Diagnosis of HIV Associated Cancer

Executive Summary

Different tests are available for HIV associated diagnosis development. Diagnosis of Kaposi’s sarcoma includes histopathological examinations, faecal occult blood test, endoscopy or colonoscopy, bronchoscopy, and imaging tests (CT scan or an X-ray ). Diagnosis of Non-Hodgkin’s lymphoma includes histopathological examination, excisional or incisional biopsy, core needle biopsy, and imaging tests (chest x-rays, CT scan, and MRI). Diagnosis of invasive cervical cancer includes histopathological examination, speculum, vaginal and rectal examinations, blood tests (complete blood count and haemoglobin levels), kidney and liver function tests, and imaging tests (CT scan and MRI).

Kaposi’s Sarcoma Diagnosis

Histopathological examinations

Histopathological confirmation of the diagnosis of HIV associated cancer such as KS still remains the gold standard, but diagnosis is often not straightforward, especially if the pathologist is unfamiliar with the spectrum of histopathological signs of KS. The histopathological diagnosis of early KS is based on the search for fine clues that the pathologist can easily miss. The well-established clinical lesions of KS are usually (but not always) characterized by histopathological signs that can be accurately diagnosed by an experienced histopathologist​1​.

Faecal occult blood test

Faecal occult blood test is performed to look for blood in the stool, which might indicate that KS is hurting the digestive tract.

Endoscopy/colonoscopy

In the presence of any stomach trouble or belly pain, endoscopy/colonoscopy is performed to look into the stomach or in the intestine for the presence of any lesions.

Bronchoscopy

In case of any breathing difficulty, bronchoscopy may be performed into the airways with a thin tube called a bronchoscope.

Imaging tests

A CT scan or an X-ray can be performed to determine whether cancer has spread to the lungs, the lymph nodes, or other body parts​2​.

Diagnosis of Non-Hodgkin’s lymphoma

Histopathological examinations

Histopathological examination involves the removal of some or all of the swollen lymph nodes and then a laboratory examination. The biopsy may be performed by a radiologist using ultrasound or CT scan, or it may be performed surgically by a surgeon. In some cases, swollen lymph nodes are not easily accessible, and general anaesthesia may be required. The pathologist then examines the tissue sample for cancer cells. Detection of cancer cells can also indicate types of non-Hodgkin’s lymphoma that are important to the treatment plan​3,4​.

There are two main ways the surgeon can get a sample of the tissue:

Excisional or incisional biopsy

The doctor cleans and numbs the area they want to cut into. They may take out the whole lymph node (excisional) or only a small part (incisional). If the node or tissue is hard to get to, the doctor may give drugs to make the patient drowsy or might opt for general anaesthesia. Once the lymph tissue is removed, they’ll close the area with stitches. The patient may have a very small scar or might not have one at all.

Core needle biopsy

Sometimes in order to get tissue samples from inside the body, a surgeon may use a hollow needle. They’ll numb the skin and may use an ultrasound or CT scan to make sure the needle is in the right place. The patient may still need an excisional biopsy later.

Imaging tests

Chest X-rays are used to get a look at your bones and lungs in case of pain in the chest or breathing difficulties. CT scans are used to determine the spread of cancer in the belly, pelvis, chest, head, and neck. MRI may be used to determine the spread of tumors in the brain. PET scans can be used to determine the presence of lymphoma or scar tissues in swollen tissue or organs.

Diagnosis of Invasive cervical cancer

  • Histopathological examination may be performed, which involves removing some tissue from the lesion and examining the spectrum of histopathological features of Invasive cervical cancer.
  • Speculum, vaginal and rectal examinations and possibly tests to examine the urinary system (cystoscopy), as well as intestinal system (proctoscopy), may be performed to determine the location of the tumour, whether it is growing outwards or inwards from the tissues of the cervix, its size, its extension to the tissues next to the cervix and the uterus and the ligaments holding the uterus in place, as well as to the pelvic walls. The tests may also help in determining the involvement of the urinary bladder and rectum in the cancer prognosis.
  • Additional tests to further investigate the extent of cervical cancer may be performed, which may include blood tests, including full blood count and haemoglobin levels (to assess the presence of anaemia caused by blood loss, which, if present, can impact the effectiveness of radiotherapy), in addition to pregnancy and HIV tests when appropriate.
  • kidney and liver function tests.
  • computerized tomography (CT) scan or, better yet, magnetic resonance imaging (MRI) of the abdomen and pelvis (to help plan radiotherapy)​5​.

References

  1. 1.
    Schneider J, Dittmer D. Diagnosis and Treatment of Kaposi Sarcoma. Am J Clin Dermatol. 2017;18(4):529-539. doi:10.1007/s40257-017-0270-4
  2. 2.
    Jonathan E. K. Kaposi’s Sarcoma (KS). WebMD. Published 2020. Accessed March 2022. https://www.webmd.com/hiv-aids/guide/aids-hiv-opportunistic-infections-kaposis-sarcoma/
  3. 3.
    Non-Hodgkin lymphoma. NHS. Published 2018. Accessed March 2022. https://www.nhs.uk/conditions/non-hodgkin-lymphoma/diagnosis/
  4. 4.
    Carol D. Diagnosis of Non-Hodgkin’s Lymphoma. WebMD. Published 2021. Accessed March 2022. https://www.webmd.com/cancer/lymphoma/non-hodgkins-lymphoma-diagnosis
  5. 5.
    World Health Organization. World Health Organization; 2006:364. Accessed March 2022. https://www.who.int/reproductivehealth/publications/cancers/cervical-cancer-guide/en/