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Malignancies – Colorectal Cancer (CRC)

Colorectal cancer (CRC)

Introduction

The relative risk of colorectal cancer in PLWHA remains uncertain. Although a prospective cohort study in PLWHA from 1992 to 2003 showed a higher incidence of colorectal cancer (standardized rate ratio 2.3) than the general population, other meta-analyses and cohort studies have failed to demonstrate an elevated risk. At least one case series suggested that colorectal cancer may occur at a younger age and be more aggressive in patients infected with HIV. In contrast, a recent registry linkage study demonstrated, after accounting for the ages of at-risk populations, that the age of colorectal cancer diagnosis is similar in the AIDS and general populations1.

Evidence for the treatment of HIV-positive colorectal cancer (CRC) patients is limited to small retrospective case studies and so specific recommendations are not possible. However it appears that standard chemotherapy in combination with HAART for patients with metastatic disease is feasible with no apparent increase in toxicity, no opportunistic infections during or after treatment, and an overall response rate of 50%2.


Screening and Prevention

Faecal occult blood test every 1-3 years en persons 50-75 years old has a marginal benefit in decreasing colorectal cancer mortality3.

Colonoscopy is recommended at age 50 years in asymptomatic patients at average risk and repeat every 10 years. More frequent testing is indicated in patients with a history of adenomatous polyps; testing at an earlier age may be advised in patients with a strong family history of colon cancer4.

The U.S. Preventive Services Task Force (USPSTF) recommends colorectal cancer screening using high-sensitivity FOBT annually, sigmoidoscopy every 5 years with FOBT every 3 years or colonoscopy every 10 years in adults at an average risk for colorectal cancer, beginning at age 50 and continuing until age 755. Application to PLWHA seems appropriate1.


References

  1. Mania D. and Aboulafia DM. Screening guidelines for non-AIDS defining cancers in HIV-infected individuals. Curr Opin Oncol. 2013 Sep;25(5):518-525.
  2. British HIV Association Guidelines for HIV-associated malignancies 2013. Version 1. 25 July 2013.
  3. European AIDS Clinical Society (EACS) Guidelines. Version 7.0. October 2013.
  4. Primary Care Guidelines for the Management of Persons Infected With HIV: 2013 Update by the HIV Medicine Association of the Infectious Diseases Society of America. November 2013.
  5. U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008; 149:627–637