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Chemotherapy

Chemotherapy treatment works just after surgery; Being a systemic treatment, it attacks young and small clusters of cancer cells anywhere in the body. Chemotherapy drugs work best against rapidly dividing cells. The flip side is that they may kill normal cells too. Since cells in the blood, mouth, nose, nails and hair area also undergoing constant and quick division, chemotherapy affects them too. This explains the side effects of chemotherapy such as falling hair, dipping energy levels and infections. Supportive medicines are prescribed to help the body during this phase.


A typical treatment process may involve four to eight cycles of chemotherapy. Chemotherapy reduces the chances of cancer recurring after surgery. The tumors are shrunk with chemotherapy treatment, especially in cases of inflammatory cancer. The chemotherapy drugs are injected through IV needles. Sometimes they are given as pills. Oncologist will monitor your response to the therapy.

Side effects of chemotherapy


Myelodysplastic Syndrome

Myelodysplastic syndrome or MDS refers to a group of blood disorders caused by defective blood cell production in the bone marrow. Bone marrow produces immature blood cells called blasts, which over a period of time develop into mature blood cells and divide themselves into red blood cells, white blood cells and platelets. In Myelodysplastic syndrome, these blasts fail to mature and either die in the marrow itself or soon after they reach the blood stream. When there are not enough healthy blood cells, the body becomes weak and is susceptible to infections. MDS is not a cancer, however, in 20 to 30% of patients, the condition may progress itself into cancer and thus this condition was earlier called preleukemia.

Causes of Myelodysplastic syndrome

Based on causes, Myelodysplastic syndrome can be classified into primary MDS and secondary MDS. Myelodysplastic syndrome presenting itself without any known cause is called primary MDS. Myelodysplastic syndrome may also occur due to some known reasons such as history of cancer treatment involving radiation and chemotherapy, exposure to certain industrial chemicals and smoking. When the cause of the MDS condition is known, it is called secondary Myelodysplastic syndrome. Identifying the type of MDS is vital to the treatment as primary MDS has better prognosis when compared to secondary MDS.


Symptoms

Myelodysplastic syndrome does not cause any symptoms in the initial stages of the disease. However, the following warning signs may show up as the disease starts to progress.


  • Fatigue due to anemia
  • Frequent infections due to damaged immune system
  • Shortness of breath
  • Paleness
  • Easy bruising or bleeding can occur due to low platelet count.
  • Small red spots just under the skin.

Diagnosis and treatment

MDS is diagnosed with the help of blood tests and bone marrow tests. A complete blood test is done to understand the different blood counts. However, blood tests alone cannot detect MDS. Bone marrow tests are conducted to confirm the presence of Myelodysplastic syndrome. This procedure involves taking bone marrow samples from the pelvic bone of the patient by inserting a needle under local anesthesia. Once MDS is determined, the following methods are followed to treat the condition.


  • Chemotherapy drugs
  • Blood transfusion to treat anemia and low platelet count.
  • Using medications called growth factors to allow the bones marrow to make more blood cells.
  • Antibiotics to treat infections
  • Stem cell transplant, an option that promises a cure to MDS, yet not widely adopted, as not many candidates qualify for this method. This method involves destroying the existing cells in the bone marrow via chemotherapy and radiation and infusing the stem cells from the donor.

Kaposi Sarcoma

Of the seven types of Sarcomas, the incidence of Kaposi Sarcoma, a type of skin cancer is found to be more prevalent in persons with immune deficiency disease like AIDS. The rate of Kaposi Sarcoma is reported to be 20 times more. It is estimated that 15% of HIV infected persons will develop Kaposi Sarcoma. The weakened immune system is unable to fight the Kaposi Sarcoma Herpes Virus. Thanks to HAART (highly active anti-retrovirus therapy), the incidence rate has decreased.


Sarcoma is a rare type of cancer. The malignant tumors occur in the body's connective tissues - the tissues that support, connect and bind various parts of the body. Muscles, fat, fibrous tissues, nerves, blood vessels, cartilage, bones and joint tissues are all connective tissues.

Sarcomas fall into three broad categories.

Soft tissue cancers

  • Benign (non cancerous)
  • Malignant (cancerous)

Primary bone cancer

Gastro-intestinal stromal tumors

Kaposi Sarcoma is a soft tissue sarcoma, malignant in nature.


Kaposi Sarcoma causes

Human herpes virus 8 (HHV8) also called Kaposi Sarcoma associated herpes virus (KSHV), a virus causes the infection. Though as many as 1 in 20 people may have this virus sans any symptom, certain groups of people are vulnerable to its effect and develop Kaposi Sarcoma. Mostly, people whose immune system isn't working properly either due to a medical condition or medication (immunosuppressive medications) can develop Kaposi sarcoma. The weakened immune system allows the HHV8 to multiply to high levels in the blood thus increasing the chance of developing Kaposi Sarcoma.


