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HIV-associated malignancies Flashcards

1
Q

HIV is associated with what THREE AIDS-defining cancers?

A

KAPOSI sarcoma
high grade B cell non-Hodgkin LYMPHOMA
invasive CERVICAL cancer

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2
Q

What virus causes Kaposi sarcoma?

A

Kaposi sarcoma herpesvirus or human herpesvirus 8 (HHV8)

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3
Q

Where in the body does KS typically present?

A

cutaneous or mucosal lesions

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4
Q

What proportion of people with KS have visceral disease?

A

14%

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5
Q

What THREE factors are included in the KS clinical staging system?

A

1) TUMOUR related criteria
2) host IMMUNOLOGICAL status
3) presence of SYSTEMIC illness

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6
Q

What TWO factors confer an improved prognosis in KS?

A

1) FIRST AIDS illness

2) increasing CD4, improvement with every 100cells

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7
Q

What TWO factors confer a poorer prognosis in KS?

A

1) age >50 yrs

2) SYSTEMIC disease

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8
Q

What blood test gives idea of KS tumour burden and acts as a prognostic indicator?

A

HHV8 DNA level

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9
Q

What are the FIVE stages of response criteria for KS?

A

1) Complete response
2) Clinical complete response
3) Partial response
4) Stable disease
5) Progressive disease

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10
Q

What is the difference between complete response and clinical complete response in KS criteria?

A

complete - clinical and histological

clinical - no KS lesions, no histological confirmation

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11
Q

What is the reduction in KS since HAART introduction?

A

14% (1980s) to 2% (2000s)

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12
Q

Which antivirals have been shown to reduce the risk of KS?

A

GANCICLOVIR

FOSCARNET

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13
Q

Which common antiviral has NOT been shown to reduce the risk of KS?

A

ACICLOVIR

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14
Q

What has been most effective against HHV8 replication - ART or antivirals such as ganciclovir?

A

ART

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15
Q

LOCAL therapies for cutaneous KS are now uncommon due to ART - list FIVE?

A 
RADIOTHERAPY
RETINOIDS
VINBLASTINE
CRYOTHERAPY
EXCISION
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16
Q

What proportion of patients with KS starting ART experience IRIS?

A

up to 29%

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17
Q

How is IRIS KS managed?

A

systemic CHEMOTHERAPY

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18
Q

When is systemic cytotoxic chemotherapy recommended for KS?

A

ADVANCED
SYMPTOMATIC
rapidly PROGRESSIVE
Poor prognostic risk index

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19
Q

Which TWO chemotherapy classes are typically used against KS?

A

LIPOSOMAL ANTRACYCLINES (doxorubicin)
&
TAXANES (Paclitaxel)

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20
Q

Which chemotherapy is GOLD STANDARD against KS?

A

LIPOSOMAL ANTRACYCLINES (doxorubicin)

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21
Q

What side effects are associated with LIPOSOMAL ANTHRACYCLINE ie doxorubicin?

A

ALOPECIA
EMESIS
MYELOSUPPRESSION

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22
Q

When might interferon-A be used for KS?

A

RARELY
residual KS
reconstituted immune system

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23
Q

What other targeted therapies may be useful in treatment of KS?

A

anti-VEGF-A monoclonal antibody (BEVACUZIMAB)
c-kit (IMATINIB)
inhibition of Ras/Raf/MEK/ERK (SELUMETINIB - MEK inhibitor)

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24
Q

What is RECOMMENDED local therapy for KS?

A

RADIOTHERAPY
or
INTRALESIONAL VINBLASTINE

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25
Q

What is SECOND line chemotherapy for KS?

A

TAXANES (ie paclitaxel)

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26
Q

What are the TWO most common subtypes of Non-Hodgkin lymphoma for PLW HIV?

A

Diffuse large B cell
&
Burkitt’s lymphoma/leukaemia

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27
Q

At what stage do PLW HIV present with Non-Hodgkin lymphoma?

