Acquired immune deficiency syndrome (AIDS) is a disease of the immune system caused by infection with the human immunodeficiency virus (HIV). HIV is transmitted 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 immune system. And, when there are clinical symptoms and specific disease syndromes associated with it, the disease is called AIDS.
People with HIV/AIDS are at high risk for developing certain cancers, such as Kaposi's sarcoma, non-Hodgkin lymphoma, and cervical cancer (see below). In people with HIV, these cancers are often referred to as "AIDS-defining conditions," meaning the presence of one of these cancers in a person with HIV 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.
Kaposi's sarcoma
Kaposi's sarcoma is a rare type of skin cancer, which has traditionally occurred in older men of Jewish or Mediterranean descent, young men in Africa, or people who have received organ transplantation. Today, Kaposi's sarcoma is found most often in homosexual men with HIV/AIDS, with most cases related to an infection with the human herpesvirus 8 (HHV-8). Kaposi's sarcoma in people with HIV is often referred to as epidemic Kaposi's sarcoma.
HIV/AIDS-related Kaposi's sarcoma causes lesions to arise in multiple sites in the body, including the skin, lymph nodes, and organs such as the liver, spleen, lungs, and digestive tract. For more information, see the Cancer.Net Guide to Kaposis Sarcoma.
Non-Hodgkin lymphoma
Non-Hodgkin lymphoma is a cancer of the lymph system. The lymph system is made up of thin tubes that branch to all parts of the body. Its job is to fight infection and disease. The lymph system carries lymph, a colorless fluid containing white blood cells called lymphocytes. Lymphocytes fight germs in the body. Groups of bean-shaped organs called lymph nodes are located throughout the body at different sites in the lymph system. Lymph nodes are found in clusters in the abdomen, groin, pelvis, underarms, and neck. Other parts of the lymph system include the spleen, which makes lymphocytes and filters blood; the thymus, an organ under the breastbone; and the tonsils, located in the throat.
HIV/AIDS-related non-Hodgkin lymphoma is the second most common cancer associated with HIV/AIDS, after Kaposi's sarcoma, occurring in 4% to 10% of people with AIDS. The most common subtypes of non-Hodgkin lymphoma in people with HIV/AIDS are primary central nervous system lymphoma (affecting the brain and spinal fluid), primary effusion lymphoma (causing fluid to accumulate around the lungs or in the abdomen), or intermediate and high-grade lymphoma. More than 80% of lymphomas in people with HIV/AIDS are high-grade B-cell lymphoma, while only 10% to 15% of lymphomas among people with cancer who do not have HIV/AIDS are of this type. It is estimated that between 8% and 27% of cases of non-Hodgkin lymphoma are related to HIV/AIDS. For more information, see the Cancer.Net Guide to 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 are at a greater risk for developing cervical intraepithelial neoplasia (CIN), a precancerous growth of cells in the cervix. CIN occurs in 11% to 29% of women with HIV/AIDS, and may be associated with human papillomavirus (HPV) infection. High-grade CIN can turn into invasive cervical cancer, and women with AIDS are at higher risk for developing this type of cancer. For more information, see the Cancer.Net Guide to Cervical Cancer.
A risk factor is anything that increases a person's chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can 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 communicating them to your doctor may help you make more informed lifestyle and health-care choices.
The following factors can raise a person's risk of developing an HIV/AIDS-related cancer:
HPV infection. The human papillomavirus (HPV) can be passed from one person to another during sexual intercourse. Factors that raise the risk of being 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. This infection increases the risk of cervical cancer in women with HIV/AIDS.
HHV-8 infection. The human herpesvirus 8 (HHV-8) is related to other herpes viruses, such as the viruses that cause cold sores and genital herpes, as well as the Epstein-Barr virus (EBV, the virus that causes mononucleosis) and 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 primary effusion lymphoma and Kaposi's sarcoma (see Overview).
EBV infection. EBV is a herpes-related virus known to be associated with primary central nervous system lymphoma, high-grade B-cell lymphoma, and primary effusion lymphoma.
