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AIDS-related lymphoma is a condition in which cancer (malignant) cells build in the patient's immune system in those who already have AIDS (acquired immunodeficiency syndrome). AIDS is a condition that is caused by HIV (human immunodeficiency virus), a virus that weakens and attacks the immune system. Lymphomas are a type of cancer that affect the lymph system's white blood cells. The lymph system is made up of lymph, lymph nodes, thymus, bone marrow, lymph vessels, spleen, and tonsils. In some cases, patients are diagnosed with this lymphoma and AIDS at the same time.
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Types of Lymphoma
There are two primary types of this type of cancer, including non-Hodgkin lymphoma and Hodgkin lymphoma. Non-Hodgkin lymphoma occurs more often in AIDS patients, but both types can occur. The three primary types of AIDS-related lymphoma include:
- B-cell immunoblastic lymphoma
- Diffuse large B-cell lymphoma
- Small non-cleaved cell lymphoma
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Signs and Symptoms
If a patient has been diagnosed with this cancer, certain symptoms often occur. However, these symptoms are not exclusive to this condition and are relatively common overall. Signs and symptoms include:
- Fever or weight loss for no known reason
- Swollen, painless lymph nodes in the chest, groin, neck, or underarm
- Night sweats
- Feeling full below the ribs
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Diagnosis and Evaluation
Several different diagnostic tests and evaluative methods may be performed in order to arrive at a definitive diagnosis. A physical exam and complete blood count are often the first things done. During the physical exam every routine element is performed, as well as looking for lumps or other unusual findings. The complete blood count will:
- Look at how many platelets, white blood cells, and red blood cells a patient has
- Look at how much of a patient's blood is red blood cells
- Look at how much hemoglobin is in the red blood cells
A lymph node biopsy can be done to look for cancer cell. Several types of biopsy can be performed, such as excisional biopsy, core biopsy, incisional biopsy, or fine-needle aspiration biopsy. A bone marrow aspiration and biopsy may also be performed to look for abnormal cells.
Other possible tests include an HIV test, chest x-ray, and Epstein-Barr virus test. To stage the cancer, the following tests may be performed:
- CT scan
- Lumbar puncture
- PET scan
- Bone marrow aspiration and biopsy
- Blood chemistry studies
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As with most cancers, chemotherapy is commonly used to treat AIDS-related lymphoma. This treatment involves the use of powerful drugs capable of stopping and/or killing cancer cells. These drugs can be administered orally or intravenously, depending on the drug. It can also be administered directly into the spinal column (intrathecal chemotherapy), or regionally (directly into a body cavity or organ) For this specific cancer, most patients will not receive just one chemotherapy, but a combination. The stage and type of the cancer will determine how chemotherapy is administered. In some cases, the bone marrow-associated side effects may be lessened by drugs known as colony-stimulating factors.
Radiation therapy is also common and often used along with chemotherapy. This also help in either stopping and/or killing cancer cells. Patients may be given internal radiation or external radiation.
Another treatment that may be given is high-dose chemotherapy along with a stem cell transplant. The stem cell transplant helps to replace some, or sometimes all, of the blood-forming cells that can be destroyed by high-dose chemotherapy. The stem cell transplant would be performed via infusion after the patient completes chemotherapy to help restore any blood cells the patient lost.
Some patients will receive targeted therapy which uses certain drugs to attack, after identifying, specific cancer cells, while not harming any normal cell. Monoclonal antibody therapy is the most often used for this cancer.
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The Cleveland Clinic. (2010). AIDS-Related Lymphoma. Retrieved on September 9, 2010 from The Cleveland Clinic: http://my.clevelandclinic.org/disorders/aids_and_hiv/hic_aids-related_lymphoma.aspx
National Cancer Institute. (2010). General Information About AIDS-Related Lymphoma. Retrieved on September 9, 2010 from the National Cancer Institute: http://www.cancer.gov/cancertopics/pdq/treatment/AIDS-related-lymphoma/Patient#Keypoint4