A

ADVANCED clinical stage
B symptoms
EXTRANODAL involvement inc bone marrow

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28
Q

What is the survival for PLW HIV and non-HOdgkin lymphoma?

A

On ART:
near HIV negative population
dependent on HISTOLOGICAL type

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29
Q

What BASELINE investigations are required for work up of AIDS-related lymphoma?

A

BLOOD tests
CT
BONE MARROW aspirate and trephine

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30
Q

Why is PET scan recommended in AIDS-related lymphoma work up?

A

Improves STAGING accuracy

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31
Q

When should CSF sampling be done in work up for AIDS-related lymphoma?

A 
CNS symptoms
or involvement of:
PARANASAL sinus
BREAST
EPIDURAL
TESTICULAR
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32
Q

Which Non-Hodkin lymphoma subtype has a high risk of CNS involvement?

A

BURKITTS

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33
Q

What staging classification should be used for AIDS-related lymphoma?

A

Ann Arbor

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34
Q

Which PLW HIV are more at risk of infection-related mortality during treatment for AIDS-related lymphoma?

A

CD4 cell count <50

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35
Q

Which parts of the body should be CT scanned for work up for AIDS-related lymphoma?

A

Neck, chest, abdomen, pelvis

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36
Q

What infections should be screened for in the work up for AIDS-related lymphoma?

A

Hepatitis B (HBsAg, sAB, cAb)
Hepatitis C (HCV Ab)
Varicella (VZV IgG)
CMV IgG

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37
Q

In addition to renal, liver and bone profile what other biochemistry is required for work up for AIDS-related lymphoma?

A 
LDH
URATE
IMMUNOGLOBULINS
PROTEIN ELECTROPHORESIS
B2 MICROGLUBULIN
CRP
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38
Q

Which blood test result is used in prognostic scoring for non-Hodgkin lymphoma?

A

LDH

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39
Q

Pre-HAART what limited clinical outcomes with chemotherapy for AIDS-related lymphoma?

A

Risk of opportunistic INFECTION
and
DEATH
(despite lymphoma response)

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40
Q

What TWO factors has led to conventional chemotherapy and doses to be able to be used for PLW HIV with AIDS-related lymphoma?

A

1) HAART

2) haematopoietic growth factors (G-CSF)

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41
Q

FIRST LINE treatment for diffuse large B cell lymphoma?

A 
CHOP
cyclophosphamide
doxorubicin
vincristine
prednisolone
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42
Q

What is the potential advantage of EPOCH vs CHOP chemotherapy for diffuse large B cell lymphoma?

A

Potentially as effective with less toxicity
Multi-agent
LOW dose
PROLONGED exposure

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43
Q

When is radiotherapy indicated for diffuse B cell lymphoma?

A

stage I or II disease
in combination with chemo
Not common

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44
Q

What are the BENEFITS of addition of RITUXIMAB to chemotherapy for diffuse B cell lymphoma in PLW HIV?

A

Improved RESPONSE rate
reduced PROGRESSION of lymphoma on treatment
reduced DEATH due to lymphoma

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45
Q

What is the RISK of addition of RITUXIMAB to chemotherapy for diffuse B cell lymphoma in PLW HIV?

A

increase DEATH due to INFECTION

CD4 cell count <50

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46
Q

Is RITUXIMAB recommended for PLW HIV and diffuse B cell lymphoma?

A

YES

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47
Q

What additional prophylactic measures should be taken if a PLW HIV has CD4 cell count <50 and is being treated with RITUXIMAB as part of diffuse B cell lymphoma chemotherapy?

A 
antimicrobial PROPHYLAXIS
- cotrimoxazole
- fluconazole
- aciclovir
- azithromycin
preemptive G-CSF
prompt treatment of opportunistic infection
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48
Q

What is the BENEFIT of HAART in treatment of AIDS-related lymphoma?

