KAPOSI'S SARCOMA: An HIV related cancer

What you need to know:

This cancer mainly affects men but the risk of catching it is high if your immunity is low or if you are HIV positive.

In Africa, before the Aids epidemic, Kaposi’s sarcoma (KS) was found among elderly men. According to Dr Nixon Niyonzima, an oncologist at the Uganda Cancer Institute, Mulago Hospital, it still affects mostly elderly men aged between 40 and 70 years. But ever since the Aids epidemic break out, it also affects men who are not in this age bracket. He explains, “Since 1960 to 1993 (after the Aids epidemic break out), there was a 25 times (four fold) increase in the number of patients with Kaposi’s sarcoma.”

KS is an HIV defining disease therefore, every patient diagnosed with it, is advised by doctors to go for an HIV test. It is caused by the human herpes virus 8 (HHV8) and is described as a blood vessel tumour.

Dr Fred Okuku, an oncologist at the Uganda Cancer Institute Mulago Hospital says KS is an infectious cancer and 40-70 per cent of the population carries the virus (HHV8). It’s believed to be passed on to children from parents for example through breast feeding. And according to the doctors, this virus can be kept at bay only if the immune system is good. Unlike the other cancers, Dr Niyonzima says KS can affect any part of the body though the virus is found in the mouth.

Who is prone?
Kaposi’s sarcoma is categorised into four types. These also show the people that are prone to the cancer.
• The epidemic, which is associated with the HIV infection and still remains the commonest in the country according to Dr Okuku.
• The endemic that affects elderly men in Uganda above the age of 50 years.
• The classic which is common among Mediterranean men like Greeks, Italians, Spaniards etc
• The transplant-associated is the other category and this is got through an organ transplant. The organ may be infected with the cancer or the person being given the organ, may have a weak immunity due to the drugs taken.
Dr Niyonzima says it also affects children and women who are HIV positive. He explains, before the Aids epidemic breakout, the ratio of men to women affected by the cancer was 17:1. Presently the ratio is 2:1.
According to research, in Uganda, it’s the second commonest cancer in men after prostate cancer while it’s the third commonest among women after the cervical and breast cancer.
He says, “We don’t know why it’s the men who are highly affected, there is no clear biological research. However, we think it’s because of their lifestyle like having many sexual partners.”

Diagnosis
Dr Chris Nakholi, a medical co-coordinator at St Francis Health Care Services, Njeru, says that usually, to diagnose the cancer, the doctors look at clinical symptoms. He adds, “We also do a laboratory test if in doubt. To do this, we cut a person’s tissue from the skin and send it to hospitals where such tests are carried out.” The tests are either done from Mulago Hospital, St Francis Hospital, Nsambya or Lacor Hospital, Gulu. The tests at the cancer institute, Mulago Hospital are carried out at no cost.

Where to get reatment
Though Dr Niyonzima says no matter what stage the cancer is, it can be treated and heal, Dr Okuku refutes that and says any cancer, in its last stage, that is stage 4, cannot heal. Dr Nakholi says that if diagnosed early, it can be treated to heal.

Dr Niyonzima says, “The lesions (abnormal structural change on the skin) develop one by one on any part of the body, which people ignore. But once this happens, the person should go see a doctor where screening mammography needs to be done.” He says that the nodules may be cut out but that is not treatment because the cancer may keep on recurring. KS drugs are given and the dose depends on the clinical analysis.

One can be put on drip (which is given at the institute). The doctor says that the dose is given every after three weeks. “Ideally, the dose is supposed to be taken six times. However, if the patient doesn’t respond, we increase treatment depending on the reaction of the patient,” he says. The doctors say if the patient has HIV, they can start on ARVs early because they help boost one’s immune system.

The patient can take both ARVs and the cancer chemotherapy concurrently, Dr Nakholi says. The ARVs are in all hospitals. Medication for KS at the Uganda Cancer Institute is free and a dose in the private hospitals could cost Shs40,000.

Some patients do not react to the treatment given to them which Dr Niyonzima says could be related to the biology of the cancer. He says, “If one doesn’t respond to the first line of treatment, we immediately put him on the second.” Though the cancer may not heal, the doctors advise a good balanced diet to boost one’s immunity and blood levels which in turn increases their survival. Dr Niyonzima says that they cannot stop one from eating anything because it’s a disease that is not caught through one’s eating habbits.

Current stand
Dr Okuku says that there are fewer cases that are reported at the hospital. Before, in a year, the referral would have close to 450 patients. The oncologist attributes the reduction in the number of the Kaposi’s sarcoma patients to the fact that HIV prevalence has also gone down. Dr Okuku says though research shows that there is an increase in the new HIV infections, this doesn’t mean that the people with the new infections have the cancer; one doesn’t get it immediately.

How to prevent it
The experts advise safe sex. And avoid having many sexual partners, to prevent HIV which in the long run is a way of preventing the cancer.