Have you ever wondered if autoimmune diseases can make someone more prone to developing cancer? Are there any autoimmune diseases linked to certain types of cancers? How about the treatment used to treat autoimmune diseases? Do they cause cancers? And if you have cancer, will the treatment used to treat the cancer increase your risk for autoimmune diseases?
These are the questions that many patients seen in my clinic, Rheumatologist OnCall will ask.
Why Cancer Happens in Patients with Autoimmune Diseases?
The connection between autoimmune diseases and cancer isn’t coincidental. Autoimmune diseases are not just about the immune system attacking healthy tissues; they also create conditions where cancer can thrive. But how exactly does this happen?
Chronic inflammation and immune dysfunction are at the heart of this connection.
Think of inflammation as a double-edged sword. While it’s the body’s natural response to injury or infection, prolonged inflammation is a problem. Imagine a fire constantly burning in your body—this is what chronic inflammation feels like.
Over time, this inflammation damages tissues, weakens repair mechanisms, and increases the chances of cellular mutations, setting the stage for cancer.
Additionally, immune system dysfunction in autoimmune diseases sometimes fails to detect and destroy cancerous cells. In autoimmune diseases, the immune system is out of balance. It mistakenly attacks healthy tissues but might also fail to recognize and eliminate cancer cells, giving malignancies a chance to grow unchecked.
Plus, many autoimmune disease treatments, such as immunosuppressive drugs, weaken the immune system’s ability to fight off cancer cells, inadvertently increasing the risk of malignancies.
This interplay of factors creates a perfect storm, linking autoimmune diseases and cancer
What Are the Most Frequent Cancers in People with Autoimmune Diseases?
Not all cancers are equally common in people with autoimmune diseases. Here are the ones most frequently observed:
- Lymphomas: These are strongly associated with autoimmune diseases like rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and Sjögren’s syndrome. Non-Hodgkin and Hodgkin’s lymphomas are particularly common in patients with SLE and Sjogren’s disease.
- Lung Cancer: A significant risk for patients with RA and systemic sclerosis. Chronic inflammation and scarring in lung tissues create an environment where cancer can develop.
Skin Cancers: Immunosuppressive therapies often increase the risk of basal and squamous cell carcinomas. Some studies also suggest an increased melanoma risk in autoimmune patients on certain medications like TNF- alpha inhibitors. - Bladder Cancer: Frequently linked to the use of cyclophosphamide, a drug commonly prescribed for severe autoimmune diseases like vasculitis and lupus nephritis.
- Breast and Ovarian Cancers: These are more common in patients with systemic sclerosis and dermatomyositis.
What Autoimmune Diseases are Linked to Cancer?
Dermatomyositis
Dermatomyositis is a rare autoimmune disease with a striking connection to cancer. Did you know that up to 20% of patients with dermatomyositis will develop cancer? The risk is highest in the first five years after diagnosis. Common cancers include ovarian, lung, pancreatic, and stomach cancers. Patients with specific autoantibodies, like TIF1-gamma, are at even greater risk. Regular screenings are crucial for early detection.
Polymyositis
Polymyositis shares similarities with dermatomyositis but has a slightly lower cancer risk. Lung cancer, bladder cancer, and non-Hodgkin lymphoma are among the malignancies associated with this condition. Chronic muscle inflammation creates an environment conducive to cancer development, making vigilance essential.
Rheumatoid Arthritis (RA)
Did you know that people with RA are twice as likely to develop lymphoma? Chronic inflammation and immune dysregulation are the culprits. Lung cancer is another common malignancy linked to RA, particularly in smokers or patients with long-standing disease. This dual risk highlights the importance of managing inflammation and maintaining healthy lungs.
Systemic Lupus Erythematosus (SLE)
Patients with SLE face a significantly increased risk of lymphomas, especially non-Hodgkin lymphoma. Virus-associated cancers, such as those linked to Epstein-Barr virus, are also more prevalent in this group. Interestingly, SLE patients have a lower risk of breast and prostate cancers compared to the general population.