A

reduce OPPORTUNISTIC infection
superior RESPONSE rate
&
SURVIVAL

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49
Q

What is the difference in treatment strategy for HIV Burkitts lymphomas vs HIV diffuse B cell lymphoma?

A

more INTENSIVE

CNS penetration

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50
Q

FIRST LINE treatment for Burkitts lymphoma in PLW HIV?

A 
CODox-M/IVAC
cyclophosphamide
vincristine
doxorubicin
methotraxate
ifosamide
etoposide
cytarabine
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51
Q

What is an ALTERNATIVE treatment for Burkitt’s lymphoma in PLW HIV to CODox-M/IVAC?

A 
DA-EPOCH
dose adjusted
etoposide
prednisone
vincristine
cyclophosphamide
hydroxydaunorubicin
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52
Q

What chemotherapy related toxicity is universal in treatment for Burkitts lymphoma?

A

NEUTROPENIC fever
MUCOSITIS
due to intensive regimen

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53
Q

Is RITUXIMAB recommended for PLW HIV and Burkitt’s lymphoma?

A

YES

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54
Q

What is the impact of HIV on risk of CNS involvement with lymphoma?

A

HIGHER incidence

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55
Q

What is the prognostic implication of SECONDARY CNS lymphoma (ie in context of other systemic lymphoma type)?

A

VERY POOR prognosis

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56
Q

How can the risk of secondary CNS lymphoma be reduced?

A

PREVENTIVE treatment as part of FIRST LINE chemotherapy

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57
Q

Which anatomical sites affected by lymphoma increase the risk of CNS relapse?

A 
TESTES
PARANASAL
PARASPINAL
EPIDURAL
BREAST
RENAL
TESTICULAR
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58
Q

Which lymphoma subtype should include INTRATHECAL CNS chemotherapy in PLW HIV?

A

BURKITT’S

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59
Q

What adverse event is common when giving chemotherapy for a cancer with high tumour burden, especially so for lymphoma?

A

TUMOUR LYSIS SYNDROME

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60
Q

Within what time frame does tumour lysis syndrome most commonly occur after chemotherapy for lymphoma?

A

12-72 hours

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61
Q

What preventative therapy can be used to reduce the effect of tumour lysis syndrome?

A

HYDRATION
anti-URATE (rasburicase or allopurinol)
measurement and correction of electrolyte disturbance

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62
Q

For RELAPSED or REFRACTORY AIDS-related lymphoma, what is the treatment?

A

INTENSIFIED chemotherapy inc PLATINUM
&
AUTOLOGOUS STEM CELL TRANSPLANT (ASCT)

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63
Q

What might be a typical INTENSIFIED second line treatment of RELAPSED AIDS-related lymphoma?

A

DHAP
dexamethasone
high-dose cytarabine
cisplatin

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64
Q

When is response to first line treatment usually first assessed for AIDs-related lymphoma?

A

HALF WAY through treatment

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65
Q

What imaging modality is SUPERIOR when assessing for treatment response at the end of treatment for AIDS-related lymphoma?

A

PET scan

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66
Q

Which chemotherapy is associated with cardiomyopathy and heart failure and might need follow up in people treated for AIDs-related lymphoma?

A

ANTHRACYCLINES (doxorubicin)

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67
Q

Which haematological malignancies are associated with chemotherapy for lymphoma?

A

MYELODYSPLASIA

ACUTE MYELOID LEUKAEMIA

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68
Q

What is the definition of primary CNS lymphoma?

A

non-hodgkin lymphoma
confined to cranio-spinal axis
no systemic involvement

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69
Q

What virus is found in CNS cells in HIV-associated primary CNS lymphoma?

A

EBV

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70
Q

How does primary CNS lymphoma most commonly present on CT scan?

A

DIFFUSE and MULTIFOCAL supratentorial brain masses

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71
Q

Which parts of the eye can be involved in primary CNS lymphoma?

A

VITREOUS
RETINA
OPTIC nerve

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72
Q

What additional work up is recommended for primary CNS lymphoma?

