Kaposi's sarcoma (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor-In-Chief: Jinhui Wu, M.D.

Overview
Kaposi sarcoma (KS) is a cancer caused by the Kaposi sarcoma herpesvirus (KSHV). Someone who is infected with KSHV is more likely to develop Kaposi sarcoma if he is infection with the human immunodeficiency virus (HIV). Usual symptoms may be lesions on the surface of skin, or painful swelling in the legs, groin area, or skin around the eyes. Besides, Kaposi's sarcoma can cause serious problems such as bleeding and difficulty breathing when the lesions are in internal organs. Treatments include local therapy, radiation therapy, chemotherapy and biologic therapy.

What are the symptoms of Kaposi's sarcoma?
Usual symptoms include skin and internal organs.


 * Lesions in skin: The lesions can develop anywhere on the body, but most often on the legs, nose, the feet. Typical lesions begin as flat or slightly raised pink or red spots. With the developement of the disease, the colour of the lesions may be change into blue, purple, or brown.


 * Lesions in mouth and throat: The disease may cause sore, ooze, bleed, or swallow and breath problems in mouth and throat.


 * Lesions in gastrointestinal tract: The sarcoma may cause bleeding, anemia, abdominal pain and discomfort, even bowel obstruction.


 * Lesions in lung: When Kaposi's sarcoma in lung, it can make coughing, bloody sputum, shortness of breath, and fever.

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

What causes Kaposi's sarcoma?
Before the AIDS epidemic, Kaposi's sarcoma was seen mainly in elderly Italian and Jewish men, and rarely, in elderly women. Among this group, the tumors developed slowly. In AIDS patients, the cancer can develop quickly. The cancer may also involve the skin, lungs, gastrointestinal tract, and other organs.

In people with AIDS, Kaposi's sarcoma is caused by an interaction between HIV, a weakened immune system, and the human herpesvirus-8 (HHV-8). Kaposi's sarcoma has been linked to the spread of HIV and HHV-8 through sexual activity.

People who have kidney or other organ transplants are also at risk for Kaposi's sarcoma.

African Kaposi's sarcoma is fairly common in young adult males living near the equator. One form is also common in young African children.

Who is at highest risk?
Clinical data has suggested that the development of kidney cancer is related to several factors.


 * Infection with Kaposi sarcoma herpesvirus (KSHV): Kaposi's sarcoma only develops in people who are infected with KSHV.


 * Immune deficiency: A defect in the immune system increases the chance to developing Kaposi's sarcoma, especially when people with AIDS.


 * Race: Epidemiological data show that people in Eastern European, Mediterranean, and Middle Eastern descent have a higher rate of getting Kaposi's sarcoma.


 * Gender: Men are much more likely to get Kaposi's sarcoma than women in many places. But in Africa, men, women and children are all at risk of Kaposi's sarcoma


 * Sexual activity: Scientists have found faggotry are more likely to get Kaposi's sarcoma than Lesbian.

When to seek urgent medical care?
Kaposi's sarcoma in internal organs is a tumor that cannot be found early. If symptoms of Kaposi's sarcoma develop, go to see your doctor as soon as possible:


 * Severe gastrointestinal tract bleeding
 * Severe breath prolem

Diagnosis

 * Biopsy: For the skin lesions, biopsy is the best way to detect whether the lesion is Kaposi's sarcoma or not. In this procedure, the doctor usually performs a punch biopsy and removes a tiny round piece of tissue. Then, the pathologists can detect the tissues under the microcope.


 * Computed tomography (CT) scan: CT scans are often used to show abnormal in the lung. It can confirm the location of the cancer and show the organs near the lung as well as lymph nodes.


 * Bronchoscopy and biopsy: This is the way to remove the abnormal tissues in the lung and to detect whether it is Kaposi's sarcoma or not by the pathologist.


 * Gastrointestinal endoscopy and biopsy: This is the way to remove the abnormal tissues in the gastrointestinal tract and transfer to the pathologist to detect whether it is Kaposi's sarcoma or not.

Treatment options
Patients with Kaposi's sarcoma have many treatment options. The selection depends on the stage of the tumor. The options are local therapy, radiation therapy, chemotherapy, biologic drugs treatment, or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effect may not be the same for each person, and they may change from one treatment session to the next.


 * Local therapy


 * Topical treatment: This is the treatment to put medicine directly on the lesions.
 * Cryosurgery: During this procedure, the doctor use a probe cooled with liquid nitrogen to freeze the lesions.
 * Intralesional chemotherapy: In this procedure, the chemotherapy drug is injected directly into the Kaposi's sarcoma lesions.


 * Radiation therapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation.


 * Chemotherapy: The treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing


 * Biologic therapy: This treatment uses chemicals such as interferon alpha to help the immune system attack cancer cells.

Diseases with similar symptoms

 * Lesions in skin


 * Skin cancer
 * Seborrheic Keratosis
 * Erythematous lupus


 * Leisons in lung


 * Lung cancer
 * Metastatic lung cancer


 * Lesions in gastrointestinal tract


 * Peptic ulcer
 * Gastrointestinal tract cancer
 * Crohn's Disease and ulcerative colitis

Where to find medical care for Kaposi's sarcoma?
Directions to Hospitals Treating Kaposi's sarcoma

What to expect (Outook/Prognosis)?
The prognosis of Kaposi's sarcoma depends on the following:


 * The type of Kaposi sarcoma
 * Whether the cancer has spread
 * Whether the cancer has just been diagnosed or has recurred
 * The patient's general health, especially the immune system.

Prevention

 * Avoiding the infection of HIV:


 * Avoiding unprotected sex with people infected with HIV
 * Using a condom during any sexual contact
 * Do not use contaminated needles to inject recreational drugs


 * For people infected with HIV, reducing the chance to develope Kaposi's sarcoma:


 * Highly active antiretroviral therapy (HAART)
 * Taking drugs such as ganciclovir or foscarnet to block herpesvirus