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KAPOSI’S SARCOMA

Kaposi’s sarcoma is a type of cancer that begins from cellular structures like the blood vessels and lymph nodes. They typically appear as painless purplish or red spots  on the skin, genitals  and lining of the mouth, although they can appear in different organs like the liver, lungs. stomach and bowel at the same time.  

There were several reports of Kaposi’s sarcoma in Africa that started in 1947. The number of cases has now increased so much that it is now an endemic. African population suffering from immunosuppression suffer from Kaposi Sarcoma the most. The problem with Kaposi’s sarcoma in Africa is so serious that a type of disease exists with its name.  

Types of Kaposi’s Sarcoma

There are four types of Kaposi’s sarcoma. The type of population depends on the population that it affects.  

Epidemic Kaposi Sarcoma (HIV-related)

This type of Kaposi’s sarcoma is most common in the United States. It develops in a population that already suffers from HIV. This means that those with weakened immune systems caused by HIV have the highest risk of Kaposi’s sarcoma if they have HHV8 – the virus that causes Kaposi’s sarcoma.

Classic Kaposi Sarcoma (Mediterranean)

This type of Kaposi Sarcoma occurs in older adults. It usually affects the older male from the Mediterranean. Eastern European or the Middle East. People suffering from this type do not usually have fast-growing lesions and usually found on the legs and skin. The leading cause can be because of a weak immune system in older people.  

Endemic Kaposi Sarcoma (African)

This type usually affects people that live in Equatorial Africa.  and is more prominent in areas where HHV8 is common. A subtype of this disease is Kaposi Sarcoma Associated Herpesvirus (KSHV) infection. A distinguishing factor in this type is that it can affect young people as well. African Kaposi’s Sarcoma tends to progress rapidly. 

Iatrogenic Kaposi Sarcoma (Transplant Related)

Iatrogenic Kaposi Sarcoma occurs in people who suffer from immune system suppression caused by organ transplants. This is because patients who have organ transplants have to take immune suppressing drugs to reduce the risk of the body rejecting the donated organ. Discontinuation of these drugs can make Kaposi Sarcoma go away.  

 

Symptoms of Kaposi’s Sarcoma

Symptoms of Kaposi Sarcoma depends on the organ that it majorly affects 

  • If on the skin, it can appear as a patch, slightly raised area or a raised bump (nodule).
  • If the disease affects the mucous membrane, then it may affect the throat and mouth. Such people may find trouble swallowing or eating. It may affect eyes or eyelids.  
  • If the disease affects the lymph nodes, it can cause swollen lymph nodes
  • If the disease affects the digestive system, it can cause vomiting, diarrhoea and stomach pain.
  • The lesions may bleed occasionally and cause cause anaemia.

Causes of Kaposi’s Sarcoma  

  • Viral Infection 

Kaposi Sarcoma is caused by a virus called  human Herpes virus (HHV-8). When infected, it usually causes no symptoms in people with strong immune systems. It is common among the African population.

Diagnosis

Biopsy

A  biopsy may be performed on a lesion if your doctor suspects Kaposi’s sarcoma. This involves taking a sample of the tissue and examining it under  a microscope in the laboratory.

Chest X-ray:

This may show abnormal lesions or growths in the lungs which may suggest Kaposi’s sarcoma.

Colonoscopy

A thin tube called a colonoscope is passed through the back passage into the colon to examine the walls of the organs for Kaposi’s sarcoma in the rectum or colon.

Staging

Stages of the Classic Kaposi Sarcoma are as follows; 

Stage 1

It contains small macules and nodules. However, this stage 1 is only restricted to the lower extremities. 

Stage 2

This is the infiltrative type of Kaposi Sarcoma. It involves plaques limited to the lower extremities. It may sometimes contain nodules.

Stage 3

This is a florid type of Kaposi Sarcoma. It contains multiple plaques that are angiomatous in nature. Nodules may contain ulcerations.

Stage 4

This is the disseminated type of Kaposi Sarcoma. It contains angiomatous nodules as well as plaques. This extends further from the lower extremities. 

Treating Kaposi’s Sarcoma

Kaposi’s Sarcoma has different clinical manifestations and this will determine the type of treatment needed.

Most often, the doctor may recommend a combination of treatments. These treatments work on the elimination of the disease and its management. 

  • In cases that portray the involvement of skin, the doctor may locally excise the skin. Another method is to apply liquid nitrogen or injecting vincristine. 
  • For HIV-related Kaposi’s sarcoma, the treatment would be to start an antiviral drug combo, which  is called anti-retroviral therapy. This works by reducing the level of HIV virus in the body and boosting immunity.
  • The doctors may only recommend chemotherapy to treat Kaposi Sarcoma in children. This is most common in endemic and systemic forms of the disease. 
  • If it is an advanced stage, systemic chemotherapy should be used.
  • For transplant-related Kaposi’s sarcoma, it can controlled by reducing or stopping the immunosuppressant drugs. If this doesn’t work, chemotherapy is used.
  • Classical cases of Kaposi Sarcoma is sensitive to radiotherapy. This sensitivity makes it easily treatable with the help of radiation. Palliative therapies help to reduce pain, swelling, and bleeding in the patient. 

REFERENCES 

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