A

CT
Bone marrow biopsy
Testicular ultrasound

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73
Q

On identifying brain lesions, in addition to work up for primary CNS lymphoma what initial treatment should be given?

A

anti-TOXOPLASMOSIS treatment
TWO weeks
sulfadiazine 1g 4xdaily
pyrimethamine 75mg daily

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74
Q

What impact has HAART had on the incidence of primary CNS lymphoma?

A

REDUCED dramatically

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75
Q

What is the preferred treatment of primary CNS lymphoma for PLW HIV on HAART?

A

TWO chemotherapy agents
METHOTREXATE
+
cytarabine

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76
Q

When is radiotherapy indicated for primary CNS lymphoma?

A

if TOXICITY with chemotherapy too high
or
PALLIATIVE for symptom control

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77
Q

What is primary EFFUSION lymphoma?

A 
HIV-associated non-HOdgkin lymphoma
SEROUS body cavities
- pleural
- peritoneum
- pericardial
NO tumour mass or lymphadenopathy
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78
Q

Which virus is primary effusion lymphoma associated with?

A

HHV8

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79
Q

What is proportion of HIV-related non-Hodgkins lymphoma does primary effusion lymphoma account for?

A

4%

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80
Q

What is proportion of NON-HIV-related non-Hodgkins lymphoma does primary effusion lymphoma account for?

A

<1%

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81
Q

Does primary effusion lymphoma affect MEN or WOMEN?

A

MEN

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82
Q

In addition to HHV8, which other virus MAY play a role in primary EFFUSION lymphoma?

A

EBV

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83
Q

What is the typical clinical presentation of primary effusion lymphoma?

A

Dyspnoea (pleural or pericardial involvement)
or
Abdominal distension (peritoneal involvement)

84
Q

What immunohistochemistry stain should be performed on the serous fluid to confirm primary EFFUSION lymphoma?

85
Q

What is the FIRST LINE treatment for primary EFFUSION lymphoma?

A 
HAART
\+
CHOP
cyclophosphamide
doxorubicin
vincristine
prednisolone
86
Q

PLASMABLASTIC lymphoma is a subtype of which lymphoma group?

A

Diffuse large B cell lymphoma

87
Q

How many SUBTYPES are there for plasmablastic lymphoma?

88
Q

Describe the THREE subtypes of PLASMABLASTIC lymphoma.

A

ORAL mucosa, monomorphic plasmablasts
EXTRAORAL more plasmablastic differentiation
associated with CASTLEMANN’S disease

89
Q

Does PLASMABLASTIC lymphoma affect MEN or WOMEN?

90
Q

Which virus is plasmablastic lymphoma associated with?

91
Q

What is the UNIQUE presenting feature of PLASMABLASTIC lymphoma?

A

occurs in ORAL cavity of HIV +ve people

92
Q

What are the most common EXTRAORAL sites in PLASMABLASTIC lymphoma?

A

GI tract
lymph nodes
skin

93
Q

What is the RECOMMENDED treatment for plasmablastic lymphoma?

A 
HAART
\+
CHOP (ie anthracycline containing regimen)
cyclophosphamide
doxorubicin
vincristine
prednisolone
94
Q

What is the association between HPV and women with HIV vs women without HIV?

A

women with HIV
more likely to have
HPV 16 or 18

95
Q

What is the association between cervical intraepithelial neoplasia (CIN) and women with HIV vs women without HIV?

A

women with HIV
more likely to have
CIN

96
Q

What is the association between CD4 cell count and incidence of CIN?

A

lower CD4 cell count - CIN INCREASED

higher CD4 cell count - CIN DECREASED and less progression

97
Q

What are the risk factors for treatment failure of CIN in women living with HIV?

A

CD4 cell <200
high viral load
no HAART

98
Q

What imaging modality is used to stage invasive cervical carcinoma?

99
Q

What BENEFIT may PET or PET-CT add in the staging of invasive cervical carcinoma?