People with HIV/AIDS-related cancers often experience the following symptoms. Sometimes, people with HIV/AIDS-related cancers do not show any of these symptoms. Or, these symptoms may be similar to symptoms of other medical conditions. If you are concerned about a symptom on this list, please talk to your doctor.
Kaposi's sarcoma
Elevated purple, pink, or red lesions appearing anywhere on the skin, most commonly on the upper body, face, and mouth
Unexplained cough or chest pain
Unexplained stomach or intestinal pain
Unexplained bleeding from the mouth or rectum
Non-Hodgkin lymphoma
Swelling or lumps in the lymph nodes in the abdomen, groin, neck, or underarm
Fever that cannot be explained by an infection or other illness
Weight loss with no known cause
Sweating and chills
Headaches, seizures, or confusion
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
Doctors use many tests to diagnose cancer and determine 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. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer
Severity of 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:
Kaposi's sarcoma
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 from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).
X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs.
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. Sometimes, a contrast medium (a special dye) is injected into a patient's vein 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.
Endoscopy. This test allows the doctor to see the inside of the stomach. The patient is sedated, and the doctor inserts a thin, lighted tube called a gastroscope through the mouth, down the esophagus, and into the stomach. If abnormal areas are found, the doctor can remove a sample of tissue and check it for evidence of cancer. In a similar fashion, the doctor can examine the large intestine with a procedure called colonoscopy.
Bronchoscopy. In this procedure, the doctor passes a thin, flexible tube with a light on the end into 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 the diagnosis and treatment of lung disease). The tube lets the doctor see inside the lungs. Tiny tools inside the tube can gather samples of fluid and tissue and remove them, so the pathologist can examine the samples. Patients are given mild anesthesia (sedation) during a bronchoscopy.
Photography. Because multiple and scattered skin lesions can develop, doctors regularly photograph parts of the skin (called mapping) in order to determine whether new lesions have developed over time.
Non-Hodgkin lymphoma
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 from the biopsy is analyzed by a pathologist.
Blood tests. Many different blood tests provide information about the diagnosis of lymphoma, its effect on the body, and how the disease is responding to treatment.
Bone marrow aspiration and biopsy. Lymphoma often spreads to the bone marrow, the spongy material in the center of bones where blood cells are produced. Looking at a sample of the bone marrow can be important for doctors in the diagnosis of lymphoma and to determine if the cancer has spread. The most common site to biopsy the bone marrow is the back of the pelvic (hip) bone. The skin is numbed, and a needle is inserted into the bone in the hip until it reaches the marrow. A small amount is removed and examined under a microscope.
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. Sometimes, a contrast medium (a special dye) is injected into a vein to provide better detail. CT scans of the chest and abdomen can help find cancer that has spread to the lungs, lymph nodes, and liver.
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.
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 perform 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 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. The colposcope gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix.
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 from the biopsy is analyzed by a pathologist.
Staging is a way of describing where a cancer is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all 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's sarcoma
There is no officially accepted staging system for HIV/AIDS-related Kaposi's 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)
The spread of the disease or the presence of HIV/AIDS-related systemic illness (Systemic Illness, S)
Within each of the three components of the system, there are two subgroups: good risk (0, zero) or poor risk (1, one).
The five-year relative survival rate (the percentage of patients who survive at least five years after the cancer is detected, excluding those who die from other diseases) for people in the good-risk category in both the T and I factors is 80%. People in the poor-risk category in the T and I factors have a five-year relative survival rate of less than 10%. Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this 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 Kaposi's sarcoma. Because the survival statistics are measured in five-year (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this cancer.
Source of statistics: American Cancer Society
The following table has been adapted from the original developed by the ACTG to illustrate the TIS system.
