Encyclopedia of Health and Medicine

Kaposi’s sarcoma 169
ENDOSCOPY can determine whether there are
lesions elsewhere in the body, such as in the gastrointestinal
tract, when symptoms suggest or the
doctor suspects this is the case.
Treatment Options and Outlook
Treatment depends to some extent on whether
the Kaposi’s sarcoma is AIDS related or transplant
related. In either form, methods to remove or
reduce the lesions for improved comfort and
appearance. Such methods may include
• localized CHEMOTHERAPY (injecting a cytotoxic
agent directly into the lesion)
• external-beam RADIATION THERAPY that narrowly
targets the lesion
• the topical retinoid preparation alitretinoin
(Panretin) applied to the lesion
• surgery to reduce or excise (cut out) the lesion
• liquid nitrogen or cryotherapy, which freezes
the lesion
Systemic chemotherapy reduces lesions in
recurrent, widespread, or systemic (involving
internal organs as well as the skin) disease in
AIDS-related Kaposi’s sarcoma, though it is not
usually an option for transplant-related Kaposi’s
sarcoma because the immune system cannot withstand
the assault. Treatment for Kaposi’s sarcoma
in people who have received organ transplants is
often a delicate balance between suppressing
enough immune function to stave off organ rejection
and preserving enough immune response to
fight INFECTION. Sometimes changing the immunosuppressive
agent gives the immune system
enough of a boost to fight the lesions, causing
them to retreat or disappear.
SYSTEMIC CHEMOTHERAPY AGENTS TO TREAT AIDS-
RELATED KAPOSI’S SARCOMA
daunorubicin doxorubicin paclitaxel
(DaunoXome) (Doxil) (Taxol)
For most cancers, doctors apply an algorithm of
symptoms and progression that helps determine
effective treatment options and prognosis (potential
for improvement). Kaposi’s sarcoma occurs
nearly always in circumstances of depressed or
suppressed immune system function, skewing the
conventional cancer-staging algorithms. The AIDS
Clinical Trials Group (ACTG) system is the most
commonly used staging algorithm for Kaposi’s sarcoma
associated with AIDS or transplant-related
immunosuppression. The ACTG system assesses
three factors:
• number of lesions
• CD4 cell count, which represents immune system
function
• systemic conditions that indicate compromised
immune function
Each factor receives a rating of zero (good) or
one (poor), reflecting the likelihood for five-year
survival, a standard prognosis marker for cancer.
Kaposi’s sarcoma of the skin is seldom itself fatal,
though the extent of its presence indicates the
immune system cannot protect the body from
infection. Kaposi’s sarcoma of internal organs can
be fatal. This cancer is not curable in AIDS or
active immunosuppressive therapy, so treatment
aims to relieve symptoms.
Risk Factors and Preventive Measures
In the United States, HIV infection is the leading
risk factor for Kaposi’s sarcoma. Methods to
reduce exposure to HIV/AIDS also reduce the risk
for Kaposi’s sarcoma. Most AIDS-related Kaposi’s
sarcoma occurs in men who have sex with men,
leading researchers to postulate that there is a
route of sexual transmission for HHV-8. Safer sex
practices are crucial.
As a result of the growing availability and acceptance
of organ transplantation, the number of cases
of Kaposi’s sarcoma among transplant recipients is
steadily rising. The risk increases the longer the person
receives immunosuppressive therapy. Newer
immunosuppressive agents more selectively target
the immune functions responsible for organ rejection,
leaving other immune functions undisturbed.
See also CANCER TREATMENT OPTIONS AND DECISIONS;
HIV/AIDS PREVENTION; SEXUAL HEALTH; SEXUALLY TRANS-
MITTED DISEASE (STD) PREVENTION; SEXUALLY TRANSMIT-
TED DISEASES (STDS); STAGING AND GRADING OF CANCER;
VIRUS.