A

to identify metastatic lymphadenopathy

100
Q

What effect does HIV have on invasive cervical cancer compared with women without HIV?

A

occurs at a YOUNGER age

101
Q

In addition to annual cervical cytology what additional screening investigation is recommended for women living with HIV?

A

initial COLPOSCOPY at time of diagnosis

102
Q

What is the incidence of anal cancer in PLW HIV vs general population?

A

40 times HIGHER

103
Q

Which specific patient group demographic of PLW HIV has the highest risk of ANAL cancer?

104
Q

What is the association with HAART and incidence of anal cancer in PLW HIV?

105
Q

Why has anal cancer incidence increased since HAART was introduced?

A

longer SURVIVAL of PLW HIV

progression of HPV to anal dysplasia to invasive anal cancer

106
Q

What are the clinical features of anal cancer?

A

Rectal BLEEDING
PAIN
INCONTINENCE (if sphincter involved)

107
Q

What imaging is required to stage ANAL cancer?

A 
CT chest, abdomen, pelvis
\+
MRI pelvis (to assess lymph nodes and local extension)
108
Q

What potential BENEFIT might PET imaging offer in initial work up of ANAL cancer?

A

greater ACCURACY in identifying inguinal lymph nodes

109
Q

Tumour grading of ANAL cancer is based on what size intervals?

A

<2cm (T1)
2-5cm (T2)
>5cm (T3)
local invasion (T4)

110
Q

FIRST LINE treatment - ANAL cancer?

A 
concurrent CHEMORADIOTHERAPY
5fluorouracil (5FU)
\+
mitomycinC
\+
Radiotherapy
111
Q

What is the potential role of intensity-modulated radiation therapy in treatment of ANAL cancer?

A

HIGH dose radiation

less TOXICITY

112
Q

What is the benefit of HAART in addition to chemoradiotherapy for anal cancer?

A

less TOXICITY of chemoradiotherapy

improved SURVIVAL

113
Q

When is surgical resection indicated in treatment of ANAL cancer?

A

SALVAGE therapy for residual disease or local recurrence

114
Q

What surgical intervention is indicated for SALVAGE therapy for ANAL cancer?

A 
Abdominoperineal excision of rectum and anal canal
\+
colostomy
with 
reconstructive pedicle flap
115
Q

In patients with anal intraepithelial neoplasia (AIN) what follow up is recommended?

A

surveillance by HIGH RESOLUTION ANOSCOPY

116
Q

How much more common is Hodgkins lymphoma in PLW HIV vs the general population?

A

10 to 20 fold INCREASE

117
Q

At what stage of disease are PLW HIV more likely to present with Hodgkins lymphoma?

A

ADVANCED
EXTRANODAL involvement esp BONE MARROW
B symptoms
poor PERFORMANCE status

118
Q

What investigation is mandatory as part of the work up for Hodgkin lymphoma in PLW HIV but not HIV negative people?

A

BONE MARROW biopsy

119
Q

Why is bone marrow biopsy mandatory as as part of the work up for Hodgkin lymphoma in PLW HIV but not HIV negative people?

A

HIGHER proportion of bone marrow involvement

120
Q

At what CD4 cell count is there a HIGHER incidence of Hodgkin lymphoma?

121
Q

What is the treatment decision for HIV-associated Hodgkin lymphoma based on?

A

STAGE of disease
early favourable
early unfavourable
advanced

122
Q

What it the recommended treatment for HIV-associated Hodgkin lymphoma?

A 
chemotherapy + radiotherapy
ABVD
doxorubicin
bleomycin
vinblastine
dacarbazine
123
Q

Which ART should be avoided in combination with chemotherapy for Hodgkin lymphoma?

A

PI/ritonavir boosted

124
Q

What it the recommended treatment for relapsed or refractory HIV-associated Hodgkin lymphoma?

A

High-dose SALVAGE chemotherapy
+
autologous STEM CELL Transplant

125
Q

Against what organisms is prophylaxis recommended during treatment for HIV-related lymphomas?

