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). Kaposi sarcoma lesions can be multifocal, meaning lesions are found in different areas of the body.
There are certain people who are at a higher risk for developing Kaposi sarcoma:
- Those who have 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?
Staging is a way to find out how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. These tests may be:
Physical Exam: This is a general exam to look at your body and to talk about past health issues.
Radiologic Imaging: Radiology tests can look inside your body to look at the cancer and determine if it has spread. These tests can include:
- CAT scan (CT scan).
- Chest X-Ray.
- Positron emission tomography scan (PET scan).
Laboratory Testing: Blood tests such as a blood chemistry tests and a CD34 lymphocyte count.
Procedures: These include:
- Biopsy: A piece of tissue is removed and looked at under a microscope to look for cancerous cells. Types of biopsy used to evaluate for Kaposi sarcoma include:
- Excisional biopsy: A scalpel is used to remove the whole abnormal area or growth on the skin.
- Incisional biopsy: This type of biopsy uses a scalpel to remove only a part of an abnormal tissue or growth.
- Core biopsy: Removal of a small portion of the abnormal skin growth with a wide needle.
- Fine-needle aspiration (FNA) biopsy: A small portion of the abnormal growth is removed with a thin needle.
- 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 needing biopsy. Lymph nodes can be removed for evaluation.
- Bronchoscopy: A thin lighted tube is placed into the trachea (wind pipe) and larger airways of the lung to look 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
Surgery is often used to treat Kaposi Sarcoma. The procedure used will depend on many factors, including the size and location of the cancer. Your surgeon will talk to you about your specific procedure.
Surgical procedures used to treat Kaposi sarcoma include:
- 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. An electrical current is administered with a special needle to stop any bleeding and kill remaining Kaposi sarcoma cells.
- Cryosurgery/Cryotherapy: 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 surgery, there are risks and possible side effects. These can be:
- 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 you have had. You will be taught 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?
You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.
Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.
There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.
Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.
- Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.