Good Risk (0)
Poor Risk (1)
(Any of the following)
(Any of the following)
Tumor (T)
Confined to skin and/or lymph nodes and/or minimal oral disease (flat lesions confined to the palate or roof of the mouth)
Tumor-associated edema (fluid buildup) or ulceration
Extensive oral (mouth) Kaposi's sarcoma
Gastrointestinal Kaposi's sarcoma
Kaposi's 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
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 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, lymphoma)
*CD4 lymphocytes are a type of white blood cell that has a major regulatory role in the immune system. CD4 lymphocytes are infected with and destroyed by HIV; a CD4 count lower than 200 indicates that HIV has developed into AIDS.
**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 at the time of diagnosis, and doctors use a staging system called the Ann Arbor system. This is the same system that is used for non-HIV/AIDS-related non-Hodgkin lymphoma.
The stage of lymphoma describes the extent of spread of the tumor, using Roman numerals one through four (I, II, III, or IV).
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 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, with or without cancer in other lymph node regions on the same side of the diaphragm (stage IIE).
Stage III: Any of these conditions:
There is cancer in lymph node areas on both sides of the diaphragm (stage III).
There is involvement of an organ in the localized area (stage IIIE); involvement of the spleen, using the letter "S" (stage IIIS); or both (stage IIIES).
Stage IV: Lymphoma is called stage IV if there is a tumor in organs outside of the lymph node system (called disseminated involvement). Common sites are the liver, bone marrow, or lungs.
Cervical cancer
The staging of HIV/AIDS-related cervical cancer applies the same system used in women with cervical cancer who do not have HIV. For more information, see the Cancer.Net Guide to Cervical Cancer Staging.
The treatment of HIV/AIDS-related cancer depends on the size and location of the tumor, whether the cancer has spread, and the person's overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. It is often difficult to treat cancer in people with AIDS because of the increased risk of infections due to decreased white blood cell count and immune function caused by HIV.
Kaposi's sarcoma
The treatment of HIV/AIDS-related Kaposi's sarcoma usually cannot cure the cancer, but it can help relieve pain or other symptoms. Doctors will often try to treat the HIV/AIDS itself with antiretroviral treatments; recent advances in the treatment against HIV with highly active antiretroviral treatment (HAART) have produced good control of the virus in most patients. This can be followed by palliative care (care given to improve quality of life by treating symptoms and side effects of the cancer or its treatment) for Kaposi's sarcoma.
Surgery. The goal of surgery is to remove the lesion. It involves removing the lesion with the surrounding normal tissues. Surgery is most useful when the lesions are located in a single area or a few specific areas.
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 white scar. More than one freezing may be needed.
Photodynamic therapy. In photodynamic therapy, a light-sensitive substance is injected into the lesion and 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 uses high-energy rays to destroy cancer cells, and several treatments may be needed. Traditional external-beam radiation therapy delivers x-rays from a machine outside the body to the tumor and may be given as a palliative treatment. The treatment may produce a rash, make the skin dry or red, or change the color of the skin.
Chemotherapy. Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. This may help control advanced disease, although cure of HIV/AIDS-related Kaposi's sarcoma with chemotherapy is extremely rare. Usually, for HIV/AIDS-related Kaposi's sarcoma, chemotherapy is used to help relieve symptoms and to prolong life. The side effects of chemotherapy depend on the individual drug and the dose used, but can include fatigue, risk of infection, nausea and vomiting, and hair loss. These side effects usually go away once treatment is finished. Commonly used drugs are liposomal doxorubicin (Doxil), paclitaxel (Taxol), and vinorelebine (Navelbine).
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.
Intralesional injections. In this therapy, a form of chemotherapy (see above) is injected directly into the lesion in order to kill the cancer cells.
Immunotherapy. Immunotherapy is the use of substances (made by the body or created in a laboratory) to support or stimulate the body's own immune system to fight the cancer. Some people with HIV/AIDS-related Kaposi's sarcoma may be treated with alpha-interferon, which appears to work by altering the surface proteins of cancer cells and by slowing their growth. Immunotherapy is generally used in 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 a decreased white blood cell count and flu-like symptoms.