A

PCP
MAI
Fungal infection

126
Q

What follow up investigation should be performed after treatment for HIV-associated Hodgkin lymphoma?

A

FDG-PET
+
BONE MARROW biopsy (if involved)

127
Q

What effect does HIV have on the interpretation of PET scan?

A

INCREASED uptake of FDG if unsuppressed VIRAL LOAD

128
Q

What long term follow up is required for patients who have had radiotherapy for Hodgkin lymphoma?

A

Thyroid function tests
&
Mammography (if female)

129
Q

What is multi centric Castlemann’s disease?

A

LYMPHOPROLIFERATIVE disease

HHV8

130
Q

How does multi centric Castlemann’s disease classically present?

A

FEVER
ANAEMIA
multifocal LYMPHADENOPATHY

131
Q

How does multi centric Castlemann’s disease present differently in PLW HIV vs HIV negative people?

A

YOUNGER age

132
Q

What other neoplastic process is associated with multi centric Castlemann’s disease?

A

Kaposi sarcoma

133
Q

Which virus is multi centric Castlemann’s disease associated with?

134
Q

How does the incidence of multi centric Castlemann’s disease differ between people of African ancestry and non-AFrican ancestry?

A

HIGHER incidence 2 to 4 fold

135
Q

What are the initial baseline investigations for work up of multi centric Castlemann’s disease?

A

CT neck, chest, abdomen, pelvis
LYMPH NODE biopsy
Immunohistochemistry for HHV8 and IgM lambda
HHV8 viral load

136
Q

What is the characteristic histology of multi centric Castlemann’s disease?

A

‘onion skin’ appearance
interfollicular plasmablasts
HHV8

137
Q

What is the utility of HHV8 viral load testing in the diagnosis of multi centric Castlemann’s disease?

A

LOW viral load may EXCLUDE multi centric Castlemann’s disease (<1000copies/ml)

138
Q

When should a BONE MARROW biopsy be considered in work up for multi centric Castlemann’s disease?

A

if haemophagocytic lymphohistiocytosis (HLH) is suspected

139
Q

Multi centric Castlemann’s disease is potentially fatal, through what mechanism?

A

organ FAILURE

140
Q

What malignancy is multi centric Castlemann’s disease associated with a higher incidence of?

A

Non-Hodgkin lymphoma

141
Q

Why does ART apparently not improve clinical outcomes for multi centric Castlemann’s disease?

A

multi centric Castlemann’s disease may ‘ESCAPE’ immune reconstitution

142
Q

Multi centric Castlemann’s disease is a relapsing and remitting disease, through what mechanism does an ‘attack’ occur?

A

CYTOKINE STORM

143
Q

What blood test can predict a ‘relapse’ of Multi centric Castlemann’s disease?

A

HHV8 viral load RISE

144
Q

What is recommended FIRST LINE treatment for multi centric Castlemann’s disease?

145
Q

What is recommended treatment for RELAPSED multi centric Castlemann’s disease?

146
Q

In addition to rituximab what should be added to treatment for aggressive multi centric Castlemann’s disease?

A 
Chemotherapy
CHOP
cyclophosphamide
doxorubicin
vincristine
prednisolone
147
Q

What should be measured as clinical monitoring for people with multi centric Castlemann’s disease in remission?

A

HHV8 levels

148
Q

Which testicular cancer has an increased risk associated with HIV?

149
Q

What is the expected survival rate for people with SEMINOMA and HIV on ART?

A

similar to HIV negative comparisons

150
Q

What are the specific baseline investigations for testicular cancer?

A 
US testes
\+
HCG
\+
AFP
151
Q

Which TWO tumour markers are required in the work up of testicular cancer?

152
Q

What factors that may be related to HIV can contribute to false-positive AFPs?

A

HAART
or
hepatitis related liver disease

153
Q

What is the differential diagnosis of testicular mass in a PLW HIV?

