Contents
What is Kaposi’s sarcoma?
Kaposi’s sarcoma is a rare tumor that affects the tissue of blood and lymph vessels. Caused by the HHV 8 virus, it is more common in people with a suppressed immune system.
Although rare, Kaposi’s sarcoma became more visible in the medical community in the 1980s, with the HIV pandemic , especially in patients with the disease in its last stage ( AIDS ).
Even though it is not very fatal, mortality is high among patients with compromised immune systems. However, the treatments available these days can help these patients lead a full life.
The main symptom is the appearance of red or violet spots on the skin, which can be limited to a single area or spread throughout the entire body. In fact, they can affect even the internal organs.
Causes
Kaposi’s sarcoma is caused by infection with the HHV 8 (or HVSK) virus, of the Herpesvirus family. However, there is no need to worry: this virus has no relationship – apart from belonging to the same family – with the HHV 1 and HHV 2 viruses, which cause cold sores and genital herpes .
Although the relationship between the virus and the disease is clear, infection alone is not enough for the tumor to develop. In fact, only 0.03% of infected people develop Kaposi’s sarcoma. This is because the immune system of a healthy person is strong enough to keep the virus under control, which is not the case for people using immunosuppressive drugs and HIV carriers.
Transmission of HHV 8
It is not known, even today, how HHV 8 is transmitted. However, several cases point to sexual contact and contact with contaminated saliva as the main routes for infection by the virus.
Types
Kaposi’s sarcoma can be classified into 4 types, according to its origin and cause:
Classic Kaposi’s sarcoma
This type occurs in the elderly and is not related to immunosuppression. It is a rare tumor, which affects more often ethnic groups linked to the peoples of the Middle East and the Mediterranean.
African Kaposi’s sarcoma (endemic)
The African version of the disease bears this name because it is more common in people in equatorial Africa. Like the classic, it is not linked to immunosuppression. However, this type is more aggressive and preferentially attacks young people and children.
Epidemic Kaposi’s sarcoma
Associated with HIV , this type became more common after the explosion of AIDS in the 1980s. It is 15 times more common in men than in women, especially homosexuals.
It is not known why, but the disease tends to affect more HIV-positive homosexual men than men who acquire the disease through blood transfusion, injecting drug use or through sexual relations with women.
Kaposi’s sarcoma induced by immunosuppressants
Also known as post-transplant Kaposi’s sarcoma , this type occurs through the use of immunosuppressive drugs. Such drugs weaken the immune system, being very useful in autoimmune diseases and in cases of organ transplantation. Because of this suppression, the organism is no longer able to fight the virus, which leads to the development of the disease.
Groups of risk
As it is a disease that manifests itself in very specific conditions, the risk groups are:
- Men: aThe disease is 15 times more common in men than in women;
- HIV-positive : due to the weakening of the immune system that the disease causes, HIV-positive patients are more affected;
- Homosexuals: exactly why is not known, but HIV-positive people with HIV are the most affected by Kaposi’s sarcoma;
- People with autoimmune diseases and people who needed organ transplants: these two conditions imply the use of immunosuppressive drugs, increasing the chances of the virus to manifest itself;
- Elderly: due to the weaker immune system, a common effect of the elderly;
- People of certain ethnicities: the peoples of the Middle East, the Mediterranean Sea and Africa are the most affected by the disease.
Symptoms
In the classic form of the disease, symptoms progress very slowly. Many patients do not die because of the tumor itself, managing to live well with it until death for other reasons.
In the form related to AIDS, the symptoms are much more aggressive and the disease progresses quickly. However, due to the antiretroviral treatments available, Kaposi’s sarcoma is no longer as aggressive as it has been in the past decades.
Most of the time, the tumor causes only skin symptoms. However, depending on the extent of the disease, it can reach some internal organs, mainly in the respiratory and gastrointestinal tracts. Other organs that can be affected are lymph nodes, bones, pancreas, testicles, liver, heart and muscles.
The main symptoms of Kaposi’s sarcoma are:
In the skin
Appearance of skin lesions that vary between red, violet and brown, in the form of spots or even nodules in high relief. These lesions mainly affect the face, lower limbs (legs and feet), oral mucosa and genitals.
Such lesions can open and bleed easily, and can cause ulcerations at the site. In other cases, they grow so much that they start to put pressure on the nearby structures, especially when the internal organs are affected, causing pain.
