Discussing Kaposi’s sarcoma (KS), it is essentially a vascular tumour that originates from the cells that surround the lymphatic or blood channels. Since these blood vessels are found all over the body, Kaposi’s sarcoma can arise in multifocal sites. It is seen primarily at mucocutaneous sites,that is skin and mucous membranes, but it may involve all organs and anatomic locations.
Kaposi’s Sarcoma cause purplish, red, or brown blotches or tumours on the skin, otherwise known as lesions. Most often, the skin lesions of Kaposi’s sarcoma occur on the legs, back or face.
Most of the skin lesions of Kaposi’s Sarcoma are asymptomatic. But sometimes, it can cause some serious problems or even turn into life threatening if lesions are in the lungs, liver, or digestive tract. When Kaposi’s sarcoma occurs in the digestive tract, for example, we see chronic bleeding in the tract, while tumours in the lungs may cause trouble breathing.
What are the types of Kaposi’s sarcoma ?
The classification of Kaposi’s sarcoma is done based on the populations it affects. The basic pathology behind each is still similar.
Kasposi’s Sarcoma has four classifications, based on varying clinical characteristics and risk factors.
- Epidemic (AIDS-related)
- Classic (Mediterranean)
- Endemic (African) &
- Secondary to iatrogenic immunosuppression.
1) Epidemic (AIDS-related) Kaposi’s sarcoma : Kaposi’s Sarcoma sprang into prominence, in the 1980’s, as modern society got afflicted by Acquired Immuno Deficiency Syndrome (AIDS) at that time. This variant of Kaposi’s Sarcoma occurs in people who have the Human Immunodeficiency Virus (HIV) infection. Basically, this virus is the culprit behind Acquired Immuno Deficiency Syndrome. What HIV does is, it targets and destroys the immune system, thus letting other diseases spring up in affected people. It is then that other viruses such as the Kaposi sarcoma herpesvirus/ human herpesvirus 8 (KSHV/HHV8) attack and cause Kaposi’s Sarcoma. Kaposi’s Sarcoma falls under the category of an “AIDS defining” illness. Basically, what this implies is that when Kaposi’s Sarcoma is seen in an HIV positive person, it confirms full-fledged AIDS and not just HIV positivity.
2) Classic (Mediterranean) Kaposi’s sarcoma : Classic Kaposi’s sarcoma affects a particular age group and a particular race. The Mediterranean or Eastern European people of elderly ages are primarily affected. Unlike the HIV variant, here the affected patients are immunocompetent. It is a relatively slow-progressing and benign form of the cancer.
3) Endemic (African) Kaposi’s sarcoma : As the name suggests, this type is endemic to Africa, especially the Central and Eastern parts. It mostly is seen affecting adults. As the Kaposi’s sarcoma associated herpesvirus infection is far commoner in Africa than in other parts, the risk of is higher. Other factors in Africa that weaken the immune system (these include malaria, infections, and poor nutrition) also have a contributing role to play in the development of Kaposi’s sarcoma.
4) Kaposi’s sarcoma secondary to Iatrogenic Immunosuppression : Iatrogenic Kaposi’s sarcoma is found in people with depressed immune systems, principally in patients who have gotten organ transplants. These people are given corticosteroids and immunosuppressants (antirejection medicines) so that their body does not reject the transplanted organ, and this lets other infections and cancers to occur in the body.
Do we know what causes Kaposi’s sarcoma ?
Kaposi’s sarcoma is a low-grade, vascular tumour caused by a virus. This virus is known as the Kaposi sarcoma herpes virus/human herpes virus 8 (KSHV/HHV8). Discussing the virus, the Kaposi sarcoma associated herpes virus (KSHV) belongs to the same family as Epstein-Barr virus (EBV), the virus that is linked to several other types of cancer.In Kaposi’s sarcoma, the cells that line blood and lymphatic vessels (also known as endothelial cells) are infected with the virus. The virus carries genetic material into the cells that can make the cells divide uncontrollably and live longer than they ought to. These changes may ultimately transform them into cancer cells.