A

ORCHITIS

LYMPHOMA

154
Q

What imaging is required for staging in testicular cancer?

A

CT chest, abdomen, pelvis

155
Q

STAGE 1 testicular germ cell cancer - what is the treatment?

A 
SURVEILLANCE
or
Seminoma - CARBOPLATIN
or
Non-seminoma germ cell tumour - BEP
bleomycin
etoposide
platinum
156
Q

What is the chemotherapy for STAGE 1 SEMINOMAS?

A

CARBOPLATIN

157
Q

What is the chemotherapy for STAGE 1 NON-SEMINOMA GERM CELL TUMOUR?

A

BEP
bleomycin
etoposide
platinum

158
Q

Surveillance is a suitable option for stage 1 testicular germ cell cancers, in what instance is better to start chemotherapy?

A

HIGH RISK disease
or
CHAOTIC lifestyle, unlikely to engage with follow up

159
Q

What is the treatment for metastatic testicular germ cell cancer?

A 
BEP
bleomycin
etoposide
cisplatin
(either THREE or FOUR cycles)
\+
HAART
160
Q

What antimicrobial prophylaxis may be required during chemotherapy for metastatic testicular germ cell cancer?

A

antifungals

161
Q

What THREE non-AIDS defining malignancies have higher risk associated with HIV?

A

TESTICULAR GERM CELL
NON-SMALL CELL LUNG
HEPATOCELLULAR

162
Q

Which lung cancer type is increased in PLW HIV?

A

NON-small cell lung cancer

163
Q

How does the presentation of non-small cell lung cancer in PLW HIV differ to those HIV-negative?

A

YOUNGER age

ADVANCED disease

164
Q

Which parts of the body need imaging in work up for non-small cell lung cancer?

A 
CT
chest
abdomen
adrenals
BONE SCAN
165
Q

What are the treatment options for non-small cell lung cancer?

A

curative SURGERY
CHEMORADIATION
TARGET receptor therapy
HAART

166
Q

What is the treatment for METASTATIC non-small cell lung cancer?

A

ERLOTINIB or GEFITINIB
(epidermal growth factor receptor (EGFR) targeting tyrosine kinase inhibitors (TKI))
or
CHEMOTHERAPY

167
Q

If a non-small cell lung cancer expresses EGFR mutations what are the treatment options?

A

ERLOTINIB or GEFITINIB

epidermal growth factor receptor (EGFR) targeting tyrosine kinase inhibitors (TKI)

168
Q

What proportion of people in Western countries are co-infected with HIV and hepatitis C?

169
Q

What impact does HIV infection have on hepatitis C?

A

increases likelihood of CHRONIC infection ie not clearing it

hastens development of CIRRHOSIS

170
Q

Through what mechanism might HCC occur without cirrhosis due to hepatitis B infection?

A

hepatitis B is directly CARCINOGENIC

171
Q

What association is there between CD4 count and HCC development in hepatitis B and HIV co-infection?

A

LOWER CD4 count = higher risk of HCC

172
Q

What impact does HIV infection have on hepatitis B?

A

accelerates PROGRESSION of hepatitis B infection

173
Q

Which hepatitis (B or C) is associated with more HCC in co-infection with HIV?

A

Hepatitis C

174
Q

What is the investigations or surveillance for HCC?

A

AFP

US liver

175
Q

What imaging is required to stage HCC?

A

CT chest, abdomen, pelvis

176
Q

What impact does HIV have on HCC patients risk of liver disease?

A

more likely to have COMPENSATED LIVER DISEASE

177
Q

For HCC, when is surgical resection an option?

A

Solitary, or small number of lesions

178
Q

Is biopsy required if complete resection of HCC is possible?

A

No (potential to seed)

179
Q

What are the alternative treatment options to resection for localised HCC disease?

A

Injection of ETHANOL
RADIOFREQUECNY ablation
Transarterial CHEMO-EMBOLISATION

180
Q

What is the criteria for the HCC lesion to be considered for liver transplant?

