What is a Kaposi Sarcoma?Kaposi sarcoma is a cancer type that develops in the lining of blood and lymph vessels. It is characterized by painless purplish spots on the legs, the mouth, the eyes, the feet, the face, or the anus. Tumors may also be seen in the genital area, the mouth, or the lymph nodes. In severe cases of Kaposi sarcoma, lesions may well develop in the digestive tract, the lungs, and the liver. Picture Courtesy: slideshare
How is Kaposi sarcoma diagnosed?Picture Courtesy: slideshare Kaposi sarcoma may be diagnosed with the following investigations:
- Physical examination: the doctor will examine the patient to look for abnormal signs in the skin, rectum, and mouth. The doctor will also check for lymph nodes.
- Skin biopsy: The doctor will remove a small piece of tissue from the lesion during this procedure. The pathologist will examine the sample to look for Kaposi sarcoma. Skin biopsies are of two types: core needle biopsy and surgical biopsy.
- Fecal occult blood test to detect hidden blood in the stool. The presence of blood in the stool can result from Kaposi sarcoma developing in the digestive tract.
- Chest X-ray.
- Upper endoscopy
- The exact type of Kaposi sarcoma helps predict how rapidly the disease can grow and spread.
- The population and location of the lesions.
- The kinds of problems the Kaposi sarcoma has led to.
- The individual’s overall health
What are the types of Kaposi sarcoma?Kaposi sarcoma is basically of four types:
- Epidemic or AIDS-associated Kaposi sarcoma: This type of Kaposi sarcoma affects those with HIV. It’s termed an AIDS-defining ailment because it is on the CDC’s list of conditions that signify the advancement of HIV infection to AIDS.
- Classic or Mediterranean Kaposi sarcoma: This is the type of Kaposi sarcoma found mainly in older men of Mediterranean, Middle Eastern, or Eastern European descent.
- Endemic Kaposi sarcoma: Commonly occurring in children and young people of African descent. It is known as African Kaposi sarcoma.
- Immunosuppressive Kaposi sarcoma: This type of Kaposi sarcoma usually develops in those who have undergone organ transplants and taken medications that slow down their immune system.
How is Kaposi sarcoma treated?
Antiretroviral treatmentFor those suffering from epidemic Kaposi sarcoma, antiretroviral treatment (ART) for HIV/AIDS is usually the first point of call, before any other treatments, to treat the tumor and reduce symptoms. ARTs may either be given alone or in combination with chemotherapy, depending on the spread of the disease and the symptoms displayed. In rare situations, ART can make pre-existing infections or Kaposi sarcoma worse. The reaction it causes is called immune reconstitution inflammatory syndrome, IRIS.
SurgeryThis is the complete surgical removal of the tumor and some surrounding healthy tissue. This is most suitable when the lesions are in a particular area or a few specific areas. There are, however, two (2) types of surgical procedures used for Kaposi sarcoma treatment.
- Curettage and electrodesiccation: The surgical procedure for Kaposi sarcoma treatment removes the tumor with a curette (a sharp spoon-shaped instrument). The area is then treated with an electrodesiccation (the use of an electric current to control bleeding and destroy any leftover cancer cells). This may, however, leave a flat, pale scar.
- Cryosurgery: Liquid nitrogen is used to freeze and destroy cells for this technique. This causes a blister, which later falls off. This may also leave a pale scar, and Kaposi sarcoma may require more than one freezing. Also known as cryotherapy or cryoablation.
Photodynamic therapyPhotodynamic therapy involves the injection of a light-sensitive substance into the lesion. This substance is left to remain in cancer cells longer than in healthy cells. A laser is directed at the injected lesion to destroy the cancerous cells that have absorbed the substance.
Radiation therapyThis involves the use of high-energy X-rays to destroy cancer cells. This treatment option can also be adopted as a palliative to improve the quality of life through the treatment of symptoms and side effects. Radiation therapy can be either of two types: external beam radiation therapy (which is when the radiation is given from a machine. It is also the most commonly used) and internal radiation therapy or brachytherapy (which is when the radiation treatment is given with the aid of implants).
