AIDS- related cancer
By Tranquilino Elicano, Jr., M.D., D.M.R.T.C.H.A.
TOYM Awardee in Cancer management

We have to pay closer attention to AIDS (Acquired Immune Deficiency Syndrome) which, although comparatively only recently recognized in our country, is unfortunately dramatically increasing in incidence. From the cancer specialist point of view, it is a very important problem since approximately 40 percent of AIDS sufferers can be expected to develop some form of cancer. Although the type of tumors encountered which are all related to AIDS are not very common among the rest of the non-infected population, it is very sad to note that when first diagnosed, these cancers are already at a relatively advanced stage among patients who do not tolerate treatment well.

Malignant disease may also be the first manifestation of infection with HIV (Human Immune Deficiency Virus) and so the following risk factors for AIDS should be looked into:

1. Sexual contact with an infected heterosexual partner;

2. Sexual contact with an infected homosexual;

3. Use of infected syringe and needle such as for example among intravenous drug abusers;

4. Blood transfusion in Africa or a particular treatment of hemophilia.
Wherever necessary, positivity for HIV can be confirmed by a specific blood test.

Physicians are aware that a patient with AIDS actually, as of the present time, has an incurable illness with poor prognosis. The outcome of treatment of the accompanying cancer will usually be very unsatisfactory because the tumor is already in an advanced stage and is growing very rapidly because of its environment which has a suppressed cellular immune system. The immune protection of the patient is very low and so the combination of HIV infection and the cancer will make the risk of an accompanying (opportunistic) infection extremely high. Records in well-developed nations show that many of the AIDS victims die from uncontrolled infection rather from the cancers. Patients with AIDS and cancer do not tolerate chemotherapy well.

Health workers such as doctors, nurses, dentist, medical technologist and radiographers who could potentially come in contact with bodily secretions of patients with AIDS should be aware of the patient's illness. Surgeons and dentist are advised to use double gloves and are encouraged to use eye-shields during operations. Specimens obtained should be handled with care and approximately labeled before sending to the laboratory. Therapeutic radiators should be handled with care and appropriately labeled before sending to the laboratory. Therapeutic radiographers should be careful in use of skin tattoos and immobilization devices such as bite blocks. Those performing cancer chemotherapy should take special care of needles and canulae and whenever venepuncture is done, the laboratory should be properly notified of any blood samples sent for analysis.

Patients suffering from HIV are usually given preparations such as AZT (Zidovudine) to try to control the disease.

Unfortunately, this medication markedly lowers the blood elements of the patient and so the ill-effects of other treatment procedures such as radiation and chemotherapy are markedly exacerbated (myelosuppressive results) and will therefore limit the intensity of their use.

Kaposi's Sarcoma is the most common AIDS-related cancer. The first patient I ever attended to suffering from this condition was in the late 1959. He was a middle aged Filipino who had previously worked in Africa for 10 years. Of course, during those years we had never heard of AIDS yet in the Philippines. Today's science now reveals that this cancer is more commonly seen especially among homosexuals suffering from AIDS. The cancerous masses are frequently seen in oral cavity and anal area. Reddish skin lesions which ulcerate and bleed are observed mostly in the lower extremities and gastro-intestinal tract. Victims suffer from pain, ulcerations, bleeding, marked swelling of soft tissues, massive disfigurement and respiratory obstruction. Most deaths occur after extensive hemorrhage in the gastro-intestinal tract. Those who are very fortunate to initially respond well to the radiation and chemotherapy of their Kaposi'Sarcoma lesions usually die from other AIDS-related complications. Other cancers related to AIDS are brain cancer, Lymphoma, Hodgkins disease, Testicular cancer, Hepatocellular carcinoma, tongue cancer and cancer of the anus.

AIDS as far as I am concerned is much more deadly than cancer. There are cancers that are preventable while others are curable if detected early, diagnosed correctly and given proper treatment promptly. Unfortunately there is at present no definite cure for AIDS. But on the other hand, many victims could have avoided it if they had only followed the preventive warning and advice given by health authorities.