Kaposi's sarcoma
Kaposi's sarcoma: Excerpt from Professional Guide to Diseases (Eighth Edition)
Initially, this cancer of the lymphatic cell wall was described as a rare blood vessel sarcoma, occurring mostly in elderly Italian and Jewish men. In recent years, the incidence of Kaposi's sarcoma has risen dramatically along with the incidence of acquired immunodeficiency syndrome (AIDS). Currently, it's the most common AIDS-related cancer.
Kaposi's sarcoma causes structural and functional damage. When associated with AIDS, it progresses aggressively, involving the lymph nodes, the viscera, and possibly GI structures.
Causes and incidence
The exact cause of Kaposi's sarcoma is unknown, but the disease may be related to immunosuppression. Genetic or hereditary predisposition is also suspected. In people with AIDS, Kaposi's sarcoma is caused by an interaction between the human immunodeficiency virus (HIV), immune system suppression, and human herpesvirus-8 (HHV-8).
Occurrence has been linked with sexual transmission of HIV and HHV-8. Approximately 3 out of every 100,000 people develop Kaposi's sarcoma each year.
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) appearing most commonly on the skin, buccal mucosa, hard and soft palates, lips, gums, tongue, tonsils, conjunctiva, and sclera.
In advanced disease, the lesions may join, becoming one large plaque. Untreated lesions may appear as large, ulcerative masses.
Other signs and symptoms include:
❑health history of AIDS
❑ 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
CONFIRMING DIAGNOSIS 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. Endoscopy shows Kaposi's lesions. (See Laubenstein's stages in Kaposi's sarcoma.)
Treatment
Treatment isn't indicated for all patients. Indications include cosmetically offensive, painful, or obstructive lesions of rapidly progressing disease.
Radiation therapy, chemotherapy, cryotherapy, and biotherapy with biological response modifiers are treatment options. Radiation therapy alleviates 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.
Chemotherapy includes combinations of doxorubicin, vincristine, etoposide, paclitaxel, bleomycin, and dacarbazine.
Biotherapy with interferon alfa-2b may be prescribed for AIDS-related Kaposi's sarcoma. The treatment reduces the number of skin lesions but is ineffective in advanced disease.
Special considerations
❑Listen to the patient's fears and concerns and answer his questions honestly. Stay with him during periods of severe stress and anxiety.
❑The patient who's coping poorly may need a referral for psychological counseling. His family members may also need help in coping with the patient's disease and with any associated demands that the disorder places upon them.
❑As appropriate, allow the patient to participate in care decisions whenever possible, and encourage him to participate in self-care measures as much as he can.
❑Inspect the patient's skin every shift. Look for new lesions and skin breakdown. If the patient has painful lesions, help him into a more comfortable position.
❑Follow standard precautions when caring for the patient.
❑Administer pain medications as prescribed. Suggest distractions, and help the patient with relaxation techniques.
❑To help the patient adjust to changes in his appearance, urge him to share his feelings, and provide encouragement.
❑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 antiemetics and sedatives, as ordered.
❑Be alert for adverse effects of radiation therapy or chemotherapy — such as anorexia, nausea, vomiting, and diarrhea — and take steps to prevent or alleviate them.
❑Reinforce the physician's 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 possible breakdown and subsequent infection.
❑Explain all prescribed medications, including any 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 items that may be contaminated with blood. These measures are especially important if the patient also has AIDS.
❑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.
❑Explain the proper use of assistive devices, when appropriate, to ease ambulation and promote independence.
❑Stress the need for ongoing treatment and care.
❑As appropriate, refer the patient to support groups offered by the social services department.
❑If the patient's prognosis is poor (less than 6 months to live), suggest immediate hospice care.
❑Explain the benefits of initiating and executing advance directives and a durable power of attorney.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 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.
» Next page: Acquired immunodeficiency syndrome (Professional Guide to Diseases (Eighth Edition))
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:
