There are many types of cancer treatment. The types of
treatment you need will depend on the type of cancer you have and how advanced
it is. Most people have a combination of treatments, for example chemotherapy
and surgery, or chemotherapy and radiotherapy.
Surgery: an
operation to remove tissue from the body. Surgery is most often used for solid
tumours that are contained in one area (rather than cancers that have spread).
It is not used for blood cancers.
Radiotherapy: using
radiation to destroy cancer cells. Most often, it is given externally with a
large machine that aims beams of radiation to a specific part of the body. Less
frequently, radiotherapy is given internally (having a solid or liquid source
of radiation put inside the body).
Chemotherapy: drugs
which destroy cancer cells. They work by stopping cells from dividing which
stops them from growing and spreading. Chemotherapy drugs are carried in the
blood to almost all parts of the body.
Hormone therapy: drugs
which block or lower the amount of hormones in the body. This can stop or
slow down the growth of some cancers.
Targeted (biological)
therapy: drugs which are designed to precisely identify and attack cancer
cells. There are many different types of biological therapy, including gene
therapy and monoclonal antibodies.
Immunotherapy: drugs
which help the immune system to attack cancer cells.
Chemotherapy and the other drug treatments mentioned above
are given in different ways. Many are given through a drip into a vein, while
other drugs are taken as tablets, with a pump that you are connected to at
home, or as an injection.
Like any other treatment, cancer treatments can have side-effects.
While these can sometimes be unpleasant, each treatment has different
side-effects. It’s important to ask about the potential side-effects of the specific
treatment that is suggested for you. For example, not all chemotherapy drugs
make your hair fall out. Some newer treatments (such as hormone therapies and
targeted therapies) may have fewer side-effects than older treatments. You may
be given additional medications to counteract side-effects.
The same types of treatment are used in people with HIV. For
many cancers, people with HIV who are taking effective HIV treatment have
similar treatment outcomes as HIV-negative people. For some types of cancer,
people with HIV have poorer outcomes than other people. In particular, people
with low CD4 counts or other co-morbidities may have more treatment
side-effects and poorer outcomes.
It may be necessary to make some adjustments to your cancer
treatment or your HIV treatment, taking into account the impact of each disease
on the other, and the potential for drug-drug interactions. For this reason, it's
very important that the doctors treating your HIV and your cancer work
together.
The British HIV
Association (BHIVA) recommends that people with cancer and HIV should be
treated at hospitals with a lot of experience of treating cancer in people with
HIV. You have the best chance of a good outcome if you go to a hospital with
this experience.
The British HIV Association also recommends that all people
with HIV who need cancer treatment should start HIV treatment, if they have not
done so already. Continuing to take HIV treatment during cancer treatment is
associated with living longer and a lower risk of opportunistic infections.
There can be drug-drug interactions between chemotherapy and
HIV treatments (including protease inhibitors, cobicistat and non-nucleoside
reverse transcriptase inhibitors). The integrase inhibitors raltegravir and
dolutegravir are less likely to have interactions than some other anti-HIV
drugs, so your doctor may recommend that you switch to one of these drugs.
As treatments for HIV and cancer can both cause side-effects,
your doctors should keep an eye on how they are affecting you. In some cases
(such as nausea from chemotherapy), highly effective treatments to limit
side-effects are now available. If side-effects become too severe, your doctors
may need to adjust one of the treatments.
Chemotherapy and radiotherapy both
suppress the immune system, which may result in a significant drop in your CD4
count. You should be given drugs to prevent opportunistic infections (this is
known as prophylaxis). Your CD4 count may be checked more often after cancer
treatment than it would be normally.
Recommendations about your treatment will be made by a
multi-disciplinary team. This team may include an oncologist (a doctor who
specialises in treating cancer), a haematologist (a doctor who specialises in
treating blood cell disorders), a radiologist (a doctor who interprets the
results of scans or provides radiotherapy) and a pathologist (a doctor who
examines tissue for cancer cells). You will be supported by a cancer specialist
nurse during your cancer journey.