Cancers

Anal Cancer

Anal cancer is on the rise, in men as well as women. It is also tied to specific strains of HPV. An anal Pap smear and physical examination are the best ways to detect anal dysplasia. It is important to ask your health care provider to perform these tests on a regular basis. Because some of the same strains of HPV that cause cervical cancer can cause anal cancer, getting vaccinated with one of the two FDA-approved HPV vaccines can help to prevent anal cancer, too.

Symptoms

• Anal bleeding or discharge
• Itching, pain, or pressure in the anal area
• A lump or swelling in the anal area
• Changes to bowel movements, including changes to the diameter of stool

Diagnosis

Anal pap smear

• Anal pap smears check for changes to the anus; some experts recommend that HIV+ people receive regular anal pap smears
• Your provider may also perform a digital rectal exam (DRE). During this test, the provider inserts a gloved finger with lube into the anus to feel for lumps or abnormalities.

Anoscopy

• If you have an abnormal anal Pap, you may need a anoscopy (an exam of your anus using a microscope to look at the tissue more closely)
• During the anoscopy, your health care provider may remove a tissue sample (biopsy) for laboratory examination to determine if the abnormal cells are cancerous

Treatment for Dysplasia or Cancer That Is Very Localized

• Infrared coagulation (IFC): Using short bursts of infrared light to cut off the blood supply to the affected area
• Laser therapy: Using an intense light to destroy the cells
• Electrocautery: Burning off the cells with an electrical current
• Trichloracetic acid: Burning off the cells with acid
• Surgery

Treatment for Anal Cancer

• Chemotherapy with radiation

Liver Cancer

The increased risk for liver cancer among HIV+ people is strongly linked to infection with the hepatitis B and/or hepatitis Cviruses (HBV and HCV, respectively). Researchers have also shown a direct link between having a low CD4 cell count and having an increased risk for liver cancer. Other factors involved in damaging the liver include opportunistic infections (e.g., Mycobacterium avium complex, tuberculosis, cytomegalovirus, and cryptosporidiosis), excessive alcohol and recreational drug use, and even some HIV drugs.

Symptoms

• Many people have no symptoms until the disease is very advanced
• Weight loss
• Nausea and vomiting
• Upper belly pain
• Loss of appetite
• White, chalky stool
• Swelling of the belly
• Jaundice (yellowing of the eyes and/or skin)

Diagnosis

• Blood tests to check liver function
• Imaging tests (e.g., CT scan, ultrasound, MRI) to look for masses
• Biopsy: removing a tissue sample by inserting a needle through the skin and into the liver

Treatment

Depending on the size, type, and location of the liver cancer, your provider will suggest treatment, which may include:

• Chemotherapy
• Radiation
• Surgery to remove a part of the liver
• Liver transplant surgery to remove the liver and replace it with healthy liver from a donor
• Cryotherapy: Freezing the cells with liquid nitrogen
• Radiofrequency ablation: Using electrical current to heat and kill cancer cells
• Injecting alcohol into the tumor

Lung Cancer

Although lung cancer is not an AIDS-defining cancer, people living with HIV have a greater chance of developing lung cancer than HIV-negative people. This difference is likely due to the weakened immune systems of those living with HIV. Unfortunately, lung cancer is one of the deadliest cancers. In the US, it is the leading cause of cancer-related deaths among both women and men.

An increased risk of developing lung cancer is also strongly tied to smoking. Both the duration (how long) and amount (how much or how many per day) of smoking contribute to the risk for lung cancer. Second-hand smoke exposure (breathing smoke in the environment) also contributes to an increased risk for lung cancer. The best way to prevent lung cancer is to avoid or stop smoking. For more information, see our Smoking and HIV info sheet.

Symptoms

• Cough, with or without phlegm or mucus
• Coughing up blood
• Shortness of breath
• Chest pain
• Fatigue
• Loss of appetite

Diagnosis

• Sputum sample for microscopic examination, which shows if abnormal cells are present in the lungs. Sometimes a person can cough up the sputum. If not, a procedure known as bronchoalveolar lavage (BAL) can be done. In this procedure, sputum is obtained by placing a small scope down the windpipe.
• Bronchoscopy: insertion of a thin, flexible tube with a light on the end into the windpipe to look inside the lungs and possibly take a sputum or tissue sample for examination under a microscope
• Biopsy: removal of a tissue sample for examination under a microscope
• Imaging tests: chest x-ray, CT scan, PET scan, or MRI

Treatment

Depending on the size, type, and location of the lung cancer, cancer specialists will recommend some combination of chemotherapy, radiation therapy, and surgery.

Conclusion

Cancers can be very serious for HIV+ people. On-going medical care allows for early diagnosis and treatment, or even prevention, in the case of cervical and anal cancers.

Seeing your health care provider on a regular basis and taking your HIV drugs regularly can help keep your immune system strong and your CD4 cell counts up. This also helps fight off cancers.