Kaposi's Sarcoma
Published on March 1st, 2020. Information will be updated.
Kaposi’s sarcoma is where cancer cells are found on the skin or in the mucous membranes of the gastrointestinal tract (GI tract) from the mouth to the anus, including the stomach and the intestines. These malignant tumors look like purple patches on the skin that can spread to the lungs and lymph nodes, affecting the lymphatic system. This disease is more common in men and patients with autoimmune disease.
Cause
There is only one cause for Kaposi’s sarcoma: when the body gets infected with a virus called human herpesvirus 8 (KSHV). This virus is in the same family as the Epstein-Barr virus. It is sporadic in the United States, with less than 1% of the population being a carrier (not having the disease) of Kaposi’s sarcoma. Although the United States is lucky enough not to achieve the virus, it is more common in other countries.
Risk Factors
As a risk factor, the patient must be infected with KSHV. However, most people with the virus don’t develop Kaposi’s sarcoma. The cancer is activated by a weak immune system, HIV (Human Immunodeficiency Virus) positive, patients who received an organ transplant, or older patients because they would have a weak immune system.
Surprisingly, there are different types of Kaposi’s sarcoma, even though it’s not common in the United States (currently). There are four types of Kaposi’s sarcoma which include Epidemic (AIDS-related) Kaposi sarcoma, Classic (Mediterranean) Kaposi sarcoma, Endemic (African) Kaposi sarcoma, and Transplant-Related Kaposi sarcoma.
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Epidemic Kaposi sarcoma is the only type of sarcoma prevalent in the United States because it was related to HIV. Among HIV-positive patients, men who have sex with other men are more likely to have Kaposi sarcoma would also be the reason because it’s more common in this population. Although scientists thought that there could be sexual transmission of the virus, it has been debunked as it was detected that saliva could transmit KSHV rather than semen. During the AIDS epidemic, Kaposi sarcoma cases significantly increased in the United States. People with HIV at that time had a 50% chance of getting Kaposi sarcoma. However, as time passed, Kaposi became less common and eventually rare thanks to the antiretroviral treatment for HIV-positive patients.
Classic Kaposi sarcoma occurs in older men in the Mediterranean, Middle East, and Eastern Europe area. Unfortunately, those areas are prone to KSHV without any reason. However, a possibility would be the saliva transmission from mother to child during infancy or childhood. As mentioned before, older men tend to develop Kaposi sarcoma because they have a weaker immune system.
Endemic and Transplant-related Kaposi sarcoma are slightly less common than Classic Kaposi. Endemic Kaposi sarcoma occurs near the equator in Africa, and there is a high population around the area. Therefore, it is a greater risk if people lived near the equator. Again, scientists claim that saliva transmission from mother to child is the cause of the KSHV. Therefore, women and young children, specifically young boys, are affected. Patients who had organ transplants must receive immunosuppressive drugs to prevent the immune system from attacking the transplanted organ. However, if the patient has KSHV, they are likely to develop sarcoma because of their weakened immune system. If you get a transplant in countries close to the equator, there is a high chance that Kaposi sarcoma will develop.
Signs and Symptoms
There are several symptoms for Kaposi sarcoma, and it is almost clear to identify if they have Kaposi sarcoma if the physician knows that the patient has KSHV. Symptoms include lesions on the skin, mucous membranes, inside the body, and lymph nodes. Lesions on the skin would appear purple, red, or brown that can look as flat as a bruise or as raised as acne. Lesions on the skin can occur in one or multiple areas, but the most common areas are the face, arms, and legs. Lesions in the mucous membranes can occur in the mouth, anus, or anywhere in the GI tract. Lesions can occur in different organs of the body, such as the lungs and GI tract. If lesions occur in the lungs, then the patient might cough up blood; if lesions occur in the GI tract, they may develop anemia. The groin may become swollen and hurt the patient’s legs due to the groin’s lymph nodes.
Diagnosis
Conflicting enough, Kaposi sarcoma is so rare that US doctors haven’t diagnosed anyone with it. Individuals who do have Kaposi sarcoma in the US would probably go to the hospital multiple times looking for a solution to the problem (that’s why we, as healthcare students, should be familiar with this disease, even if it’s rare). If there are signs of Kaposi’s sarcoma, then a physical examination must be performed on the mouth, rectum, and skin. Other tests such as a skin biopsy, chest x-ray, bronchoscopy, and endoscopy are performed to check the lymph nodes.
Treatment
Unfortunately, this disease cannot be cured because once you have KSHV, you will have it for the rest of your life. It’s similar to HIV because you will have the virus and then later develop AIDS, the worst version of HIV. Kaposi’s sarcoma is the worst version of KSHV, but treatment will focus on reducing the symptoms and hopefully treating cancer. Treatments include chemotherapy and immunotherapy. Both of these therapies have different functions. Chemotherapy is to prevent cancer from spreading, and immunotherapy is to strengthen the immune system.
Prognosis
Unlike the AIDS epidemic, Kaposi’s sarcoma is treatable but incurable. People with Kaposi sarcoma have a 72% survival rate than normal people, which is pretty high for a cancer-related disease. As a result, very few people die with Kaposi sarcoma, and even if they die, they would have likely died from another disease or just age. Luckily, the United States doesn’t have to worry about a lot of people having Kaposi’s sarcoma, but we should be prepared at all costs if the epidemic rises.
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Resources
Kaposi Sarcoma. (2021). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/sarcoma/kaposi-sarcoma