Sjögren’s Syndrome
This condition isn’t just about dry eyes and mouth. Sjögren’s syndrome is closely linked to lymphoproliferative cancers like mucosa-associated lymphoid tissue (MALT) lymphoma. Chronic inflammation in the salivary glands drives this increased risk, making early diagnosis and management critical.
Systemic Sclerosis (Scleroderma)
Systemic sclerosis significantly raises the likelihood of lung, liver, and bladder cancers. Patients with RNA polymerase III antibodies are particularly prone to malignancies, including breast cancer. The risk is especially high in patients with interstitial lung disease, emphasizing the need for regular monitoring.
Can Cancers Mimic Arthritis and Autoimmune diseases?
Could your arthritis actually be a sign of cancer? Some cancers can mimic autoimmune arthritis, making diagnosis challenging. Here are examples to watch for:
- Paraneoplastic Polyarthritis: This condition can feel just like rheumatoid arthritis but is often linked to solid tumors like lung and breast cancers. The key is identifying unusual patterns, such as rapid progression or lack of typical RA markers.
- Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE): Commonly associated with hematologic cancers like leukemia and lymphoma, RS3PE presents with swelling and stiffness in the hands and feet. This condition often resolves when the underlying cancer is treated.
- Hypertrophic Osteoarthropathy: Frequently tied to lung cancer, this condition causes joint pain, swelling, and digital clubbing. Symptoms may precede cancer diagnosis, acting as an early warning sign.
- Leukemia: Acute leukemia can present with migratory arthritis and severe bone pain, mimicking inflammatory arthritis. Early recognition is crucial for timely treatment.
Can Antirheumatic Drugs That May Increase Cancer Risk?
Certain medications used to treat autoimmune diseases can inadvertently increase cancer risk, but this is often debatable. Some studies support this association, while other studies dont. Here’s what you need to know:
- Cyclophosphamide: A powerful immunosuppressive drug was linked to bladder cancer. Patients should undergo regular urinary screening.
- Methotrexate: There’s ongoing debate about whether methotrexate increases lymphoma risk. Close monitoring is recommended for long-term users.
- TNF Inhibitors: While these biologics revolutionized autoimmune disease treatment, they slightly elevate the risk of skin cancers. Patients should remain vigilant for unusual skin changes.
Recommendations for Cancer Prevention
- Routine Screening: Age- and sex-appropriate cancer screenings should be part of every autoimmune patient’s care plan. Early detection saves lives.
- Risk Stratification: Evaluate each patient’s unique risk factors, including specific autoantibodies and family history, to customize monitoring.
- Healthy Lifestyle Choices: Smoking cessation, regular exercise, and a nutrient-rich diet can significantly lower cancer risk.
Can Cancer Treatments That Cause Arthritis and Autoimmune Diseases?
New treatments like immunotherapy, as well as older treatments used for cancer treatments, seem to increase the risk of activating the immune system and causing autoimmune diseases. They can look like RA, dermatomyositis, and even lupus.
Immune Checkpoint Inhibitors
Immune checkpoint inhibitors, a type of immunotherapy, are a breakthrough in cancer treatment, but they can trigger autoimmune-like side effects. These include:
- Inflammatory arthritis
- Vasculitis
- Polymyalgia rheumatica
These conditions often resolve with immune-modulating therapies, but careful management is needed.
Chemotherapy Agents
- Taxanes: Often used in breast cancer treatment, taxanes can cause joint pain and stiffness. Physical therapy can help manage symptoms.
- Bleomycin: Linked to systemic sclerosis-like symptoms and skin tightening.
- Aromatase Inhibitors: Commonly cause joint pain in breast cancer patients, often requiring supportive care.
Radiation Therapy
Radiation therapy can lead to localized fibrosis, resembling systemic sclerosis. It’s also known to cause hypothyroidism, which results in muscle weakness and joint pain. Monitoring and early intervention can minimize long-term effects.
Thus, the connection between autoimmune diseases and cancer is more than a coincidence—it’s a complex interplay of inflammation, immune dysregulation, and treatment effects. Whether it’s cancer increasing the risk of autoimmune conditions or vice versa, understanding this relationship is key to early detection, prevention, and management. Patients can navigate this dual challenge with resilience and hope by staying informed, advocating for regular screenings, and balancing treatment approaches.