AIDS-Related Primary Central Nervous System Lymphoma

Definition

Lymphomas are cancers of the lymph system. The lymph system is a series of nodes, channels, and tissue throughout the body. There are different types of lymphomas. The ones discussed here include:

• Primary central nervous system (CNS) lymphomas—occur in the brain and spinal cord
• AIDS-related primary CNS lymphoma—occurs in people with HIV. It is one of the complications that show that AIDS has developed.

AIDS-related primary CNS lymphoma is a type of non-Hodgkin lymphoma (NHL). NHL can be more aggressive in people with AIDS.

The Lymphatic System.

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Causes

Lymphoma starts because of DNA damage in a new white blood cell that divides and grows in an abnormal way. This process creates more damaged cells that can form a tumor and invade nearby tissue. The cancer can also spread to other areas of the body. It is not clear what causes the change to DNA. Genetics and the environment may play a role.

Risk Factors

Having HIV infection raises the risk of AIDS-related primary CNS lymphoma.

HIV damages the white blood cells in the body. The body will need to make more white blood cells to replace the damaged ones. This raises the chance that a white blood cell with damaged DNA can develop.

HIV also lowers the immune system. This makes people more vulnerable to cancer.

Symptoms

Cancer growth can put pressure on tissue around it. It can cause swelling that also puts pressure on brain tissue. Brain tissue, nerves, and the spinal cord can all be affected. This will cause a wide range of symptoms. Some examples are:

• Nausea and vomiting
• Limb weakness or pain
• Headaches
• Hearing or vision problems
• Back pain
• Seizures
• Problems swallowing
• Difficulty controlling the flow of urine (pee)
• Changes in alertness
• Paralysis

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. Nervous system and eye exams may also be done.

The doctor may test fluids to look for signs of lymphoma. This can be done with:

• Blood tests
• Lumbar puncture—to tests fluids around the spinal cord and brain

A biopsy may be done if a tumor is found. A small sample of the growth will be removed. It will be tested to make a diagnosis.

Pictures of the spine and brain may also be taken. They can help to find tumors and see what tissue is affected. This can be done with:

• MRI scan
• PET scan

Tests will help to determine the stage of the cancer. Staging is based on how far the cancer has spread and what body parts are affected. This will help to make a treatment plan

Treatment

Treatment depends on the type and stage of the cancer and how aggressive it is. Treatment for HIV infection will start or continue as well.

It is important to manage the HIV infection and keep the immune system as strong as possible during treatment. This can be done with highly active antiretroviral therapy (HAART). Cancer treatments like chemotherapy medicine can weaken the immune system and interfere with some AIDS medicine. Medicine may need to be adjusted during treatment.

Treatment for the lymphoma may include:

Prevention

There are current guidelines to prevent AIDS-related primary central nervous system lymphoma.