Kaposi's sarcoma: symptoms, causes and treatment

Definition

What is Kaposi's sarcoma (SK)?

Kaposi's sarcoma (SK) is a type of cancer that develops in the tissues around the blood vessels and lymph vessels. Usually, this disease appears as a tumor on the skin or on the surface of the mucous membrane (mucosa) in the mouth.

However, these tumors can also appear in other parts of the body, such as the lymph nodes, lungs, or gastrointestinal tract.

This cancer is divided into several types. More specifically, the types of Kaposi's sarcoma are:

AIDS-related epidemic Kaposi sarcoma

This type is most common in people in the United States, namely in people who are infected with HIV. So, someone who has this type of Kaposi's sarcoma, automatically himself also has AIDS.

HIV itself is a human immunodeficiency virus, which is the virus that causes AIDS. A person with AIDS will experience severe immune system damage, so he is very susceptible to various types of infections.

Classic Kaposi sarcoma

This type of cancer generally affects elderly men, rather than women living in Eastern Europe, the Middle East and the Mediterranean coast. The growth of abnormal tissue lesions is slow and more likely to affect people who are infected with HPV (human papilloma virus).

Endemic Kaposi sarcoma

This type of cancer generally affects African people who are infected with the herpes virus, or another disease that causes the immune system to become weak. This cancer is also more susceptible to attacking young people and can spread quickly.

Iatrogenic Kaposi sarcoma (transplant-related)

This type of cancer occurs after an organ transplant is performed. A patient who receives an organ transplant is usually asked to take drugs that suppress the immune system.

The goal is that the immune system does not reject and attack the new organ that is paired. Unfortunately, the use of these drugs can trigger the cells in the vessels to become abnormal.

How common is this cancer?

Kaposi's sarcoma is a type of cancer that can affect anyone. Based on 2018 Globocan data, new cases of Kaposi's sarcoma reached 91 people with a death rate of 63 people.

Signs & symptoms

What are the signs and symptoms of Kaposi's sarcoma (SK)?

The symptoms of Kaposi's sarcoma vary widely, but the ones that generally appear are:

Lesions appear on the face and legs

Lesions are abnormal tissue on the skin. Initially, the disease causes lesions that are purple, red, or brown spots. If observed, the lesions can be patches, which are flat on the skin or do not cause lumps.

It can also protrude slightly upwards and this is called plaque. Sometimes they are in the form of a lump that is clearly visible and this is called a nodule. Most often these lesions appear on the foot or face area. However, it can also appear in other areas such as the groin.

Swelling of the lesion

The appearance of the lesions can cause the flow of fluid in certain areas to become obstructed. As a result, swelling will occur accompanied by severe pain. Generally, the symptoms of Kaposi's sarcoma occur in lesions of the feet and groin.

Lesions on the mucous membrane or other areas of the body

Lesions that appear not only on the feet or face. These lesions can also appear in areas of the mucous membrane (mucosa), such as the inside of the mouth, throat, outer area of ​​the eye and the inside of the eyelids. However, these lesions usually cause no pain or itching.

Lesions can also appear in the lungs and can block part of the airway, causing symptoms of shortness of breath. Lesions that form in the lining of the stomach or intestines, can cause symptoms of abdominal pain and diarrhea.

Bleeding in the lesion

The lesions that appear can sometimes bleed. If the lesion is in the lungs, it will cause coughing up blood and shortness of breath. Meanwhile, if the lesion is in the area of ​​the digestive system, the stool will turn black, slimy, or there are blood spots around it.

This internal bleeding if not treated over time can cause anemia (low red blood cell count). As a result, you will feel very tired and often short of breath.

When to see a doctor?

Immediately see a doctor, if you experience the symptoms of cancer mentioned above. Especially if you do not know the exact cause and the condition does not improve after treatment.

Each person may experience different symptoms, which are not listed in the description above. Talk to your doctor about this worrying symptom further.

Cause

What causes Kaposi's sarcoma (SK)?

The cause of caposi sarcoma is a viral infection, such as human herpesvirus 8 (HHV8). This virus is in the same family as the Epstein-Barr virus, which causes infectious mononucleosis and is linked to several types of cancer, one of which is nasopharyngeal cancer.

In this cancer, the cells lining the blood vessels and lymphatic vessels (endothelial cells) are infected by a virus. Then, the virus enters the genes in the cell and causes damage so that the cell divides too much and does not die. These abnormal cells will later cause cancer.

Risk factors

What increases the risk of Kaposi's sarcoma (SK)?

Although the cause of Kaposi's sarcoma is not known with certainty, scientists have found several factors that can increase the risk of the disease, such as:

• People who have a low immune system

Generally this is closely related to people infected with HIV / AIDS, undergoing an organ transplant, or elderly people.

