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.

Hepatocarcinoma

Malignant hepatoma, which is primary cancer of the liver is termed hepatocarcinoma. Hepatocarcinoma is secondary in about 20% to either a viral hepatitide infection (hepatitis B and C) and about 80% to cirrhosis. In some cases, it is metastasis of cancer, spread from elsewhere in the body. It is also associated with chronic alcohol abuse. Hepatocellular carcinoma is relatively rare in the United States but quite common in the African and Southeast Asian countries. In fact, this is the fifth most common tumor worldwide. In some African countries the disease onsets between late teens and 30s although the normal occurrence is in patients over age 50. Hepatocarcinoma is more common in males than females.

Hepatocarcinoma patients are put under surveillance with ultrasound. Possibly the best method of diagnosis involves a CT scan of the abdomen. This is done using intravenous contrast agent and three phase scanning, enabling the radiologist to detect subtle tumors as well. Another possible alternative to a CT imaging is MRI, using contrast agents which is used to detect the presence of a tumor capsule. Diagnosis is further confirmed by percutaneous biopsy and histopathological parameters.

Treatment for hepatocarcinoma depends especially on the size of the tumor and staging. Some of the treatment options are liver transplantation, which is to replace the liver with a cadaver liver or a live donor lobe; surgical resection wherein the tumor is removed if diagnosed early; Percutaneous ethanol injections in case of solitary tumors and transcatheter arterial chemoembolization for large tumors.

Sometimes sealed source radiotherapy is used to destroy the tumor from within. Here, the radioactive particles are deposited to the area of interest using a catheter. Radio frequency ablation uses high frequency radio waves to ablate the tumor. As an adjuvant therapy in resected patients, intra-arterial-iodine-131-lipiodol administration is performed. High intensity frequency ultrasound is a relatively new but powerful technique used to treat the tumor. Hormonal therapy and adjuvant chemotherapy are other treatment modalities adopted. Cryosurgery is yet another new technique that can destroy tumors in a variety of sites, in the brain, breast, kidney, prostate and liver.

Acromegaly

Acromegaly is a hormonal disorder that usually affects middle aged adults. Acromegaly is the result of excessive production of Growth Hormone (GH) from the pituitary gland. In children it can result in Gigantism - unusual bone growth and consequent unusual height. Acromegaly is characterized by enlarged hands, feet and face (lips, tongue and nose). Acromegaly can affect heart and bones also.

Acromegaly Causes

The hands and feet are over sized when the body makes elevated amounts of growth hormone due to a benign tumor in the pituitary gland located at the base of the brain. The elevated levels cause an excess of bone and tissue growth.

Acromegaly symptoms

The most noticeable symptom is an over-sized finger necessitating the ring if worn, to be removed. Hitherto fitting shoe may seem unfitting due to an increased shoe width. Noticeable change in the face is a swollen/larger/broader lip, tongue and nose. Other symptoms may include one or a combination of the following.

• Weight gain
  
• Swollen and painful joints that restrict movement
  
• Spaces appearing between teeth
  
• Hoarse voice
  
• Fatigue
  
• Headache
  
• Inability to sleep
  
• Muscle weakness
  
• Excessive sweating
  
• Body odor due to enlargement of sweat glands
  
• Enlarged sebaceous glands that make skin oily
  
• Severe acne
  
• Severe snoring
  
• Impaired vision
  
• Menstrual cycle irregularities in women
  
• Abnormal breast milk production in women
  
• Erectile dysfunction in men
  
• Increased chest size
  
• Non-cancerous thickened skin and skin tags.

Acromegaly diagnosis

The physical changes occur gradually and are often not recognized immediately. There are instances when individuals recognize symptoms after comparing old photographs. Awareness is the key to seeking medical attention. If any of the symptoms persists for more than few weeks, seek medical attention. An early diagnosis can avert severe health complications.

Doctors proceed to laboratory tests after discussing medical history followed by physical examination. Blood tests are done to confirm diagnosis. To assess the size and location of the tumor, magnetic resonance imaging (MRI) of the brain or a Computerized Tomography (CT scan) is required.

Instead of checking random levels of hormones which vary minute to minute, doctors recommend testing for protein called insulin like growth factor 1 or IGF-1 which indicate the presence of abnormal body growth.

Another definitive diagnosis method is the growth hormone suppression test. Blood levels of growth hormone before and after drinking a preparation of glucose is measured. If the test shows high GH level, it confirms Acromegaly.

Acromegaly Treatment

Medications, surgery and radiation are suggested depending on the age and health condition of the individual. The aim is to restrict the excessive production of hormones and improve problems caused by the condition. Doctors prescribe medicines for treatment after surgery or in cases where surgery cannot be performed. Surgery is performed to remove the tumor if it is not too large. In cases where medicines and surgery do not treat the condition, radiotherapy (stereotactic radio surgery or conventional radio therapy) that eventually leads to reduction in growth hormones is recommended.