Due to fluid retention, there may be swelling of the lower limbs.
In the organs
Lung
- Coughing up blood or sputum;
- Lack of air;
- Chest pain.
Gastrointestinal treatment
- Bleeding in the stool;
- Intestinal obstruction (constipation);
- Diarrhea;
- Abdominal pain.
How is Kaposi’s sarcoma diagnosed?
The best doctor to diagnose the tumor is the oncologist , a specialty that diagnoses and treats cancer . The diagnosis of Kaposi’s sarcoma involves several tests that can indicate both the presence of the disease and its extent. Understand:
Medical history
In case of suspicion, the doctor may ask about the patient’s medical history and situations in which he may have been exposed to the HHV 8 virus, such as during sexual activity, blood transfusion, among others.
Physical exam
On physical examination, the doctor will look closely for signs of sarcoma. He should look for the typical lesions of the disease in places like legs, face, inside the mouth and even in the rectum (the portion of the large intestine that is just at the exit to the anus).
Biopsy
When suspecting Kaposi’s sarcoma, the doctor should order a biopsy of the skin lesions. These lesions often contain cancer cells, new blood vessels, and blood cells such as white and red blood cells.
Chest X-ray
In order to detect whether the sarcoma has reached the thoracic organs (lung, heart, etc.), the doctor may order an X-ray , an examination that uses radioactivity to create images of the internal organs of the body.
Broncoscopia
Bronchoscopy is an examination that allows you to assess the entire upper part of the respiratory tract, such as the trachea and the main bronchi.
Using an endoscope – a long, thin device with a microcamera on the end, which allows entry through various channels of the human body -, the doctor will look for lesions similar to those of the skin through the respiratory system.
If there is a suspicion that sarcoma has reached the intestine, the doctor may order a hidden blood test. In this examination, the patient must follow a specific diet for a few days and then collect a stool sample.
This sample is sent to the laboratory, where a biomedical doctor will be able to detect whether there is blood in the waste.
Upper digestive endoscopy
In upper gastrointestinal endoscopy, the doctor uses an endoscope to check for lesions in the esophagus, the channel that takes food from the mouth to the stomach.
Colonoscopy
A colonoscopy is an examination similar to endoscopy, but going the other way: the endoscope enters the anus and runs through the large intestine, the demand for injuries.
In general, before a colonoscopy, the patient should be on a special diet for a few days and then have an intestinal cleansing with laxative medications.
Endoscopia capsular
As the small intestine is very long and has many curves, the traditional endoscope is not able to pass through there. Therefore, the doctor may suggest a capsular endoscopy, which is not exactly an endoscopy, but has the same function.
In this examination, the patient swallows a capsule containing a small light and camera. This capsule will pass through the entire digestive canal, taking pictures of the small intestine. The images are sent to a small device that the patient takes with him, which is then connected to a computer where the images are downloaded for analysis.
At the end of the process (which takes about 8 hours), the capsule is discarded along with the faeces.
Double balloon enteroscopy
Double balloon enteroscopy is an examination of the small intestine that is very similar to an endoscopy, but it uses other resources to improve visualization.
In this examination, the endoscope is thinner and longer, being covered by a slightly larger tube. At the ends of both the endoscope and the tube are inflatable latex balloons. When the device penetrates the small intestine, it goes up to a portion and the balloon at the end of the endoscope inflates.
Then, the tube slides to the endoscope tip region and the tube balloon is also inflated. Thus, the balloon at the end of the endoscope is deflated and the device can continue on its way. This process occurs about 12 times during the journey and serves for the intestine to move and stay in a way that facilitates the passage.
In general, this test usually lasts more than 1 hour and can be done both orally, as in upper digestive endoscopy, and anally, as in colonoscopy.
How is the treatment?
The treatment of Kaposi’s sarcoma can be both local, in the case of few lesions, and systemic. For this, the doctors who will be responsible for the treatment plans are the dermatologist , oncologist and, in the case of AIDS sarcoma, an infectious disease .
It is worth remembering that some types of treatment do not prevent new lesions from appearing, as they are only local treatments. To prevent or slow down the course of the disease, treatment is preferably done with chemo and radiotherapy.
Some treatment alternatives are:
Topical treatment
Using topical retinoids, local lesions can be treated without too many problems. This treatment is more used in cases of few injuries and helps a lot in the patient’s self – esteem , which is shaken by the aesthetic discomfort they cause.
