Health Check A-Z

Many hospitals use multidisciplinary teams (MDTs) to treat Kaposi’s sarcoma. These are teams of specialists who work together to decide about the best way to proceed with your treatment.

Members of your MDT may include a:

• HIV specialist
• dermatologist (skin specialist)
• plastic surgeon
• clinical oncologist (a specialist in the non-surgical treatment of cancer)
• clinical radiotherapy oncologist (a specialist in the radiotherapy treatment of cancer)
• virologist (a specialist in the treatment of viruses)
• pathologist (a specialist in diseased tissue)
• social worker
• psychologist
• counsellor

You may also be assigned a key worker who will usually be a specialist nurse. They will be responsible for co-ordinating your care.

Deciding on the treatment that's best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.

Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions that you'd like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

Your treatment plan

The treatment of Kaposi’s sarcoma will depend on:

• the severity of your symptoms
• the stage of the cancer (see Kaposi’s sarcoma - diagnosis for more information)
• the type of Kaposi’s sarcoma
• your general health

Treatment plans can vary from person to person, but typical treatments for each type of Kaposi’s sarcoma are outlined below.

HIV-related Kaposi’s sarcoma

If you have HIV-related Kaposi’s sarcoma, you are usually given a course of combination highly active antiretroviral therapy (HAART) to help strengthen your immune system. If you're already on HAART, the types of medication and dosages may be changed. HAART may be followed by courses of radiotherapy or chemotherapy.

Classic Kaposi’s sarcoma

As classic Kaposi’s sarcoma spreads slowly, immediate treatment isn't usually required, and a policy of ‘watchful waiting’ may be recommended. This means that your MDT will delay treatment to see whether any symptoms progress. This is often recommended for older people when it's unlikely that the cancer will affect their natural life span.

If treatment is required, radiotherapy is usually used to treat cases of classic Kaposi’s sarcoma.

Endemic African Kaposi’s sarcoma

Endemic African Kaposi’s sarcoma is usually treated using a combination of radiotherapy and chemotherapy.

Transplant-related Kaposi’s sarcoma

Transplant-related Kaposi’s sarcoma is usually treated by reducing or stopping your immunosuppressants. The aim is to strengthen your immune system enough to fight off the human herpes virus 8 (HHV-8) while ensuring that your body doesn't reject the transplanted organ.

It may take some time to find the best balance between these two treatment objectives.

Surgery

If the lesion is small, it may be removed using surgery. Your GP will inject a local anaesthetic into the affected area to numb the lesions before they're surgically removed.

Cryotherapy – in which the lesions are frozen using liquid nitrogen – is also sometimes used.

Chemotherapy

Chemotherapy is where powerful medication is used to treat cancer by destroying 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
• increased vulnerability to infection

Liposomal chemotherapy is often used to treat Kaposi’s sarcoma. The medicines that are usually 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 Kaposi’s sarcoma cells while doing as little harm as possible to healthy cells. It can be very effective in reducing the symptoms of internal Kaposi’s sarcoma, such as breathlessness and swelling of the arms and legs.

Possible side effects of radiotherapy include:

• tiredness
• sore skin (particularly for people with HIV or AIDS)
• stiff joints and muscles
• feeling sick (nausea)
• temporary hair loss
• loss of appetite
• loss of libido (interest in sex)
• early menopause
• temporary erectile dysfunction (inability to obtain or maintain an erection) in men

Most of these side effects gradually disappear after the course of treatment has been completed.

Immunotherapy

Immunotherapy is sometimes used to treat transplant-related Kaposi’s sarcoma. Also known as biological therapy, immunotherapy uses special proteins that have been genetically engineered in a laboratory. Normally, the body doesn't regard the cancerous cells as foreign objects so the immune system doesn't attack them.

In immunotherapy, special antibodies are created in a laboratory that change the make-up 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-alpha is one of the most common types of medicines used in immunotherapy. It's 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
• aching in the back, joints and muscles