as the vagina or tissue near the cervix, but it is still inside the pelvic area. It has not spread to lymph nodes or other parts of the body.

Stage III: The cancer has spread outside of the cervix and vagina but not to the lymph nodes or other parts of the body.

Stage IVa: The cancer has spread to the bladder or rectum and may or may not have spread to the lymph nodes, but it has not spread to other parts of the body.

Stage IVb: The cancer has spread to other parts of the body.

Recurrent: Recurrent cancer is cancer that has come back after treatment. It may come back in the cervix or in another part of the body. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Learn more about cervical cancer staging.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010), published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.

HIV and AIDS-Related Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will learn about the different ways doctors use to treat each of the most common types of HIV/AIDS-related cancers. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for these types of cancer. When making treatment decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatment. This is called a multidisciplinary team.

Descriptions of the most common treatments for HIV/AIDS-related cancers are listed below, outlined by the specific type of cancer. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment.

It is often difficult to treat cancer in people with AIDS because of the increased risk of infections from lower levels of white blood cells and poorer immune function caused by HIV. However, doctors and researchers are always looking for better treatments, and recent research has resulted in medical advances.

Learn more about making treatment decisions.

Getting care for symptoms and side effects. Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.

Antiviral treatment. It is extremely important that all patients with HIV/AIDS and associated cancers receive treatment with highly active antiretroviral treatment (HAART) both during the cancer treatments and afterwards. HAART can effectively control the virus in most patients. Better control of the HIV infection decreases the side effects of many of the treatments, may decrease the chance of a recurrence and can improve a patient’s chance of recovery from the cancer.

Kaposi Sarcoma

The treatment of HIV/AIDS-related Kaposi sarcoma usually cannot cure the cancer, but it can help relieve pain or other symptoms. This can be followed by palliative care for Kaposi sarcoma. Antiviral treatment for HIV/AIDS helps reduce a person’s chance of getting Kaposi sarcoma and can reduce the severity of Kaposi sarcoma. HAART helps treat the tumor and reduce the symptoms associated with Kaposi sarcoma for people with HIV/AIDS. It is usually used before other treatments, such as chemotherapy (see below).

Surgery

Surgery is the removal of the tumor or lesion and surrounding tissue (called a margin) during an operation. Surgery may be performed by a surgical oncologist, a doctor who specializes in treating cancer using surgery. Surgery is most useful when the lesions are located in a single area or a few specific areas. Two types of surgical procedures used for Kaposi sarcoma are described below. 

Curettage and electrodesiccation. In this procedure, the cancer is removed with a curette, a sharp, spoon-shaped instrument. The area can then be treated with electrodesiccation, which uses an electric current to control bleeding and kill any remaining cancer cells. Many patients have a flat, pale scar from this procedure.

Cryosurgery. Cryosurgery, also called cryotherapy or cryoablation, uses liquid nitrogen to freeze and kill cells. The skin will later blister and slough off (shed off). This procedure will sometimes leave a pale scar. More than one freezing may be needed.

Learn more about cancer surgery.

Photodynamic therapy

In photodynamic therapy, a light-sensitive substance is injected into the lesion that stays longer in cancer cells than in normal cells. A laser is directed at the lesion to destroy the cancer cells.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy. External-beam radiation therapy may be given as a palliative treatment. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

Chemotherapy may help control advanced disease, although curing HIV/AIDS-related Kaposi sarcoma with chemotherapy is extremely rare. Usually, for HIV/AIDS-related Kaposi sarcoma, chemotherapy is used to help relieve symptoms and to lengthen a patient’s life. Commonly used drugs are liposomal doxorubicin (Doxil), paclitaxel (Taxol), and vinorelbine (Navelbine, Alocrest). Sometimes, chemotherapy is injected directly into the lesion to kill the cancer cells, called an intralesional injection.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Immunotherapy

Immunotherapy (also called biologic therapy) is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Some people with HIV/AIDS-related Kaposi sarcoma may receive alpha-interferon, which appears to work by changing the surface proteins of cancer cells and by slowing their growth. Immunotherapy is generally used for people who are in the good-risk category in the immune system (I) factor of the TIS staging system (see Staging). The most common side effects of alpha-interferon are low levels of white blood cells and flu-like symptoms. Learn more about immunotherapy.

Learn more about the treatment options for Kaposi sarcoma.

Non-Hodgkin Lymphoma

The main treatments for HIV/AIDS-related non-Hodgkin lymphoma are chemotherapy, targeted therapy, and radiation therapy.

Chemotherapy. Chemotherapy is the most common treatment for non-Hodgkin lymphoma. It may be given by mouth or injected into a vein. Previously, chemotherapy treatment for HIV/AIDS-related non-Hodgkin lymphoma was given at lower doses because of the person’s weakened immune system. Now, with better antiretroviral treatment, patients with HIV/AIDS-related non-Hodgkin lymphoma can usually receive the same doses of drugs given to people with lymphoma who do not have HIV.

Targeted therapy. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells.

