Treatment of Kaposi's sarcoma

Kaposi's sarcoma is a cancer of the linings of the lymphatic channels and blood vessels. It commonly affects individuals with lowered immunity especially those with HIV infection or those on immune suppressing drugs after organ transplantation.

Who treats Kaposi's sarcoma?

The team of physicians and health care providers treating Kaposi's sarcoma includes:

• HIV specialists
• skin specialists
• plastic surgeon
• clinical oncologist or specialist in cancer
• radiotherapy oncologist
• a virologist (who deals with viruses)
• a pathologist
• a social worker
• psychologists and a counsellor

Types of treatment of Kaposi's sarcoma

Treatment of Kaposi's sarcoma includes drugs against HIV if the person is HIV positive; radiotherapy, chemotherapy and so forth. (1-5)

Antiretroviral therapy

If the Kaposi's sarcoma is detected in an HIV positive individual then drugs against HIV are prescribed. These are known as highly active antiretroviral therapy (HAART).

Normally administration of these drugs resolves the skin lesions of Kaposi's sarcoma. HAART works by reducing the level of the virus in the body. Resolution of the symptoms of Kaposi's sarcoma may take a few months.

During this time low dose Radiotherapy may be used to shrink the lesions. Radiotherapy uses high-energy rays to destroy the cancer cells. If the disease is more widespread with general symptoms like fever or weight loss chemotherapy with anticancer drugs may be needed.

Radiotherapy

Treatment of classic Kaposi's sarcoma is slow growing and does not cause problems. Radiotherapy may be prescribed for treat large or very visible lesions.

Radiotherapy employs high energy beams to destroy the lesions. Small lesions fade completely but larger, raised and deeper lesions become smaller and flatter.

Radiotherapy also reduces swelling, pain and bleeding of the lesions especially if the lesions are present within the body.

For radiotherapy, multiple hospital visits are needed. Each treatment takes 10–15 minutes. For smaller areas 1–5 treatments or visits are suggested but larger lesions may need up to 12 sessions.

Common side effects of therapy include reddening, darkening and burning of the skin. There may be fatigue and tiredness. These side effects go away after therapy is complete.

Chemotherapy

Endemic or African Kaposi's sarcoma is generally treated with chemotherapy.

Chemotherapy uses anticancer drugs. If there are small lesions drugs may be injected into the lesion. This is called intralesional chemotherapy. It may be used instead of radiotherapy on areas such as around the eyes or face.

Intralesional chemotherapy can shrink skin lesions and make them lighter in colour. The most commonly used drug is Vinblastine. This drug may also be given intravenously for wider spread lesions. This is called systemic chemotherapy.

Common side effects include:

• loss of appetite,
• loss or hair,
• weakness,
• anemia,
• propensity to get infections,
• nausea,
• bleeding tendencies,
• sore mouth ulcers etc.

There is another systemic therapy called liposomal chemotherapy. The molecules of the drugs in this method are enveloped in a fat-based coating known as a liposome. These liposomes move to the tumour site, where they release the drug. This method has fewer side effects.

Drugs like Doxorubicin and Daunorubicin may be used in this manner. Other systemic agents include Vincristine, bleomycin, Etoposide and Paclitaxel.

Treatment for Kaposi's sarcoma after organ transplant

Kaposi's sarcoma after an organ transplant is controlled by stopping or changing the immunosuppressant drugs.

If the symptoms do not resolve then treatment with chemotherapy or radiotherapy should be initiated.

Cryotherapy

This is a procedure that uses liquid nitrogen or other extremely cool chemicals to freeze the affected tissues. This destroys the cancer.

Surgical excision of the lesions

Surgical excision of the lesions is an option that is not widely used due to fears of spread of the cancer to wound edges and surrounding tissues.

When only a few, small Kaposi's sarcoma lesions are present, they may be removed with surgical therapy.

Interferon therapy

This is a new therapy under the term biological therapy. Biologic therapy uses chemicals produced naturally by the body. These molecules are then manufactured in the laboratory.

They help the immune system to attack the cancer cells.

Interferons are highly toxic molecules that may be tried in treatment of wide spread Kaposi's sarcoma. The injections are needed daily and are given into the muscles (Intramuscular injections) or subcutaneously (under the skin).

Side effects include fever, chills, loss of appetite, headaches, nausea, fatigue and body aches.

Preventive measures

Preventive measures include practicing safe sex to reduce the risk of acquiring HIV.