Kaposi Sarcoma symptoms

The first symptom is the lesion appearing on the skin. It can be bluish-red, or brown or purple spots or lesions on the skin, flat or as a slightly raised bump, linear or in a symmetrical distribution. In fact, the appearance of the lesion indicates the possibility of the person being infected with HIV or the condition it causes, namely, AIDS. Kaposi Sarcoma can also affect internal organs which can lead to a range of symptoms, depending on the organ that is affected.


Skin lesions

The lesions can appear anywhere on the body but in most cases the lesions appear on the face (ears, mouth and tip of the nose), legs and feet and the genital area. It could occur in a single area in the beginning. These can merge to form a large tumor.


Lymph nodes: Swollen lymph nodes are the symptoms of Kaposi Sarcoma affecting the lymph nodes.

Arms and legs: If Kaposi Sarcoma affects the lymph vessels, there is buildup of fluid in the arms and legs. This condition is called lymphoedema.

Lung problems: Kaposi Sarcoma affecting the lungs can lead to breathlessness and coughing up blood.

Digestive system: Nausea, vomiting, stomach pain and diarrhea are symptoms related to Kaposi Sarcoma affecting the digestive system.


HIV related Kaposi Sarcoma: Being HIV positive or having AIDS increases the risk factor of HIV-related Kaposi Sarcoma. Compared to women, men have higher chances as also gay and bisexual men who are HIV positive are at risk of HIV related Kaposi Sarcoma.


Classic Kaposi Sarcoma: A rare condition, classic Kaposi Sarcoma affects middle-aged and elderly men of Mediterranean or Ashkenzi Jewish descent. There is a high possibility of being born with a pre-existing genetic vulnerability to the HHV-8 virus.


Endemic African Kaposi sarcoma: This type is a common cancer in parts of Africa with high levels of HIV. In most cases, the reason is either undiagnosed HIV infection or a pre-existing genetic vulnerability to HHV-8 virus.


Transplant related Kaposi Sarcoma: After an organ transplant, a strong immune system can reject the new organ. In order to weaken the immune system thereby preventing the rejection of new organ, medications (immunosuppressant) are used. This makes the person vulnerable to HHV-8 virus infection.


Tests for diagnosis of Kaposi Sarcoma

For a definitive diagnosis, a small amount of tissue is removed for examination under the microscope. If the biopsy results confirm, further tests are required to know the spread to internal organs. X-ray, Endoscopy, Bronchoscopy, CT scan and photography are the diagnostic tests that reveal the spread of cancer - staging of the cancer.


Kaposi Sarcoma staging

For all cancer types, staging determines the treatment options and the patient's survival outlook. With regard to Kaposi Sarcoma, the staging is largely influenced by the person's weakened immune system and the presence of AIDS related infections. For Kaposi Sarcoma staging, doctors use the AIDS Clinical Trial Group system. Three factors are considered under the AIDS Clinical Trial Group system while categorizing patients in good risk group and poor risk group.


  • The extent of the tumor
  • The status of the immune system as measured by the number of certain immune cells (CD4 cells) present in the blood
  • Systemic illness

These factors have two subgroups. After assessing the features, the type of Kaposi Sarcoma, doctors discuss the most suitable treatment option.


Kaposi Sarcoma treatment

Kaposi Sarcoma is incurable but can be controlled with treatment. The stage, the type of Kaposi Sarcoma, the number of lesions, age and general health are considered by the doctors before determining the appropriate treatment option. It could be chemotherapy, immunotherapy, antiviral drugs or radiation therapy. There are possible side effects for each of these treatment options.


Chemotherapy: Chemo drugs can be given into a vein or by mouth to enter the blood stream to reach all areas of the body. Chemotherapy is a treatment option when the cancer has spread to many areas of the body. Chemo drugs cannot be given for long periods as it can weaken the immune system. Particularly for HIV infected patients, there is a need to strengthen the immune system. In such cases, combined antiretroviral therapy can be used along with chemo drugs. Drug interaction is taken into account before prescribing the combined therapy. After tests indicate control of Kaposi sarcoma, chemo drugs may be stopped and the treatment may continue with combined antiretroviral therapy alone.


Immunotherapy: Transplant related Kaposi Sarcoma is usually treated using immunosuppressant medications or immunotherapy. The aim is to strengthen the immune system so as to fight the HHV-8 while ensuring the body doesn't reject the transplanted organ. Alternatively, radiotherapy or chemotherapy may also be considered.


cART: Combination antiretroviral therapy (cART) involves the use of several different medications called antiretroviral therapy to lower HIV levels in the blood by slowing down the rate at which the virus can multiply.


Radiotherapy: If Kaposi Sarcoma spreads and affects the internal organs, symptoms such as breathlessness and swelling of the arms and legs cause immense distress. Radiotherapy is chosen as a treatment option as the high-energy rays destroy cancer cells cautiously without harming the healthy cells in the body.


Surgery: If the lesions are small, after injecting local anesthetic to numb the area, surgery is performed to remove the lesion.


Cryotherapy: Cryotherapy involves freezing small lesions with liquid nitrogen.


Retinoic acid gel: Retinoic acid is applied directly to the skin several times a day on the small lesions. After few weeks of application, significant improvement can be noticed.


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Collection of Pages - Last revised Date: October 18, 2017