Recent studies show that not all cancers have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors involved in your cancer. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about targeted therapy.

For non-Hodgkin lymphoma, rituximab (Rituxan), a type of targeted therapy called a monoclonal antibody, may be used. A monoclonal antibody is directed against a specific protein in the cancer cells and it does not affect cells that don’t have that protein. Specifically, rituximab targets B lymphocytes and is used together with chemotherapy for most patients. Talk with your doctor about possible side effects for a specific medication and how they can be managed.

Radiation therapy. For people with HIV/AIDS-related lymphoma, radiation therapy may be given along with chemotherapy.

Learn more about treatment for non-Hodgkin lymphoma.

Cervical Cancer

Treatments for women with the precancerous condition called CIN (see Overview) are generally not as effective for women with HIV/AIDS because of a weakened immune system. Often, the standard treatment for HIV/AIDS can lower the symptoms of CIN.

Women with invasive cervical cancer, and whose HIV/AIDS is well-controlled with medication, generally receive the same treatments as women who do not have HIV/AIDS. Common treatment options include surgery, radiation therapy, and chemotherapy. Learn more about cervical cancer treatment.

For All HIV/AIDS-Related Cancers

Recurrent cancer

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the cancer’s stage has changed. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat the specific type of recurrent cancer.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

Metastatic cancer

If cancer has spread to another location in the body, it is called metastatic cancer.

Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Your health care team may recommend a treatment plan that includes a combination of the treatments discussed above. Supportive care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and bereavement.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.

HIV and AIDS-Related Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with HIV/AIDS-related cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating HIV/AIDS-related cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with HIV/AIDS-related cancer.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for HIV/AIDS-related cancers, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.

HIV and AIDS-Related Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will read about the scientific research being done now to learn more about HIV/AIDS-related cancers and how to treat them. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about HIV/AIDS-related cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with these diseases. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Combination therapies. Clinical trials are underway to study the effects of chemotherapy plus colony-stimulating factors (substances that help the body make white blood cells) and antiretroviral therapy. The effect of high-dose therapy with stem cell transplantation is also being tested in clinical trials.

New therapies. Based on advances in understanding the biology of HIV/AIDS-related Kaposi sarcoma, anti-angiogenesis drugs (drugs that block the formation of new blood vessels that are needed for a tumor to grow and spread), vitamin D and similar products, and a targeted therapy called imatinib (Gleevec) are being tested in clinical trials.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current cancer treatments in order to improve patients’ comfort and quality of life.

Looking for More about the Latest Research?

If you would like additional information about the latest areas of research regarding Kaposi sarcoma, NHL, and cervical cancer, explore these related items that take you outside of this guide:

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.

HIV and AIDS-Related Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for an HIV/AIDS-related cancer are described in detail within the Treatment section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the type of cancer, the stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with cancer. Learn more about caregiving.

In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.

HIV and AIDS-Related Cancer - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery in the coming months and years. Because HIV/AIDS cannot be cured at this time, patients need to be continuously treated with HAART by doctors who specialize in HIV/AIDS treatment.

For Kaposi sarcoma, there is no treatment available to cure the disease. Therefore, patients should be monitored for symptoms throughout their life and any symptoms should be managed with more than one treatment (see Treatment).

For HIV/AIDS-related non-Hodgkin lymphoma and cervical cancer, patients should receive the same type of follow-up care as people who do not have HIV. Learn more about what to expect after treatment for non-Hodgkin lymphoma and cervical cancer.

ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

People recovering from an HIV/AIDS-related cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.

HIV and AIDS-Related Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

General questions:

  • What is my diagnosis? What does this mean?
  • Can you explain my pathology report (laboratory test results) to me?
  • What are my treatment options?
  • What clinical trials are open to me?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?
  • What are the possible side effects of this treatment, both in the short term and the long term?
  • How can my HIV infection be managed during cancer treatment?
  • How will the cancer treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • Could this treatment plan affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?
  • If I’m worried about managing the costs related to my medical care, who can help me with these concerns?
  • Whom should I call for questions or problems?

For people who need surgery:

  • What are the possible side effects of surgery?
  • Will I need to stay in the hospital for this surgery? For how long?
  • When can I expect to recover from surgery?

For people who need chemotherapy, immunotherapy, or targeted therapy:

  • What type of therapy or medications will I receive?
  • How do I prepare for this treatment?
  • What side effects can I expect from this treatment?
  • What can be done to relieve the side effects?

For people who need radiation therapy:

  • What kind of radiation therapy will I receive? How often will I receive this treatment?
  • How do I prepare for this treatment?
  • What side effects can I expect from this treatment?
  • What can be done to relieve the side effects?

After treatment:

  • What follow-up tests will I need, and how often will I need them?
  • What are the chances that the cancer will return?
  • What support services are available to me? To my family?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.

HIV and AIDS-Related Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2013

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to HIV/AIDS-Related Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

This is the end of Cancer.Net’s Guide to HIV/AIDS-Related Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.