Friday, April 6, 2012

KAPOSI’S SARCOMA (KS)



·         Malignant (cancer) cells form in the tissue lining the lymph vessels under the skin or in mucous membranes.
·         Epidemic KS: is the form associated with HIV infection. It tends to follow a more variable but potentially more aggressive course than other forms of KS.
·         Produces multiple flat pink, brown, or purple patches or bumps on the skin; it is caused by herpesvirus type 8 (KS-associated herpes virus).
·         Most common AIDS-related cancer and predominantly affects gay men with HIV
·         Mainly affects the skin, the mouth, and the lymph nodes, it can also involve the bowels and lungs.

Signs & Symptoms:

ü  Cutaneous lesions:
Appearance: Macular, papular, nodular, or plaque like
Characteristic: palpable and nonpruritic
Size: several millimeters to several centimeters in diameter
Pattern: symmetrical on each side of the body and may follow the skin fold lines of the body.
Color: pink, red, or bluish color
ü  KS in lymph nodes: blocked fluid drainage may cause swelling, especially in the feet, lower legs or genital
ü  Common metastasis to GI, lungs and lymphtics.
ü  KS in the lungs (pulmonary KS):
o    Most serious form, and can be fatal. 
o    Can lead to recurrent chest infections or accumulation of fluid on the lung (pleural effusion).
o    There may be hemoptysis, cough and breathlessness.

Diagnostic Exams:

§  CD4 lymphocyte counts and plasma HIV viral-load studies
§  Biopsy
§  Chest x-ray: defect lung lesions
§  Endoscopy: defect GI lesions
§  Bronchoscopy: detect lesions in the lungs

Treatment:

·         Surgical Excision
·         Antiretroviral therapy
·         Radiation therapy: kills the over-active tumor cells with a series of low doses of radiation, leaving the rest of the body untouched.

·         Cryotherapy: for areas of thin skin such as the face and the genitals, and is most successful if the KS lesion is flat, not nodular and relatively small.

·         Intralesional injection of vinblastine (Velbe®) or vincristine (Oncovin®): causes the lesion to swell up painfully but then shrink or disappear, leaving a scar

·         Interferon therapy: used by people with early KS, limited to the skin, with CD4 cell counts above 200 cells/mm3 and no history of opportunistic infections.
Side effects: flu-like symptoms & neutropenia

·         Cytotoxic Chemotherapy:
e.g. bleomycin, doxorubicin, etoposide, tenoposide, vinblastin, vincristine, paclitaxel

·         Liposomal Chemotherapy: carries anticancer drugs in liposomes
e.g. liposomal doxorubicin and liposomal daunorubicin (DaunoXome®)

Nursing Interventions:

·         Listen to the patient’s fears & concerns and answer his questions honestly.
·         Allow patient to participate in care decisions whenever possible.
·         Inspect patient’s skin for new lesions & skin breakdown.
·         Provide high-calorie, high-protein meals. Consult with dietitian to plan meals around the patient’s treatment.
·         Be alert for adverse reactions to radiotherapy or chemotherapy.
·         Explain infection prevention techniques: hand washing; practice safe sex
·         Emphasize the need for ongoing treatment & care.

Other oncologic manifestation:
Lymphoma
Cervical Cancer


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