With improvements in medical facilities and equipment, patients with hemophilia have had longer life expectancy throughout the years. However, a new problem surfaces as these patients reach old age. Cancer is one disease that burdens patients with hemophilia as they get older. In combination with other conditions, hemophilia and cancer have become increasingly concerning. In this article, we will be exploring how hemophilia relates to cancer in terms of how they can affect one another. The article will also discuss the different challenges in treating and monitoring patients with hemophilia and cancer.
Hemophilia and its Types
Before we delve into its link to cancer, let us first understand what hemophilia is. Hemophilia is a health disorder that causes excessive bleeding due to the lack of coagulation factor proteins. These coagulation factors control bleeding by forming blood clots in the wound; hence, they are also called clotting factors. The type of hemophilia you have depends on which clotting factor you lack:
- Hemophilia A: The most common type of hemophilia that arises due to lack of clotting factor VIII.
- Hemophilia B: The type of hemophilia stemming from the lack of clotting factor IX.
- Hemophilia C: A rare type of hemophilia that occurs because of a deficiency in clotting factor XI.
Doctors most commonly treat hemophilia as an inherited condition. However, cases of hemophilia as a rare autoimmune disorder exist. Here are some of the symptoms of hemophilia that you should watch out for:
- Excessive bleeding from a wound
- Spontaneous nosebleeds
- Joint pain and tightness
- Bloody urine or stool
- Unusual bleeding after dental work
Life expectancy for patients with hemophilia increased because of the introduction of clotting factor concentrates. Medical professionals inject these concentrates into the patient’s bloodstream to balance the deficient clotting factor. However, the main concern right now is the development of other health conditions such as cancer as these patients age.
The Relationship Between Hemophilia and Cancer
Before the invention of the clotting factor concentrates, life expectancy of patients with hemophilia was low. At birth, they have a life expectancy of around 20-30 years. Life-threatening bleeding episodes cause the patient’s death. This changed around the 1960s when research for the therapy of hemophilia began. This development in medicine alludes to several studies exploring changes in the causes of death of patients with hemophilia and their life expectancy.
Connections between hemophilia and cancer began growing a decade after the development of the clotting factor concentrates treatment. This relationship especially holds true when the patient has also contracted a virus such as the human immunodeficiency virus or HIV. In a study conducted from 1978 to 1999, researchers found out that out of 89 patients with lymphoma, 72 of them had HIV and hemophilia. This marks one of the first large-scale studies to link cancer and hemophilia.
Moreover, patients with hemophilia are more susceptible to contracting the hepatitis C virus (HCV). In a research by the American Thrombosis and Hemostasis Network, patients older than 30 years and deficient in clotting factor VIII are around 50% more vulnerable to HCV infections. These patients are also at further risk of developing hepatocellular carcinoma (HCC).
On the other hand, researchers from the United Kingdom conducted a study compiled in 2007 comparing the general population and patients with hemophilia. It concluded that when viruses such as HIV do not infect patients, there seems to be no significant difference between the mortality due to cancer of those with hemophilia compared to those without hemophilia. The same study also mentions that patients with severe hemophilia live 15 years shorter than the general population. In fact, these patients only have a life expectancy of 63 years. The researchers believe that this decrease in life expectancy is due to those who suffer from liver cancer due to susceptibility to the hepatitis C virus.
Hemophilia, Cancer, and Life Expectancy
From the studies mentioned above, it appears that the link between hemophilia and cancer connects through other factors such as contracting viruses, especially HIV or HCV. When a patient with hemophilia contract such diseases, they are more susceptible to cancer.
On the contrary, data on the link between hemophilia and cancer without any other factored diseases have no significant conclusions. Nevertheless, there is an observed increase in mortality rates for those with hemophilia, and cancer is one of its causes. It appears that although life expectancy has lengthened from around 30 years then to approximately 60 years now, cancer is now the imminent problem for the elderly.
These developments in cancer became more concerning when in 2009, a study reported that patients with hemophilia aged 60 years and above could develop cancer five times more likely than the general population. These developments included HCC, colon cancer, prostate cancer, skin cancer, bladder cancer, and lymphoma.
This study prompted our medical professionals to discover newer techniques for treating hemophilia to lift the possible burden of cancer on patients in the future.
New Challenges to Treatment and Monitoring of Hemophilia
Aside from treatment using clotting factor concentrates, current treatment for hemophilia includes daily intake of multiple drugs. The prescription and combination of these drugs involve different specialized medical practitioners who specialize in the concerned organ. These drugs are now in development due to the tendency of hemophilia to produce comorbidities or other diseases such as cancer that may harm the patient further.
In monitoring loved ones with hemophilia for malignancy or cancer-related issues, these are the following check-ups recommended:
- For Hepatocellular Carcinoma (HCC) in patients with hepatitis C virus and cirrhotic patients:
- α-fetoprotein Tumor Marker Test once or twice a year
- Abdominal echography once or twice a year
- For Prostate Tumor:
- Annual Total Prostate-Specific Antigen (PSA) Test with prostatic fraction
- For Colorectal Cancer:
- Fecal Occult Blood Test (FOBT) every two years
- Colonoscopy every 5-10 years
- For Bladder Tumor:
- Annual urine examination with cytologic examination of urinary sediment.