A

THREE liver lesions <3cm
or
ONE liver lesion <5cm

181
Q

What additional consideration is required when planning liver transplant for a PLW HIV?

A

potential for drug-drug interaction with

IMMUNOSUPRRESANTS ie tacrolimus

182
Q

What is sorafenib?

A

Tyrosine kinase inhibitor

183
Q

Sorafenib, a tyrosine kinase inhibitor, targets what?

A

Raf cascade

184
Q

What target cell therapy is used for HCC treatment?

A

SORAFENIB (tyrosine kinase inhibitor)

185
Q

Which adverse events appear more common with people on HAART and sorafenib as treatment for HCC?

A

DIARRHOEA

HAND-FOOT SYNDROME

186
Q

How often should a person with HIV and hepatitis B co-infection have HCC surveillance?

A

6 monthly ultrasound scans

187
Q

What impact does HIV have on colorectal adenocarcinoma?

A

YOUNGER age
more ADVANCED disease
increased prevalence of RIGHT side tumours

188
Q

What is the most common non-AIDS-defining group of malignancies in PLW HIV?

A

Skin cancers

189
Q

What is the increased risk of NON-MELANOMA skin cancer in PLW HIV?

A

2 to 5 fold risk

190
Q

Which non-melanoma skin cancer is most common in PLW HIV?

A

BCC (ratio to SCC 7:1)

191
Q

What is the increased risk of MELANOMA skin cancer in PLW HIV?

A

3 times more common

192
Q

What pre-malignant skin lesions are VERY COMMON in PLW HIV?

A

Actinic keratosis

193
Q

What different features may occur for SCC in HIV?

A 
no sun exposed sites
may affect MOUTH, GENITALS, PERINEUM
multifocal
aggressive
high recurrence rate
metastasis
194
Q

What impact does HIV have on the presentation of melanoma?

A

ATYPICAL presentation
‘normal’ nave
‘benign macules’
multiple ‘nevoid lesions’

195
Q

Which skin cancers may remit with HAART?

196
Q

What topical treatment is indicated for BCC?

197
Q

What conditions is Merkel cell carcinoma associated with?

A

Chronic lymphocytic leukaemia (CLL)
TRANSPLANTATION
IMMUNOSUPPRESSIVE drugs
HIV

198
Q

What cutaneous manifestations of lymphoma may occur in PLW HIV?

A

PRURITIS
Cutaneous T cell lymphoma
Subcutaneous panniculitis-like T cell lymphoma
Castlemann’s disease

199
Q

What is the increased risk of PENILE CANCER in PLW HIV?

A

FIVE to SIX times higher

200
Q

What factors increase the risk of PENILE CANCER in PLW HIV?

A 
LICHEN SCLEROSUS
UNCIRCUMCISED
SMOKING
HPV
Poor HYGIENE
201
Q

Which cancers appear to be decreased in HIV infection?

A

PROSTATE

BREAST

202
Q

What histopathological features are present on biopsy of KS lesion?

A

SPINDLE cells
EXTRAVASATED red cells
HHV8 immunoSTAIN

203
Q

What are the typical histopathological features of Diffuse large B cell lymphoma?

A 
PROMINENT nucleoli
Pleomorphic nuclei (MANY SHAPES)
204
Q

What are the typical histopathological features of BURKITTS lymphoma?

A

MONOTONOUS medium sized lymphoid cells
scant cytoplasm
regular nuclei with MULTIPLE nucleoli

205
Q

What is the CLASSICAL histopathological feature in HODKIN lymphoma?

A

Binucleate Reed-Sternberg cell

206
Q

What is the histopathological feature of Multicentric Castlemann’s disease?

A

‘Crop circle’ or ‘onion skin’ of plasma blasts (circular distribution)
penetrating sclerotic blood vessel from circle - ‘lollypop sign’

DipHIV (14 decks)

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