Solid Tumors

In several case studies, patients with SLE were found to develop various cancers including, lung, breast, gastrointestinal and gynecological [5, 6, 10-16, 44, 45].

Two of the SLE-cancer cohorts [12, 15] have no indication of an increased risk of solid tumors among patients with SLE. However, the data from Danish SLE cohort [16] have shown a significantly increase risk for hepatoma (RR = 8), lung cancer (RR = 1.9) and cancers of the vulva/vagina (RR = 5.7). However, this cohort included only SLE patients who were hospitalized. Patients followed-up only at out patient clinics were not included. Therefore, the increased risk of hepatoma, lung cancer and malignancies of the vulva and vagina in this cohort may be the result of a selection bias. In the second study [13], an increased risk of soft-tissue sarcoma (RR 49, CI 6, 177) was observed. However, these data were based only on 2 cases of soft-tissue sarcoma and the clinical significance of this finding is not clear. A thorough search of the literature has not revealed a similar association between SLE and soft-tissue sarcomas.

An increased risk of cervical cancer among patients with SLE has been suggested in a small series of patients [8, 9]. Other studies have indicated an increased frequency of cervical atypia and cervical intraepethilial neoplasia [46-47].

Urinary bladder cancer and squamous cell carcinoma (SCC) were found to be associated with SLE. A strong association was suggested between bladder cancer and treatment with cyclophosphamide for SLE [48], However, in 5- and 10-year follow-up studies, none of 38 patients with lupus nephritis who were treated with cyclophosphamide developed bladder cancer [49-50],

Patients with chronic discoid lesions were reported to develop SCC of the skin inside the discoid rash [51]. The SCC lesions in patients with SLE were reported to be multiple and highly fatal [52]. Dabaki et al. [51] described 2 SLE patients who developed SCC of the skin. The first patient was white and his SCC of the skin was rapidly metastatic. The second patient was black and had developed SCC at seven different sites over his skin.

The association between thymoma and autoimmunity is of a great interest [53], SLE has been associated with thymoma. SLE may develop concurrently or subsequently to thymoma. It has been reported that more than 30% of patients with thymoma develop autoimmune diseases including, myasthenia gravis, pure red cell aplasis, pemphigus and SLE. Thymectomy may result in regression of the autoimmune diseases [53] in a large number of the patients.

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