Systemic therapy (therapies using medication)For systemic therapy, medications are adopted to destroy cancerous cells. The medications are given through the bloodstream to ensure they reach the cancer cells throughout the body. They could be given intravenously or as a pill or capsule taken orally. For Kaposi sarcoma treatment, the following are the systemic therapies that can be adopted.
- Chemotherapy: The use of medications to destroy cancerous cells and stop them from growing, dividing, and producing more cells. A chemotherapy regimen is given in several cycles over a set period. Sometimes, it is injected straight into the lesion to destroy the cells. When this is done, it is known as an intralesional injection, which often involves vinblastine (Velban) when used for Kaposi sarcoma treatment.
- Topical medications: This involves using skin creams to shrink or halt the growth of lesions. Although, topical creams do not halt all cancers. They, however, improve a person’s appearance.
- Targeted therapy: This treatment plan targets cancer-specific genes, proteins, or the tissue environment that aids cancer growth and survival. This treatment blocks cancer cells’ growth and spread while also limiting the damage to healthy cells. However, not all tumors have the same targets. Therefore, to design the most effective treatment, tests are done to identify the tumor’s genes, proteins, and other factors.
- Immunotherapy: Immunotherapy, or biologic therapy, is targeted at boosting the body’s natural defenses to enable them to fight against the cancer cells. For this, either materials made by the body are stimulated or commercially made in a laboratory to improve or restore immune system function.
What are the symptoms of Kaposi sarcoma?
Picture Courtesy: dermatologia
Symptoms of the Kaposi sarcoma include:
- Lesion on the skin- Cancerous lesions on the skin are usually purple, red, or brown in color. They can appear either flat or raised; in just one area or multiple areas. They are disfiguring and commonly appear on the feet, legs, and face.
- Lesion on the mucous membrane – Lesions on mucous membranes, such as the mouth, anus, or somewhere else in the gastrointestinal tract.
- Lesion inside the body – When lesions are present inside the body, such as the lungs, the patient can find difficulty breathing or may cough up blood. If the lesion is present inside the GI tract, then the lesion can cause pain and bleeding, which may eventually lead to anemia.
- Lymph nodes – involvement of lymph nodes, particularly in the groin area, can be associated with painful swelling in the leg.
What causes Kaposi sarcoma?
Kaposi Sarcoma is caused by the human herpesvirus 8 (known as HHV-8), also known as Kaposi sarcoma-related herpesvirus (KSHV). It mainly spreads through saliva, for example, during sexual interaction or interactions between mother and child.
HHV-8 infection is usually asymptomatic because the immune system keeps it tamed. Therefore, those with healthy and well-functioning immune systems may carry the virus with no problems. However, it can trigger Kaposi sarcoma in people with weakened immune systems.
- What is the prognosis for Kaposi sarcoma?
The prognosis of Kaposi sarcoma depends on the type of sarcoma. In most cases, the Kaposi sarcoma can be treated by following the early diagnosis and early treatment rule. According to the National cancer institute, a relatively 5-year survival rate is seen in about 72% of the cases. With advancements in technology and treatment options, these numbers are likely to continue rising.
- What are the most common risk factors associated with Kaposi sarcoma?
The most common risk factors associated with Kaposi sarcoma are listed below:
- Ethnicity- people from the Mediterranean or Jewish and equatorial Africans have a high risk of developing Kaposi sarcoma.
- Gender- Compared to women, men are at a higher risk.
- People with a compromised immune system.
- Infection with HHV-8 (Human Herpes Virus)
- Sexual activity
- Can Kaposi sarcoma be cured?
In most cases, doctors can treat Kaposi sarcoma. However, it depends on several factors, such as the type of sarcoma, chosen treatment method, early diagnosis, and early treatment.
- Does Kaposi sarcoma go away on its own?
No, Kaposi sarcoma cannot be left untreated. The sarcoma needs to be diagnosed early, and treatment should be started as early as possible for a better outcome. Kaposi sarcoma can be fatal if left untreated.
- Kaposi sarcoma is caused by which virus?
Kaposi sarcoma is caused by the HHV-8 virus (Human Herpes Virus-8)
- Can Kaposi sarcoma be transmitted?
Kaposi sarcoma can be transmitted via sexual and non-sexual routes such as saliva contact, blood transfusion of contaminated blood, and tissue transplant.