Kaposi's sarcoma
Kaposi's sarcoma: Excerpt from Handbook of Diseases
Kaposi’s sarcoma, a cancer of the lymphatic cell wall, affects tissues under the skin or mucous membranes that line the mouth, nose, and anus. In recent years, the incidence of Kaposi’s sarcoma has risen dramatically along with the incidence of human immunodeficiency virus (HIV) infection. It’s now the most common HIV-related cancer.
Kaposi’s sarcoma causes structural and functional damage. It progresses aggressively, involving the lymph nodes, the viscera and, possibly, GI structures.
Causes
The exact cause of Kaposi’s sarcoma is unknown, but the disease may be related to immunosuppression. Genetic or hereditary predisposition is also suspected.
Signs and symptoms
The initial sign of Kaposi’s sarcoma is one or more obvious lesions in various shapes, sizes, and colors (ranging from red-brown to dark purple) that appear most commonly on the skin, buccal mucosa, hard and soft palates, lips, gums, tongue, tonsils, conjunctivae, and sclerae.
With advanced disease, the lesions may join, becoming one large plaque. Untreated lesions may appear as large, ulcerative masses.
Other signs and symptoms include:
❑ a history of HIV infection
❑ pain (if the sarcoma advances beyond the early stages or if a lesion breaks down or impinges on nerves or organs)
❑ edema from lymphatic obstruction
❑ dyspnea (in cases of pulmonary involvement), wheezing, hypoventilation, and respiratory distress from bronchial blockage.
The most common extracutaneous sites are the lungs and GI tract (esophagus, oropharynx, and epiglottis).
Signs and symptoms of disease progression and metastasis include severe pulmonary involvement and GI involvement leading to digestive problems.
Diagnosis
The diagnosis is made following a tissue biopsy that identifies the lesion’s type and stage. Then a computed tomography scan may be performed to detect and evaluate possible metastasis.
Treatment
Treatment isn’t indicated for all patients with Kaposi’s sarcoma. Indications include cosmetically offensive, painful, or obstructive lesions of rapidly progressing disease.
Radiation therapy, chemotherapy, and biotherapy with biological response modifiers are treatment options. Radiation therapy alleviates signs and symptoms, including pain from obstructing lesions in the oral cavity or extremities and edema caused by lymphatic blockage. It may also be used for cosmetic improvement.
Combinations of three or more anti-HIV drugs may control HIV as well as flatten, shrink, or fade Kaposi’s sarcoma lesions.
A new treatment uses 9 cis retinoic acid, a derivative form of vitamin A that can be applied directly to skin lesions.
Chemotherapy includes combinations of doxorubicin, vinblastine, vincristine, and etoposide to treat internal, widespread Kaposi’s sarcoma. Paclitaxel may be used when other chemotherapeutic drugs fail. Liposomal drugs may also be used.
Biotherapy with interferon alfa-2b may be administered for HIV-related Kaposi’s sarcoma. The treatment reduces the number of skin lesions, but is ineffective in patients with advanced disease.
Special considerations
❑ The patient and family members may need help in coping with the disease and with any associated demands that the disorder places on them. Counseling may be advisable.
❑ As appropriate, allow the patient to participate in self-care decisions whenever possible, and encourage him to participate in self-care measures as much as he can.
❑ Inspect the patient’s skin, looking for new lesions and skin breakdown. If he has painful lesions, help him into a more comfortable position.
❑ Administer pain medication. Suggest distractions, explore alternative therapies, and help the patient with relaxation techniques.
❑ To help the patient adjust to changes in his appearance, encourage him to share his feelings.
❑ Monitor the patient’s weight daily.
❑ Supply the patient with high-calorie, high-protein meals. If he can’t tolerate regular meals, provide him with frequent smaller meals. Consult with the dietitian, and plan meals around the patient’s treatment.
❑ If the patient can’t take food by mouth, administer I.V. fluids. Also, provide an antiemetic and a sedative.
❑ Be alert for adverse reactions to radiation therapy or chemotherapy — such as anorexia, nausea, vomiting, and diarrhea — and take steps to prevent or alleviate them.
❑ Reinforce the explanation of treatments. Make sure the patient understands which adverse reactions to expect and how to manage them. For example, during radiation therapy, instruct the patient to keep irradiated skin dry to avoid breakdown and subsequent infection.
❑ Explain all prescribed medications, including possible adverse effects and drug interactions.
❑ Explain infection-prevention techniques and, if necessary, demonstrate basic hygiene measures to prevent infection. Advise the patient not to share his toothbrush, razor, or other personal items that may be contaminated with blood. These measures are especially important if the patient also has HIV infection.
❑ Help the patient plan daily periods of alternating activity and rest to help him cope with fatigue. Teach energy-conservation techniques. Encourage him to set priorities, accept the help of others, and delegate nonessential tasks.
❑ Stress the need for ongoing treatment and care.
❑ As appropriate, refer the patient to support groups or hospice care.
❑ Explain the benefits of initiating and executing advance directives and a durable power of attorney.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
More About HIV/AIDS
More Medical Textbooks Online about HIV/AIDS
Review other book chapters online related to HIV/AIDS:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
|
|
More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
|
|
» Next page: Human immunodeficiency virus infection (Handbook of Diseases)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
