The importance of early detection in Kaposi's sarcoma and its treatment.

Kaposi's sarcoma (KS) is a rare type of cancer that originates in the blood and lymphatic vessels of the body. It generally manifests on the skin through spots or nodules of a dark reddish hue, which can be mistaken for bruises in their early stages. Unlike the latter, KS lesions do not fade away; instead, they tend to multiply and grow in size. Although this disease is rare, it deserves attention due to its complexity and the implications it has for health, especially in vulnerable populations. In a recent interview, Dr. Ricardo Cubedo, a medical oncologist and head of the Medical Oncology Service at MD Anderson Cancer Center Madrid, explains that KS can affect not only the skin but also internal organs such as the lungs and the digestive tract. Symptoms can range from the appearance of skin lesions to more severe complications, such as cough, abdominal pain, intestinal bleeding, and difficulty breathing. This revealing aspect highlights the importance of early detection and accurate diagnosis. One of the distinctive features of Kaposi's sarcoma is its mode of manifestation. Unlike other types of cancer that typically develop in a specific area and then spread, KS can appear simultaneously in multiple parts of the body. This is because it affects blood vessels, which are present throughout the body, potentially resulting in lesions in various locations, from the extremities to the face, as well as in vital organs. Dr. Cubedo points out that although KS is considered rare in Spain, with an incidence of approximately one case per quarter of a million inhabitants, its frequency increases significantly in regions of equatorial Africa, such as Uganda and Tanzania. During the 1980s and 1990s, an epidemic of KS was observed linked to the AIDS pandemic in Western countries. However, with modern antiretroviral treatments, the incidence among HIV-infected individuals has significantly decreased. The relationship between Kaposi's sarcoma and human herpesvirus 8 (HHV-8) is fundamental to understanding the pathology. This virus triggers the characteristic lesions of KS, particularly in individuals with compromised immune systems, such as AIDS patients or those who have received transplants. HHV-8 is transmitted through close contact and sexual relations, although latent infection alone does not cause disease. It is the combination of this virus with other factors, such as immunosuppression, that leads to the development of the sarcoma. KS is classified into different types, including classic KS, which affects older individuals of Mediterranean descent; endemic KS, which is more prevalent in sub-Saharan Africa; epidemic KS, which is associated with HIV; and iatrogenic KS, which occurs in patients undergoing immunosuppressive treatments. This differentiating approach is crucial for understanding how KS develops in different populations and clinical scenarios. Dr. Cubedo emphasizes that patients with HIV have a higher risk of developing KS, especially if they are not receiving antiretroviral treatment. The weakening of the immune system caused by HIV allows for the activation of HHV-8, significantly increasing the risk associated with this type of cancer. Fortunately, thanks to advances in antiretroviral therapy, the risk of developing Kaposi's sarcoma has drastically decreased in recent decades. The diagnosis of KS is made through the observation of skin lesions, which are typically characteristic of the disease. To confirm the diagnosis, a biopsy is performed, and the evaluation of the internal extent of the cancer requires techniques such as endoscopies and scans. This process is essential for determining the severity of the disease and planning appropriate treatment. The treatment of Kaposi's sarcoma varies depending on the extent of the cancer and the patient's immune system status. For those linked to HIV, antiretroviral treatment may be sufficient to reduce or even eliminate the lesions. In cases of transplant patients, a reduction in immunosuppressive medication may be effective. However, in more advanced situations, specific chemotherapy treatments or localized treatments, such as laser therapy, may be recommended to address the lesions more focalized. As research progresses and the complexities of Kaposi's sarcoma are better understood, it is crucial to continue raising awareness about this disease. Education on risk factors, symptoms, and the importance of early detection can be vital for improving outcomes in patients and reducing the incidence of this type of cancer in the most vulnerable populations.