Applying topical medication several times a day, the lesions tend to diminish and even disappear in a few months. However, side effects include skin irritation and depigmentation.
Cryotherapy
Cryotherapy consists of freezing the lesions, which kill the cells and cause them to fall. It is a quick way to get rid of blemishes, but it is not very useful in deeper lesions and can leave the skin whitish after treatment.
Surgical excision
Another method to be used in local lesions is surgical excision, which consists of removing the tumor with a surgical knife. Local anesthesia is used and, after the procedure, a small spot is made on the spot. The treatment leaves a small scar where the tumor used to exist.
Curettage
In curettage , the tumor is removed by means of a scraping. Then, an electrode is used to destroy the remaining cancer cells.
Photodynamic therapy
In this type of therapy, a special medication is applied to the skin. This medicine is attracted by the cancer cells, accumulating there. However, it is sensitive to certain types of light. After a few days, the patient returns to the office and receives treatment with the lights that are capable of killing the cells.
The problem with this therapy is that the skin is usually sensitive to the sun for a while, so it is important to take proper care, such as using sunscreen every day.
Radiotherapy
Radiation therapy uses radiation beams (X-rays or protons) to kill cancer cells. It is usually accompanied by chemotherapy, but can be performed alone.
In the case of Kaposi’s sarcoma, the most used type of radiation is called electronotherapy, in which electrons are used. This is because this type of treatment does not go beyond the skin, avoiding side effects and damage to tissues that are healthy.
Lesions in the mouth or throat are preferably treated with photon radiation, another type of particle that penetrates deeper into the tissues and, therefore, is more aggressive than electrons.
The radiotherapy session is like taking an X-ray: the patient is lying on a stretcher while a large machine moves around him. This machine is programmed to target the radioactive bundles at specific points, such as skin lesions.
In general, patients usually do 1 session a week, which lasts no more than just a few minutes. In fact, the preparation time for the session takes longer than the session itself.
Some side effects of radiotherapy are: changes in the skin, fatigue , nausea and vomiting. There may also be a decrease in some blood cells, which can result in anemia and low immunity.
Chemotherapy
Chemotherapy is a treatment method that uses drugs to destroy cancer cells. It is a systemic treatment method, as the drugs are distributed throughout the body, also affecting healthy cells. But don’t worry: they are not destroyed.
The drugs used to treat Kaposi’s sarcoma are part of a group called liposomal anthracyclines. This type of medicine is better absorbed by cancer cells, causing their destruction without having so many side effects.
Although most patients experience significant improvement with chemotherapy, sarcoma is not usually cured with treatment alone. When symptoms are alleviated or go into remission, the patient may stop chemotherapy. However, if they return, it is necessary to resume treatment.
In AIDS patients
In the case of AIDS patients, chemotherapy can be hampered because these drugs also weaken the immune system, exposing the patient to greater risks.
Therefore, chemotherapy should not be given to an HIV-infected patient without also taking antiretroviral drugs. When chemotherapy is able to control sarcoma, treatment can be stopped and maintained only with antiretrovirals, which must keep HHV 8 infection under control.
Immunotherapy
As the name says, this type of treatment uses the immune system itself to destroy cancer cells. This can be done either by drugs that mimic the body’s natural defense cells or by drugs that hinder the growth of viruses and stimulate the production of antigens against them.
The biggest problems with this type of treatment is that it is still being studied and its side effects can be very harmful to health. In addition, most patients do not respond or take a long time to respond to treatment.
Medicines for Kaposi’s sarcoma
Topical medications
- Alitretinoin;
Intralesional drugs
- Vimblastina ;
- Sodium Tetradecyl Sulfate.
Chemotherapy
- Doxorubicin;
- Daunorrubicina;
- Paclitaxel;
- Gencitabina ;
- Vinorelbine;
- Bleomicina;
- Vimblastina;
- Vincristina;
- Etoposide.
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Prognosis
The news of being a cancer carrier is never good, especially since many types of cancer tend to come back (relapse). This is the case with Kaposi’s sarcoma.
Usually, the treatment is not able to cure the condition as a whole. For this reason, it can occur again several times, and the resumption of treatment is necessary. However, deaths from Kaposi’s sarcoma are very rare, because it is not a very aggressive type of cancer.
However, for people with HIV or taking immunosuppressive drugs, the tumor can develop quickly and lead to death in a short time. This happens most when treatment is not followed properly, as there are several effective treatments available today.
