I hope I find you in good health. A sarcoma is a cancer that develops in connective tissues such as cartilage, bone, fat, muscle, blood vessels, or fibrous tissues (related to tendons or ligaments). Kaposi sarcoma (KS) was named after an Austrian dermatologist Dr. Moritz Kaposi who first described classic KS in 1872.
For decades KS was considered a rare disease that mostly affected elderly men of Mediterranean or Jewish heritage, organ transplant patients, or young adult African men. In the last 20 years, however, the vast majority of KS cases have developed in association with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS), especially among homosexual men. With the use of new treatments for AIDS, this is turning around, and the number of KS cases due to HIV infection is decreasing.
This disease typically causes tumors to develop in the tissues below the skin surface, or in the mucous membranes of the mouth, nose, or anus. These lesions (abnormal tissue areas) appear as raised blotches or nodules that may be purple, brown, or red. Sometimes the disease causes painful swelling, especially in the legs, groin area, or skin around the eyes.
Although the skin lesions of KS may be disfiguring, they usually are not life threatening or disabling. In most cases, the lesions cause no symptoms. In some, the lesions may be painful, especially if they cause swelling of nearby unaffected skin. If the disease also involves the lungs, liver, gastrointestinal tract, or lymph nodes, other symptoms may develop. KS in the gastrointestinal tract, for example, can produce bleeding, while tumors in the lungs may cause difficulty breathing.
There are several types of KS. They each differ in their patterns of symptoms and organs likely to be affected, how aggressively the cancer grows and spreads, risk factors, and other personal characteristics of patients. The treatment used and the likelihood of survival depend on the type of KS, as well as other factors discussed later in this document.
Classic Kaposi sarcoma usually develops in Jewish men of Eastern European origin or among men of Mediterranean heritage (primarily Italian) between the ages of 50 and 70. Classic KS is quite rare, even in these ethnic and age groups.
African (or endemic) Kaposi sarcoma is a form of the disease that develops in people living in equatorial Africa. This disease is fairly common. It accounts for 9% of all the cancers seen among Ugandan men, for example. In many cases, this disease is identical to classic KS, although it usually strikes at a much younger age. It affects many more men than women. Typically, African (endemic) KS causes skin lesions that do not produce symptoms and do not spread to other parts of the body.
Transplant-related (or acquired) Kaposi sarcoma refers to the form of the disease developed by people whose immune systems have been suppressed following an organ transplant. Usually a transplant patient must take drugs to prevent the immune system from "recognizing" the newly transplanted organ as foreign to the body. Because these drugs weaken the body's defenses, other diseases or infections can take hold.
AIDS-related (or epidemic) Kaposi sarcoma arises in people who are infected with HIV. This is probably the commonest in Zimbabwe. It was in part the unusual and sudden appearance of this form of KS in so many young men at the start of the AIDS epidemic that led doctors to realize that a new disease had emerged.
Acquired immune deficiency syndrome (AIDS) results from infection by the human immunodeficiency virus (HIV). This virus destroys certain cells of the immune system, making the body unable to fight infections caused by certain other viruses, bacteria, and parasites. Certain forms of cancer are also more likely to develop in people whose immune systems have been damaged.
A person infected with HIV (that is, being HIV-positive) does not necessarily have AIDS. The virus can be present in the body for a long time, typically many years, before causing any major illness. The disease known as AIDS begins when the virus has caused serious damage to the immune system, which results in certain types of infections and other medical complications.
Certain diseases occur so often in people with AIDS that they are considered "AIDS-defining conditions" -- that is, their presence in a person infected with HIV is a clear sign that full-blown AIDS has developed. Certain cancers have been identified as AIDS-defining diseases e.g. Kaposi sarcoma, lymphoma (especially non-Hodgkin lymphoma and primary central nervous system lymphoma), anal cancer, and cancer of the cervix that has spread to neighboring tissue (called invasive cervical cancer). Many other kinds of cancer may be more likely to develop in people with HIV infection. Of course, people without HIV or AIDS can also have these types of cancer.
In most cases, epidemic KS causes widespread lesions that erupt at many places on the body soon after AIDS develops. Lesions of epidemic KS may arise on the skin and the mouth and may affect the lymph nodes and other organs, usually the gastrointestinal tract, lung, liver, and spleen. In contrast, classic KS usually involves only one or a few areas of skin, most often the lower legs. At the time of diagnosis, some people with epidemic KS experience no symptoms, especially if their only lesions develop on the skin. However, many even those with no skin lesions will have swollen lymph nodes, unexplained fever, or weight loss. Eventually, in almost all cases, epidemic KS spreads throughout the body. Extensive lung involvement with KS can be fatal. More often, however, patients die of other AIDS-related complications such as infections. Modern treatment of the HIV infection with antiretroviral drugs usually prevents the development of advanced Kaposi sarcoma.

KS is not considered curable. Neither surgical removal of the first-detected lesion nor obtaining a complete remission of multiple sites with chemotherapy or other techniques results in cure. Long-term survival does occur both with or without treatment, however.
Survival in classic KS is usually years and sometimes decades. Some patients with AIDS-related KS are still alive after 10 years, though most survive only a few years and treatment decisions are usually aimed at palliation.
All forms of KS are sensitive to radiation therapy. Radiation is especially useful for lesions that are cosmetically disturbing, painful, involve the mouth extensively, block lymphatics, bleed, or protrude from the skin. Response rates are quite high and treatment is well tolerated.
Chemotherapy can be used in treatment but there is concern that aggressive treatment might further depress the immune system. The disease does respond to chemotherapy, both with single agents and combinations of drugs.
KS is one of the few tumors that responds to local injections of chemotherapy. Many anticancer drugs cause intense local damage if they are accidentally injected into tissue. This undesirable effect has been used in a positive way to treat skin lesions
The prognosis (likelihood of survival) for patients with classic KS is good. Tumors can frequently be controlled and patients frequently die of other causes before any serious spread. African endemic KS can progress rapidly and lead to premature death, despite treatment. In AIDS-related KS, milder cases can frequently be controlled; the prognosis for more advanced and rapidly progressing cases is less certain and dependent on the patient's overall medical condition. There are indications that KS can be stabilized or reversed in patients whose level of HIV in the blood is reduced to undetectable levels via antiretroviral therapy.
Safer sex practices may help to prevent AIDS-related KS by decreasing the risk of transmission of HHV-8. Treatment with antiretrovirals and protease inhibitors may help to preserve the function of the immune system in HIV patients and delay the appearance and progression of KS lesions.

Till next week take care of yourself and each other. Remember, "…in all your getting, get understanding."