Cancer treatment team
Many primary care trusts (PCTs) have multi-disciplinary teams (MDTs) who treat Kaposi’s sarcoma (KS).
An MDT is made up of a number of different specialists (see the box, right).
If you have KS, you may see some or all of these health professionals as part of your treatment.
It can be difficult to decide which treatment is best for you. Your cancer team will make recommendations but the final decision will be yours.
Before going to hospital to discuss your treatment options, you may want to write a list of questions to ask the specialist. For example, you may want to find out what the advantages and disadvantages are of particular treatments.
Treatment plans
The treatment of KS depends on:
- the severity of symptoms,
- the size and location of the lesions,
- the type of KS, and
- your general health.
Treatment plans can vary from person to person, but the usual plan for each type of KS is outlined below.
HIV- or AIDS-related KS
If you have HIV- or AIDS-related KS, you will usually be given a course of highly active antiretroviral therapy (HAART) to help strengthen your immune system. If you are already on HAART, the types of medication and dosages may be changed. HAART may be followed by courses of radiotherapy and/or chemotherapy.
Classic KS
As classic KS spreads slowly, immediate treatment is not usually required and a policy of ‘watchful waiting’ may be recommended. This means that your MDT will delay treatment to see if any symptoms of progressive cancer develop. This is often recommended for older people when it is unlikely that the cancer will affect their natural life span.
If treatment is required, radiotherapy is normally used to treat classic KS.
Endemic KS
Endemic KS is usually treated using a combination of radiotherapy and chemotherapy.
Transplant-related KS
Transplant-related KS is usually treated by reducing or stopping your immunosuppressants. The goal is to strengthen your immune system enough to fight off the humanherpes virus 8 (HHV-8) while ensuring that your body does not reject the transplanted organ.
It may take some time to find the best balance between these two treatment goals.
Types of treatment
The types of treatment that are used for KS are outlined below.
HAART
HAART involves using a combination of medicines that interrupt the reproductive cycle of the HIV virus. This helps to prevent the virus from spreading quickly as well as protecting and strengthening your immune system.
As HIV can quickly adapt and become resistant to a single medicine, a combination of medicines is required.
In some people, the medicines used to treat HIV will cause side effects. These usually improve after a few weeks as your body gets used to the medicines. Common side effects of HIV medication include:
- nausea,
- tiredness,
- diarrhoea,
- skin rashes,
- mood changes, and
- gaining fat on one part of your body while losing it on another (lipodystrophy).
Surgery
If the lesion is small, surgery may be used to remove KS from the skin. Your GP will inject a local anaesthetic into the affected area to numb the lesions before they are surgically removed.
Cryotherapy may also be given. This freezes the lesions using liquid nitrogen.
Chemotherapy
Chemotherapy uses medicines to treat cancer. The medicines destroy rapidly growing cancer cells.
The medicines can either be given through a drip into a vein in your arm (intravenously) or as a tablet that is taken orally (by mouth). If the lesion is small, chemotherapy may be injected directly into it. This is called intralesional chemotherapy.
Chemotherapy can cause side effects including:
- vomiting,
- hair loss,
- tiredness, and
- increased vulnerability to infection.
Liposomal chemotherapy is often used to treat KS. The medicines that are normally used in chemotherapy are covered in a fat-based coating called liposome. The extra coating means there are fewer side effects and the medication works more effectively.
Radiotherapy
Radiotherapy uses high-energy rays to pinpoint and destroy the KS cells while doing as little harm as possible to healthy cells. It can be very effective in reducing symptoms of internal KS, such as swelling, pain and bleeding.
Possible side effects of radiotherapy include:
- tiredness,
- sore skin (particularly for people with HIV or AIDS),
- stiff joints and muscles,
- nausea,
- temporary hair loss,
- loss of appetite,
- loss of libido (interest in sex),
- early menopause, and
- temporary impotence in men.
Most side effects gradually disappear once the course of treatment is over.
Immunotherapy
Immunotherapy, also known as biological therapy, is often used alongside other treatments such as HAART. Immunotherapy uses special proteins that have been genetically engineered in a laboratory.
Normally, the body does not regard the cancerous cells as foreign objects so the immune system does not attack them.
In immunotherapy, special antibodies are created in a laboratory that change the composition of cancerous cells so that the immune system regards them as foreign objects. The immune system then starts to attack the cells in the same way that it would normally attack an infection.
Interferon is one of the most common types of medicines used in immunotherapy. It is usually given by daily injections into the skin over a number of weeks.
Side effects of immunotherapy include:
- chills,
- high temperature (fever) of 38°C (100.4°F) or above,
- loss of appetite,
- nausea,
- headaches,
- tiredness, and
- aching in the back, joints and muscles.
