Cancer and Rheumatism 4.5/5 (10)

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Cancer and rheumatism

Cancer and rheumatic disease are discussed on this page

Relationships between rheumatic disease and cancer

Symptoms of cancer difficult to recognize

Among people with rheumatic disease, it can sometimes be difficult to recognize the symptoms of cancer. Systemic (autoimmune) rheumatic diseases in themselves cause lethargy, night sweats, fever, muscle weakness, decreased appetite and weight loss. These are symptoms that also occur in cancer (B symptoms). Also rashes, joints- and muscle aches can be related to both cancer and rheumatic disease. If symptoms persist, a more thorough assessment with medical examinations and blood and urine samples is required.

Studies by suspected cancer (a selection)

  • Blood tests
  • Lung and chest CT (thoracic)
  • CT stomach area and pelvic (abdomen)
  • Mammography and gynecological examination in women
  • Stool samples
  • PET / CT if the investigation does not lead
  • The investigations are considered repeated if there is still suspicion of cancer

Rheumatic diseases (diagnoses) associated with cancer

Myositis / dermatomyositis

Myositis with typical skin changes (dermatomyositis, DM). Increased incidence also at Myositis type IMNM. With DM, there is a clearly increased risk of cancer (approximately 25% are diagnosed with cancer) in adults, most often with a onset in the same year as the rheumatic disease is diagnosed or in the following 2-3 years. About 2/3 of cancer cases are cancer of the cervix, lungs, ovaries, pancreas, bladder og stomach. Risk factors are high age at disease start (no increased cancer risk among children with DM (Juvenil DM)), Certain antibodies (blood sample): p-155 / 140 / TIF-Ƴ, NXP-2. Warning signs are new symptoms that can not be explained by muscle disease. (Reference: Dobloug C, 2015). Myositis is differenciated from muscle weakness by Myastenia gravis which can be triggered by cancer in thymus.

Rheumatoid arthritis (arthritis)

Approximately doubled the risk of lymphoma (Lymphomas, most often non-Hodgkin's lymphoma). Risk factors are high arthritis activity over many years, powerful immunosuppressive drugs and Felty's syndrome. Warning symptoms are rapid deterioration of otherwise long-term stable disease.

Sjögren's syndrome

It is increased incidence of non-Hodgkin's lymphoma. Risk during life is calculated to be 5-10%. Risk factors are high disease activity measured by frequent swelling of the large salivary glands (Glandula parotis), purpura (Vasculitis) in the skin and blood samples with low Complement C4. Warning symptoms are increasing general symptoms and changes in blood tests.

Systemic Lupus Erythematosus (SLE)

Slightly increased cancer risk, but without increased mortality observed. The frequency of Lymphomas, especially aggressive diffuse large cell B-cell lymphoma are increased. High disease activity, long-term disease and immunosuppressive treatment are risk factors. Warning symptoms include low white blood cells counts, swollen lymph nodes and enlarged spleen.

Systemic Sclerosis

There are various research results, but the risk can be 1,5 - 5,1 times increased lung cancer og non-Hodgkin's lymphoma. Also, some risk of esophageal cancer) may be expected, probably due to increased gastric acid reflux (Barett's oesophagus) over time. Warning symptoms are increasing lung problems with new CT lung changes, skin ulcers that do not grow and increase swallowing problems.

Overlapping symptoms

In the case of cancer, scleroderma-like symptoms, often with overlap with myositis and other connective tissue diseases, may occur (pseudo-scleroderma) (Reference: Frich L, 2019).

Bekterev's disease (ankylosing spondylitis) has not increased cancer risk

Psoriasis arthritis (psoriasis arthritis): No increased cancer risk

Granulomatosis with polyangiitis (GPA / Wegener's granulomatosis)

  • Skin cancer (non-melanoma type) may be increased during the first 2 year after diagnosis

Polymyalgia rheumatism: No increased cancer risk. If the onset symptoms are uncharacteristic, further investigation will still be recommended. However, polymyalgia rheumatica and similar muscle pain are a not uncommon side effect of cancer treatment with checkpoint inhibitors (please read more below under "Rheumatic complications of cancer treatment"

Temporalis arteritis (giant cell arteritis) No increased cancer risk. If the initial symptoms are non-typical for the disease, further investigation will be recommended

Medications against rheumatic disease and cancer

The indication for each drug must be evaluated against the risk of adverse effects on individual basis. Age, gender, family cases with cancer, prior chemotherapy or radiation therapy, many X-ray examinations and smoking should be included in the assessment.

People who have or have had cancer

Must be considered individually. Although the individual drugs do not show an increased risk of cancer development, immunosuppressive anti-rheumatic drugs may theoretically contribute to increased risk of proliferation or recurrence of known cancer. If one is in doubt, it is recommended that rheumatologist and cancer specialist make an individual patient assessment.

NSAIDs og cortisone: These drugs do not increase cancer risk

Azathioprine (Imurel) can derive from data for treatment of Rheumatoid arthritis over time, increase the risk of lymphomas. Data for SLE is too sparse to conclude.

Cyclophosphamide (Sendoxane) leads to increased risk of Lymphomas, Leukemia og urinary bladder cancer. However, data is based on long-term use with tablets. Modern anti-rheumatic treatment in the form of intravenous dosing over less than 6 months indicates little or no increased risk.

Hydrochlorochloroquine (Plaquenil) does not result in increased cancer risk

Methotrexate (Ebetrex, Metex, Methotrexate) have not shown an increased risk of cancer

Sulfasalazine (Salazopyrin) does not result in increased cancer risk

Biological drugs

Abatacept (Orensia): Too few observations to draw conclusions

Rituximab (MabThera): Data from more than 5000 patient-years with treatment do not indicate increased cancer risk, but non-melanoma skin cancer has not been evaluated.

TNF inhibitors (Infliximab, adalimumab, etanercept, cerulizumab, golimumab) do not seem to lead to increased cancer risk, but observation time is still somewhat short for sure conclusions.

Tocilizumab (RoActemra): Too few observations to draw conclusions

Literature

Rheumatism in cancer

  1. Rheumatic pain in direct tumor growth towards joints
  1. Rheumatic symptoms caused by cancer / Paraneoplastic (para-malignancy) rheumatic syndromes

  2. Rheumatic complications in cancer treatment

Literature


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