Kaposi’s sarcoma

Diagnosis

Diagnosing Kaposi’s sarcoma includes the following:

• Biopsy: In order to confirm a suspicious skin lesion as Kaposi’s sarcoma, a biopsy is typically performed. During this procedure, a small sample of tissue is removed for laboratory examination.
• Fecal occult blood test: This test identifies occult blood in the stool, which may indicate the presence of Kaposi’s sarcoma within the digestive tract.
• Chest X-ray: A chest X-ray is a diagnostic imaging test that involves capturing images of the chest area using X-rays. In Kaposi’s sarcoma, a chest X-ray is performed to identify if there are any abnormalities that may be indicative of the disease’s involvement in the lungs.
• Bronchoscopy: Bronchoscopy is a medical procedure in which a thin tube known as a bronchoscope is carefully inserted through either the nose or mouth and directed into the lungs. This technique facilitates a thorough visual inspection of the lining of the lungs, enabling the healthcare provider to identify any potential abnormalities. Additionally, the bronchoscope allows for the collection of samples from suspicious areas within the lungs for further analysis and diagnosis.
• Upper endoscopy: Endoscopy is a diagnostic procedure that involves the use of a thin tube called an endoscope, which is inserted through the mouth to examine the esophagus, stomach, and the initial portion of the small intestine. If there is a suspicion of Kaposi’s sarcoma within any of these organs, a biopsy may be performed to obtain a sample of the affected tissue for further examination and confirmation of the disease.
• Colonoscopy: During a colonoscopy, a thin tube called a colonoscope is inserted through the rectum and carefully maneuvered into the colon to visualize and examine its walls. This procedure allows for the detection of any abnormalities that may indicate the presence of Kaposi’s sarcoma in the rectum or colon. If suspicious areas are identified, a biopsy can be performed during the colonoscopy to obtain tissue samples for further evaluation and confirmation of the presence of Kaposi’s sarcoma.

Bronchoscopy is generally unnecessary to diagnose Kaposi’s sarcoma, unless there are respiratory symptoms without an apparent cause or abnormalities detected on a chest X-ray. Likewise, if a fecal occult blood test yields negative results, it may be possible to forego upper endoscopy or colonoscopy procedures.

Treatment

The treatment approach for Kaposi’s sarcoma is based on several factors, including:

• Type of disease: AIDS-related Kaposi’s sarcoma has been associated with a more severe course compared to classic or transplant-related disease. However, due to the advancements in antiviral drug combinations and better prevention strategies for other AIDS-related infections, the incidence and severity of Kaposi’s sarcoma have decreased among individuals with AIDS. The availability of increasingly effective antiviral treatments has contributed to the reduction in the occurrence and impact of Kaposi’s sarcoma in the population affected by AIDS.
• Number and location of lesions: The number and location of lesions in Kaposi’s sarcoma are important factors in determining the treatment approach, as widespread and internal lesions may require different strategies compared to isolated lesions.
• Effects of the lesions: Kaposi’s sarcoma lesions vary depending on their location, with mouth and throat lesions causing eating difficulties, lung lesions leading to shortness of breath, and large lesions on the upper legs causing painful swelling and mobility limitations. These factors are taken into account when developing an individualized treatment plan.
• General health: The compromised immune system that increases susceptibility to Kaposi’s sarcoma also renders certain treatments, like potent chemotherapy drugs, too hazardous to pursue. The same applies if there is a coexisting condition of another type of cancer, uncontrolled diabetes, or any severe, chronic ailment.

There are various treatment options available for small skin lesions in Kaposi’s sarcoma. These include minor surgical procedures like excision, as well as techniques such as electrodessication (burning) or cryotherapy (freezing). Low-dose radiation therapy is effective, particularly for the oral lesions, while direct injection of the chemotherapy drug vinblastine into the lesions can also be used. Additionally, the application of a retinoid, which is a vitamin A-like drug, can help manage these lesions. The choice of treatment depends on the individual’s specific circumstances and the extent of the lesions.

It is important to note that lesions treated using these methods often have a tendency to recur within a few years. In the event of recurrence, repeating the treatment can be effective for management.

For individuals with multiple skin lesions, radiation therapy is commonly used as the primary treatment approach. The type of radiation and the specific sites targeted for treatment may vary based on each person’s unique circumstances. When the number of lesions exceeds 25, chemotherapy with standard anti-cancer drugs may be beneficial. Furthermore, chemotherapy is also employed to treat Kaposi’s sarcoma affecting the lymph nodes and the digestive tract.

The primary treatment approach for AIDS-related Kaposi’s sarcoma involves initiating or adjusting a combination of antiviral drugs. The goal of this therapy is to reduce the viral load associated with HIV/AIDS and boost the number of specific immune cells in the body. In certain cases, this antiviral treatment alone may be adequate as the sole intervention for managing the condition.

In situations where transplant-related Kaposi’s sarcoma is present, individuals may have the opportunity to consider discontinuing the use of immunosuppressive medication, if it is deemed feasible. By stopping such medication, the immune system can regain strength and effectively combat the cancer, potentially leading to its eradication. Alternatively, switching to an alternative immunosuppressive medication may also offer benefits in effectively managing the condition.