• Engaging in certain sexual practices

Human herpesvirus 8 (HHV8) infection is more common in men who have sex with men. It can also be transmitted when having unprotected oral or vaginal sex with a person who is infected with HHV8.

• Mother giving birth

Pregnant women who are infected with HHV8 can pass the virus to the fetus in their womb when they are born through vaginal fluids.

Diagnosis & treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

What are the usual tests for Kaposi's sarcoma (SK)?

The presence of skin lesions is a symptom of Kaposi's sarcoma. However, making a diagnosis of cancer is not only seen from the symptoms. The reason is, there are other health problems that also cause similar symptoms.

Therefore, the doctor will ask you to undergo a series of medical tests to confirm the diagnosis of Kaposi's sarcoma cancer, namely:

• Physical test

In this test, the doctor will look at the condition of your lesion. The doctor will also ask about other symptoms you feel as well as see your medical history and family.

• Stool test

Lesions on the lining of the stomach and intestines cause bloody stools. In order to confirm whether the symptoms are cancerous or not, stool tests need to be done.

• Chest X-ray

This imaging test can help doctors see abnormalities in the blood vessel cells in the lungs.

• Endoscopy

This test uses a thin tube (endoscope) that is inserted through your mouth to examine your esophagus, stomach, and the first part of your small intestine. If your doctor suspects an abnormality, a biopsy of the affected tissue will be done to confirm the disease.

• Bronchoscopy

In this test, a thin tube (bronchoscope) is inserted through your nose or mouth into your lungs to see the lining and take a sample of the abnormal area.

• Colonoscopy

In this test, a thin tube (colonoscope) is passed through the rectum and inserted into the large intestine to examine the walls of these organs. Abnormalities suggesting cancer of the bowel may also be biopsied during a colonoscopy.

What are the treatment options for Kaposi's sarcoma (SK)?

The treatment for cancer is adjusted to the type of cancer, the number of lesions, and the patient's overall health. But in general, how to treat cancer of the blood vessels and lymph vessels that doctors recommend is:

Treatment of SK related to HIV

Treatment of HIV-related Kaposi's sarcoma is taking HIV drugs known as combination antiretroviral therapy (cART).

The goal is to prevent HIV from getting worse by increasing the immune system so that the levels of HHV-8 in the body can be reduced. In some cases, people undergoing this treatment also need to take chemotherapy or take interferon.

Classic SK treatment

This cancer generally causes lesions in the foot and lower leg area with a fairly slow spread time. Usually, people with classic Kaposi sarcoma will undergo treatment in the form of radiotherapy.

Radiation therapy is applied directly to the affected area. In some cases, cryotherapy (freezing) or minor surgery can also be used to remove skin lesions.

African endemic SC treatment

Treatment for endemic African type of Kaposi's sarcoma is primarily HIV treatment. In some cases, patients may be recommended chemotherapy or radiotherapy.

Treatment of SK related to organ transplants

When Kaposi's sarcoma cancer is detected after a transplant, the use of immunosuppressant drugs can be reduced or replaced. If the cancer is still developing, chemotherapy and radiotherapy will need to be done.

Home remedies

What are some lifestyle changes or home remedies that can be done to treat Kaposi's sarcoma (SK)?

In addition to doctor's treatment, home care also needs to be applied to people with Kaposi's sarcoma, namely improving a lifestyle that is suitable for cancer patients.

These lifestyle changes include quitting smoking, reducing alcohol consumption, adopting a cancer diet, exercising, and of course using condoms during intercourse.

In addition, you also need to keep the area of ​​the skin where the lesion is clean so that it doesn't cause infection. You must consult your doctor further if you want to undergo alternative medicine or use herbal medicines.

Prevention

How do you prevent Kaposi's sarcoma?

The way to prevent cancer of the Kaposi sarcoma type is to reduce your chances of being infected with the HHV8 virus, as well as other viruses that increase your risk. More specifically, the precautions you can take include:

• Implement healthy sex practices.Viruses can be transmitted through sexual intercourse, so it can be avoided by using a condom, be it vaginal or oral penetration.
• Take antiviral medication. People at risk may be recommended by their doctor to take a daily pre-exposure prophylaxis (PrEP).
• Avoid carelessly using syringes.The sharing of needles and syringes provides a great chance of being infected with HIV which also increases the risk of this cancer.
• Consider options for immunosuppressive drugs. For people who undergo organ transplants and are taking immunosuppressive drugs, they should choose sirolimus or everolimus (mTOR inhibitors) because the risk of cancer is quite low compared to other drugs.
• Take anti-HIV drugs. For pregnant women who are infected with HIV, consider taking anti-HIV drugs so as not to transmit the virus to the public either during pregnancy, childbirth, or breastfeeding.