In general, even with relapses, most people with Kaposi’s sarcoma are able to live with the tumor for many years and die for other reasons, such as age or other chronic diseases that arise with it.
Living together
Having the diagnosis of Kaposi’s sarcoma is the same as living in uncertainty, because even after complete treatment, it can simply come back, becoming a chronic disease. So here are some tips for living with these feelings and conditions:
Adaptations in the routine
As the treatment of Kaposi’s sarcoma is time-consuming and often requires you to stay in the hospital for hours, some adjustments should be made in your routine. This means that you will need to include time for treatment in the plans for that trip that you so want to do on vacation.
Report-be
Read all the materials available about your condition, be always up to date on clinical studies and the development of new treatments for sarcoma. You could even participate in a promising clinical study! Who knows?
Express your emotions
Often, the emotions are too great to be trapped inside. Talking to friends and family about what you are feeling is good, because it lets it all out. There are studies that show that people can let negative emotions go away if they simply express them instead of censoring them.
If you feel that cancer is making you feel a lot of negative things, seek out a mental health professional , such as a psychiatrist or psychologist .
Be in the here and now
The future is uncertain for everyone, but it is even worse for those who have a chronic tumor. Knowing that he can return at any time is hopeless, but we must always remember that we live in the present, not in the future.
So, don’t plan things thinking about what it might be in the future, but what it is now. If something happens, there is always the possibility to change the plans.
Focusing on the here and now is the best you can do to take care of your mental health in conditions like this. So never forget who you are, where you are, and always keep in mind that, regardless of anything, your life is yours, not cancer.
Take time to do what you like
If you like to play golf, look for a course and go play next weekend. No excuses, just do it! It is very difficult to stay at home knowing that your illness can weaken you at any time, and this attitude will not get you anywhere. So, take the time to do what you like now.
Don’t be selfish if you need to cancel a family dinner over the weekend to do a program you love. Although family members are important, it is even more important that you enjoy the things you want while you can.
Have a positive attitude
Positive thoughts are what make the world go round! Even though there is no cure for your problem, there are still many things in the world that can bring you good feelings and memories. Go after it!
It is not always possible to think positive, everyone has their bad moments and there is no way you can expect that you don’t. If you feel like it, cry, let it out. Don’t force yourself to be happy when things go wrong, but always try to look on the bright side.
Healthy habits
Cultivating healthy habits such as a balanced diet and physical exercise can help in the process of improving and living with sarcoma. This is because taking care of your own body promotes more energy and even positive feelings, which collaborate with a positive outlook on a daily basis.
In addition, these habits also help to strengthen the immune system, which can be very beneficial for people with epidemic Kaposi’s sarcoma, as it helps to control the virus and prevent infections by other microorganisms.
Before exercising, however, try to talk to the doctors who take care of your tumor. Only they will be able to tell you which types of exercises are right for you.
Aftercare
Even after treatment and in a state of remission, always remember to keep visiting your doctors for a check-up. That way, you will know right away if the cancer has returned, in addition to receiving treatment more quickly, which increases the chances of remission.
Support groups
For some people, participating in support groups makes a big difference. Being around people who understand your condition can alleviate the pain of having a recurrent tumor a little.
Friends and family can benefit in these environments as well: several groups are focused on people who live around someone with a tumor, as they are people who also suffer a lot, who live with the fear of losing someone loved.
Complications
Like any tumor, there is an associated risk of metastasis , in which the cancer cells multiply too much and reach other organs, causing them to also produce cancer cells.
However, this happens very rarely and is almost never fatal. The individuals most prone to complications are those infected with HIV or taking immunosuppressants.
How to prevent or Kaposi’s sarcoma?
There is no definitive way to prevent Kaposi’s sarcoma, as it is not clear how the HHV 8 virus is transmitted. However, it is recommended to always use condoms ( condoms ) during sex , regardless of your orientation, to avoid transmission of the human immunodeficiency virus (HIV).
People who use injecting drugs should seek rehabilitation. Anyone who has already been infected with the HIV virus must adhere to antiretroviral treatment properly, as it is precisely that which prevents the manifestation of the disease if the person is infected with HHV 8.
Even though it is quite rare, Kaposi’s sarcoma is there and can have several consequences for the patient’s health. Share this text so that more people are more aware of this tumor!
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