Non-Hodgkin lymphoma
The two main treatments of HIV/AIDS-related non-Hodgkin lymphoma are chemotherapy and radiation therapy.
Chemotherapy. Chemotherapy is the primary treatment for non-Hodgkin lymphoma. Chemotherapy may be given by mouth or injected into a vein. Chemotherapy attacks rapidly dividing cells, including those in normal tissues such as the hair, lining of the mouth, intestines, and bone marrow, and may cause people to lose their hair, develop mouth sores, or have nausea and vomiting. Chemotherapy may lower the body's resistance to infection, lead to bruising and bleeding, and cause fatigue. These side effects typically can be controlled during treatment and go away after chemotherapy is completed. Previously, chemotherapy treatment for HIV/AIDS-related non-Hodgkin lymphoma was given at lower doses due to the person's weakened immune system. However, with improving retroviral agents, patients with HIV/AIDS-related non-Hodgkin lymphoma are usually treated with the same doses of drugs given to people with lymphoma who do not have HIV. For more information, see the Cancer.Net Guide to Non-Hodgkin Lymphoma 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 you've been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.
Radiation therapy. Radiation therapy uses high-energy x-rays or other particles to kill cancer cells. For people with HIV/AIDS-related lymphoma, it may or may not be given along with chemotherapy. Because radiation therapy can damage healthy cells as well as cancer cells, patients may experience skin irritation, fatigue, upset stomach, and loose bowel movements. These side effects usually go away when treatment is finished.
Cervical cancer
Traditional therapies for women with the precancerous condition called CIN (see Overview) are generally not as effective in women with HIV/AIDS due to their weakened immune systems. Often, the standard therapies for HIV/AIDS can minimize the symptoms of CIN.
Women with invasive cervical cancer, and whose HIV/AIDS is well-controlled by medication, are generally treated similarly to women who do not have HIV/AIDS. For more information, see the Cancer.Net Guide to Cervical Cancer.
Doctors and scientists are always looking for better ways to treat patients with HIV/AIDS-related cancer. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are 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.
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 finding new drugs and other therapies is 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.
To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so 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. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
Cancer and cancer treatment can cause a variety of side effects; some are easily controlled and others require specialized care. Below are some of the side effects that are more common to HIV/AIDS-related cancer and its treatments. For more detailed information on managing these and other side effects of cancer and cancer treatment, visit the Cancer.Net Managing Side Effects section.
Anemia. Anemia is common in people with cancer, especially those receiving chemotherapy. Anemia is an abnormally low level of red blood cells (RBCs). RBCs contain hemoglobin (an iron protein) that carries oxygen to all parts of the body. If the level of RBCs is too low, parts of the body do not get enough oxygen and cannot work properly. Most people with anemia feel tired or weak. The fatigue (tiredness) associated with anemia can seriously affect quality of life and make it more difficult for patients to cope with cancer and treatment side effects.
Diarrhea. Diarrhea is frequent, loose, or watery bowel movements. It is a common side effect of certain chemotherapeutic drugs or of radiation therapy to the pelvis, such as in women with uterine, cervical, or ovarian cancers. It can also be caused by certain tumors, such as pancreatic cancer.
Fatigue. Fatigue is extreme exhaustion or tiredness, and is the most common problem that people with cancer experience. More than half of patients experience fatigue during chemotherapy or radiation therapy, and up to 70% of patients with advanced cancer experience fatigue. Patients who feel fatigue often say that even a small effort, such as walking across a room, can seem like too much. Fatigue can seriously impact family and other daily activities, can make patients avoid or skip cancer treatments, and may even impact the will to live.
Hair loss (alopecia). A potential side effect of radiation therapy and chemotherapy is hair loss. Radiation therapy and chemotherapy cause hair loss by damaging the hair follicles responsible for hair growth. Hair loss may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area. The hair may fall out entirely, gradually, or in sections. In some cases, the hair will simply thin-sometimes unnoticeably-and may become duller and dryer. Losing one's hair can be a psychologically and emotionally challenging experience and can affect a patient's self-image and quality of life. However, the hair loss is usually temporary, and the hair often grows back.
