Surgical Procedures: Surgery and Staging for Kaposi Sarcoma
Kaposi Sarcoma is a soft tissue cancer of the mucous membranes, lymph nodes and other organs, caused by human herpesvirus-8 (HHV-8). The Kaposi sarcoma lesions can be multifocal, in which lesions are found in different areas of the body.
There are certain people who are at a higher risk for developing Kaposi sarcoma, including:
- Those who are infected with the human herpesvirus 8 (HHV8) especially those who are immunocompromised related to an HIV infection, organ transplant, older age or other contributing factor(s)
- Those of Jewish, Mediterranean and equatorial African descent
- Those who are male
- Those who are immunocompromised
- Those who are men who have sex with men
There are a variety of Kaposi sarcoma sub-types, including:
- Epidemic (AIDS related) Kaposi sarcoma
- Classic (Mediterranean) Kaposi sarcoma
- Endemic (African) Kaposi sarcoma
- Iatrogenic (transplant-related) Kaposi sarcoma (Acquired)
- Immunosuppressive therapy–related Kaposi sarcoma (Acquired)
- Kaposi sarcoma in HIV negative men who have sex with men
- Nonepidemic Kaposi sarcoma
What is staging and how is it performed?
Once a diagnosis of Kaposi sarcoma has been made or if there is suspicion that the disease is present, your healthcare provider will typically obtain additional testing to determine the stage of cancer that may include:
Physical Exam: This is a general physical exam, as well as, an evaluation of your medical history and symptoms.
Radiologic Imaging: Imaging such as a chest X-Ray, CAT scan (CT scan) and/or positron emission tomography scan (PET scan), may be used to further evaluate the extent of your cancer.
Laboratory Testing: Certain blood tests may be obtained and include blood chemistry tests and a CD34 lymphocyte count.
Procedures: Specialized procedures may include:
Biopsy: During a biopsy, a piece of abnormal tissue is removed for evaluation. Types of biopsy used to evaluate for Kaposi sarcoma include:
- Excisional biopsy: During an excisional biopsy, a scalpel is used to remove an entire abnormal area or growth on the skin.
- Incisional biopsy: This type of biopsy uses a scalpel to remove only a portion of abnormal tissue or growth.
- Core biopsy: A core biopsy, removes a small portion of the abnormal skin growth with a wide needle.
- Fine-needle aspiration (FNA) biopsy: During an FNA, a small portion of the abnormal skin growth is removed with a thin needle.
- Endoscopy: During an endoscopy, a thin, lighted tube is placed into the esophagus, stomach and small bowel, which allows for the healthcare provider to evaluate for any abnormal areas within the gastrointestinal tract requiring biopsy. Additionally, lymph nodes can be removed for evaluation.
- Bronchoscopy: During a bronchoscopy, a thin lighted tube is placed into the trachea (wind pipe) and larger airways of the lung to evaluate for any abnormal areas requiring biopsy and/or fluid sample.
- Photography: Also referred to as mapping, photography may be used to monitor for the development of new Kaposi sarcoma skin lesions.
Cancer stage determines how extensive the cancer is, how far it has spread and what treatment course will be recommended. Currently, there is no official staging system for epidemic Kaposi sarcoma, however, the TIS staging system has been used by the AIDS Clinical Trials Group (ACTG), evaluating tumor, immune system and systemic illness. The system further describes the stage as good risk or 0 and poor risk or 1.
Often times, it may be recommended that those with Kaposi sarcoma undergo surgery.
Surgery for Kaposi Sarcoma
There are some common surgical procedures used to treat Kaposi sarcoma, depending on your particular stage and situation, including:
- Local excision: During a local excision, the abnormal area of skin tissue, as well as a small amount of healthy appearing tissue is removed.
- Electrodesiccation and curettage: This procedure removes the affected skin growth with a curette, another word for a spoon-shaped surgical tool. Following this, an electrical current is administered with a special needle to stop any bleeding and kill remaining Kaposi sarcoma cells.
- Cryosurgery/Cryotherapy: During a cryosurgery procedure, liquid nitrogen is applied to the abnormal area of skin to freeze and kill the cells affected by Kaposi sarcoma.
What are the risks associated with Kaposi Sarcoma surgery?
As with any surgical procedure, there are risks and side effects associated with undergoing surgery to treat Kaposi sarcoma. Speak with your healthcare team for more information on risks specific to your situation and procedure.
Some procedure dependent risks of undergoing surgery for Kaposi sarcoma include:
- Tissue or vessel damage
- Nerve damage
- Scarring and/or skin whitening
- Sexual dysfunction (location specific)
- Wound opening
What is recovery like?
Recovery from Kaposi sarcoma surgery will depend on the extent of the procedure performed. You will be instructed on how to care for any surgical incisions and will be given any other instructions prior to leaving the hospital or surgi-center.
Your medical team will discuss with you the medications you will be taking and will also discuss with you any particular activity restrictions depending on the surgery you have had.
How can I care for myself?
Depending on the extent of your surgery, you may need a family member or friend to help you with your daily tasks until you are feeling better and your medical team gives you the go ahead to resume normal activity.
Be sure to take your medications as directed.
Deep breathing and relaxation are important to help with pain, keep lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to perform deep breathing and relaxation exercises several times a day in the first week, or whenever you notice you are particularly tense.
- A simple exercise to do on your own: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
- Find more relaxation exercises on OncoLink.
This hand-out provides general information only. Please be sure to discuss the specifics of your surgical plan and recovery with your surgeon.