Kaposi’s sarcoma (KS) is a cancer caused by infection with human herpesvirus 8 (HHV8). It causes purple, brown, or bluish-red tumours that look like sores on the skin. It may also affect the internal organs and the mucous membranes lining the mouth, nose, and anus.
Before AIDS became widespread, Kaposi’s sarcoma was uncommon and usually only found in elderly men, usually of Italian, Jewish, or African descent. It was also infrequently found in people who had received organ transplants and were taking immunotherapy to avoid organ rejection.
As AIDS became more widespread, KS became the most common cancer found in people with acquired immunodeficiency syndrome (AIDS), occurring as a complication of late AIDS. In people with AIDS, the tumour grows and spreads more quickly than in elderly men without AIDS. As HIV infection has now become better controlled, KS is once again becoming an infrequent condition.
The most likely cause of Kaposi’s sarcoma is infection with HHV8 combined with the weakening of defense mechanisms that normally prevent this virus from multiplying.
This condition is most prevalent among sexually active homosexual and bisexual people with AIDS. Improvements in the medical treatment of AIDS have drastically reduced the number of people with this condition.
As AIDS became more prevalent, doctors became more aware of the appearance of Kaposi’s sarcoma lesions. Sometimes, the appearance of the lesions is the first clue that the person may have advanced HIV infection.
Kaposi’s sarcoma can appear as bluish-red, brown, or purple spots or lesions on the skin, which can be flat or slightly raised. The lesions can develop anywhere on the body but are most often found on the face (especially the ears, mouth, and tip of the nose), legs and feet, and genital area. For those with dark-coloured skin, the lesions may appear dark brown or black. The lesions generally aren’t itchy or painful.
Kaposi’s sarcoma may also appear as lesions on the palate (roof of the mouth), tongue, gums, or tonsils, or as gastrointestinal (stomach or intestine) lesions that bleed. There may also be lesions on the lungs, which may look like an infection or other forms of lung cancer.
Other symptoms connected with Kaposi’s sarcoma include:
Kaposi’s sarcoma can recur easily, despite treatment and remission. It can also affect the lungs and liver.
If the lesions remain isolated on the skin, Kaposi’s sarcoma isn’t a life-threatening illness. If, however, it attacks the inner organs, including the lungs, brain, and gastrointestinal tract, Kaposi’s sarcoma can be fatal.
The appearance of Kaposi’s sarcoma in a person with AIDS is often a sign that the disease is progressing. On the other hand, as the HIV infection is successfully treated and immune function is restored, the Kaposi’s sarcoma will often start to go away.
The lesions associated with Kaposi’s sarcoma can often be mistaken for other disorders, such as benign fungal infections or another type of cancer, non-Hodgkin’s lymphoma. For that reason, your doctor will need to take a thorough medical history, asking questions about lifestyle and sexuality. He or she may recommend you have a test for HIV. After a physical exam, a skin biopsy is usually done.
A punch biopsy takes a small piece of tissue, while an excisional biopsy will remove the whole lesion. If many lesions are present, several of these might be tested just to verify that they are all the same. The excisional biopsy is usually performed if there are only one or two small lesions.
Other tests might include:
Treatment of KS mainly involves treating the underlying condition that damaged the immune system in the first place. In the case of AIDS, this involves administration of HAART (highly active antiretrobiral therapy) that can suppress the HIV virus and allow restoration of immune function.
For people whose immune function cannot be restored (such as those who have had organ transplantion or are receiving cancer chemotherapy) or those rare individuals in whom no cause for immune suppression can be identified, KS is treated by physical removal of the tumour or lesion (cryotherapy in this case), chemotherapy, radiation, or a combination. When internal organs are affected, medications such as alpha interferon or medications used in the treatment of cancer such as liposomal anthracyclines or paclitaxel are occasionally used.
Because Kaposi’s sarcoma is likely caused by an interaction between immune suppression and exposure to the sexually transmitted infection of HHV8, the precautions taken against other sexually transmitted infections should also be taken to try to prevent Kaposi’s sarcoma.
Practicing safer sex can also protect you from becoming infected with HIV, the virus that causes AIDS. Since AIDS increases the risk of Kaposi’s sarcoma, practicing safer sex can help reduce your risk of this cancer.
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