What are the symptoms of Kaposi’s sarcoma ?
Kaposi sarcoma usually appears first as spots, better known as lesions on the skin. These lesions can have varied appearances, ranging from purple, red to brown in colour. Kaposi sarcoma lesions evolve in three stages. They start from early, flat (patch stage) macules, evolving into slightly raised plaques (plaque stage) and which finally grow into outsized nodules or bumps (tumour stage or the nodular stage). Newer histologic variants are also being added to the description.Kaposi sarcoma lesions are known to basically affect skin, although they can also be seen in other areas, as well. It can be seen developing on mucous membranes (a mucous membrane is a lining of a part within the body), for instance the lining in the mouth, nose, eyes or gastro-intestinal tract. The lesions generally are not tender, painful or itchy.Kaposi’s sarcoma lesions can also sometimes appear in other vital parts of the body. Lesions in the lungs may obstruct the air pathways and cause shortness of breath. Lesions that develop in the gastrointestinal tract or the stomach and intestines can cause bleeding seen in stools (malena), abdominal pain or also diarrhoea.
How is Kaposi sarcoma diagnosed ?
First and foremost, we can suspect Kaposi’s sarcoma, based on the clinical picture of the lesions we see. That is reddish- purplish, cutaneous lesions that can have varying sizes, shapes and surface textures. The lesions can either be single and localized or disseminated and widespread. Kaposi’s sarcoma along with HIV/AIDS should make the diagnosis confirmative for the physician.
If local or regional lymph nodes are swollen, that also points to the diagnosis. Nevertheless, biopsy is compulsory to diagnose and institute therapy. Tissues should be examined pathologically by a practised histopathologist.
Latency-associated nuclear antigen (in the virus that causes Kaposi’s Sarcoma-the HHV-8) is the most definite and precise immunohistochemical marker existing to help tell between Kaposi’s Sarcoma and other similar diseases.
Testing
Any patient with a diagnosis of Kaposi’s sarcoma must have the HIV test done. Positive cases should be investigated for differential lymphocyte counts tested and estimation of HIV viral loads. The laboratory findings mostly indicate the patients are anemic, thrombocytopenic, or neutropenic. Complete blood counts need to be assayed.
Testing of all the organ functions have to be carried out. Renal function studies, cardiac function tests, liver function tests and coagulation assays are recommended.
How is Kaposi’s sarcoma treated ?
Single, asymptomatic, non-ulcerated patch lesions can be treated with proper combination antiretroviral therapy. Surgical excision is recommended if lesions are symptomatic, although this is contentious, as there is a tendency for more lesions to spring up from the edges of the excisional wound. Radiation therapy can also be used for local or regional lesions.
How do we administer care for Kaposi’s sarcoma ?
The clinical need is antiretroviral therapy, and the issues surrounding HIV. Care facilities need to be proficient at managing services for HIV-positive patients, including monitoring of the HIV parameters such as CD-4 counts and management of HIV related diseases and complications. Organ functions should be monitored as well. For Kaposi’s sarcoma, care has to be taken of patients while undergoing parenteral chemotherapy.
Can Kaposi’s sarcoma be prevented ?
As Kaposi’s sarcoma (KS) is caused by the Kaposi’s sarcoma associated herpesvirus (KSHV), preventing the infection by the virus can prevent Kaposi’s sarcoma. There are no vaccines against Kaposi’s sarcoma associated herpesvirus (KSHV). Taking preventive measures against HIV could prevent most cases of Kaposi’s sarcoma in this country.
Can Kaposi’s sarcoma be found early ?
It is recommended that people infected with HIV be examined habitually by health care professionals who are experts on recognizing Kaposi’s sarcoma and all the other diseases that occur after HIV infection and AIDS.
How to find and reach cancer specialists for the treatment of Kaposi’s sarcoma ?
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Find, reach and choose a cancer specialist for the treatment of Kaposi’s sarcoma on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