Infection. An infection occurs when harmful bacteria, viruses, or fungi (such as yeast) invade the body and the immune system is not able to destroy them quickly enough. Patients with cancer are more likely to develop infections because both cancer and cancer treatments (particularly chemotherapy and radiation therapy to the bones or extensive areas of the body) can weaken the immune system. Symptoms of infection include fever (temperature of 100.5°F or higher); chills or sweating; sore throat or sores in the mouth; abdominal pain; pain or burning when urinating or frequent urination; diarrhea or sores around the anus; cough or breathlessness; redness, swelling, or pain, particularly around a cut or wound; and unusual vaginal discharge or itching.
Nausea and vomiting. Vomiting, also called emesis or throwing up, is the act of expelling the contents of the stomach through the mouth. It is a natural way for the body to rid itself of harmful substances. Nausea is the urge to vomit. Nausea and vomiting are common in patients receiving chemotherapy for cancer and in some patients receiving radiation therapy. Many patients with cancer say they fear nausea and vomiting more than any other side effects of treatment. When it is minor and treated quickly, nausea and vomiting can be quite uncomfortable but cause no serious problems. Persistent vomiting can cause dehydration, electrolyte imbalance, weight loss, depression, and avoidance of chemotherapy.
Skin problems. The skin is an organ system that contains many nerves. Because of this, skin problems can be very painful. Because the skin is on the outside of the body and visible to others, many patients find skin problems especially difficult to cope with. Because the skin protects the inside of the body from infection, skin problems can often lead to other serious problems. As with other side effects, prevention or early treatment is best. In other cases, treatment and wound care can often improve pain and quality of life. Skin problems can have many different causes, including chemotherapeutic drugs leaking out of the intravenous (IV) tube, which can cause pain or burning; peeling or burned skin caused by radiation therapy; pressure ulcers (bed sores) caused by constant pressure on one area of the body; and pruritus (itching) in patients with cancer, most often caused by leukemia, lymphoma, myeloma, or other cancers.
After cancer treatment is complete, talk with your doctor about developing a follow-up care plan. This plan should include regular physical examinations, blood tests, and possibly scans or other imaging studies 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 infectious disease doctors.
For Kaposi's sarcoma, there is no treatment available to fully eliminate the disease. Therefore, patients should be continuously monitored for symptoms and, as the need arises, treated palliatively with multiple approaches (see Treatment).
Research involving more advanced diagnostic procedures and treatment for HIV/AIDS-related cancer is ongoing. The following treatments may still be under investigation in clinical trials and may not be approved or available at this current time. Always discuss all diagnostic and treatment options with your doctor.
Combination therapies. Clinical trials are currently underway to study the effects of chemotherapy plus colony-stimulating factors and antiretroviral therapy. Other investigations are evaluating the benefit of adding a monoclonal antibody called rituximab (Rituxan) to combination chemotherapy in HIV/AIDS-related lymphoma. There are also trials studying the effect of high-dose therapy with stem cell transplantation.
Recent advances in the understanding of the biology of HIV/AIDS-related Kaposi's sarcoma have suggested new treatments. Anti-angiogenesis agents, vitamin D and similar products, and imatinib mesylate (Gleevec) are now being tested in clinical trials.
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
General questions:
What is my diagnosis, and what does this mean?
What are my treatment options?
What treatment do you recommend?
What is the goal of this treatment?
What clinical trials are open to me?
How can my HIV infection be treated during cancer treatment?
For people who need surgery:
What are the side effects of my surgery?
Will I need to stay in the hospital for this surgery? For how long?
For people who need chemotherapy:
What kind of chemotherapy will I receive?
What does the preparation for this treatment involve?
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?
What does the preparation for this treatment involve?
What side effects can I expect from this treatment?
What can be done to relieve the side effects?
After treatment:
What follow-up tests do I need, and how often do I need them?
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