7 Key Symptoms of Kaposi Sarcoma You Should Know

Kaposi sarcoma is a rare type of cancer that develops from the cells lining lymph or blood vessels. It typically appears as abnormal tissue growths or lesions on the skin, but can also affect other parts of the body including the mouth, lymph nodes, and internal organs. This condition is most commonly associated with weakened immune systems, particularly in people living with HIV/AIDS, though it can occur in other populations as well.

Recognizing the symptoms of Kaposi sarcoma early is crucial for timely medical intervention and management. The signs can vary depending on which areas of the body are affected, and symptoms may develop gradually over time. Understanding these warning signs can help individuals seek appropriate medical attention and improve health outcomes.

1. Purple, Red, or Brown Skin Lesions

The most distinctive and common symptom of Kaposi sarcoma is the appearance of abnormal skin lesions. These lesions typically present as flat or slightly raised patches on the skin that can range in color from purple and red to brown or black, depending on your skin tone.

These patches may appear anywhere on the body but are most commonly found on:

• The face, especially around the nose and eyes
• Legs and feet
• Genital areas
• Trunk of the body

Initially, the lesions may be small and painless, often mistaken for bruises or age spots. However, unlike bruises, Kaposi sarcoma lesions do not fade or change color over time. They may remain the same size for months or years, or they can grow and multiply. The lesions can vary in size from a few millimeters to several centimeters in diameter, and multiple lesions often appear simultaneously in different areas of the body.

The texture of these lesions can also vary. Some remain flat (macular), while others become raised (papular or nodular) as they progress. In some cases, the lesions may become firm to the touch or develop a hardened surface.

2. Swollen Lymph Nodes

Lymph node enlargement is a significant symptom of Kaposi sarcoma, particularly when the cancer spreads beyond the skin. The lymphatic system is one of the primary areas affected by this condition, and swollen lymph nodes may occur even before visible skin lesions appear in some cases.

The lymph nodes most commonly affected include those in the:

• Neck
• Armpits (axillary region)
• Groin (inguinal region)

These swollen lymph nodes may feel firm or rubbery to the touch and are typically painless in the early stages. However, as they continue to enlarge, they can cause discomfort or pain, particularly if they press against nearby nerves or structures. Significant lymph node swelling can also lead to complications such as lymphedema, which is the accumulation of fluid in tissues causing swelling, typically in the arms or legs.

When Kaposi sarcoma affects internal lymph nodes, particularly those in the chest or abdomen, it may not be immediately noticeable through physical examination and may only be detected through imaging studies. However, internal lymph node involvement can contribute to other symptoms such as breathing difficulties or digestive problems.

3. Lesions in the Mouth and Throat

Oral lesions are a common manifestation of Kaposi sarcoma, occurring in approximately 30% of patients with the condition. These lesions can appear anywhere in the oral cavity and may significantly impact quality of life.

Oral Kaposi sarcoma lesions commonly appear on the:

• Hard palate (roof of the mouth)
• Gums (gingiva)
• Tongue
• Inner cheeks
• Throat and tonsils

These oral lesions appear similar to skin lesions, presenting as purple, red, or brown spots or raised bumps. They may start small but can grow larger over time, sometimes becoming nodular or ulcerated. In the early stages, oral lesions are typically painless and may go unnoticed during routine activities.

As the lesions progress, they can cause several problems including difficulty eating or swallowing, especially if they are located on the tongue or throat. Large lesions on the gums or palate may bleed easily, particularly during tooth brushing or eating hard foods. Some patients experience pain or discomfort when lesions become ulcerated or infected. Speech difficulties can also occur if lesions affect the tongue or other areas involved in articulation.

4. Swelling of the Legs and Feet (Lymphedema)

Lymphedema, or the abnormal accumulation of fluid in tissues, is a distressing symptom that occurs when Kaposi sarcoma affects the lymphatic system. This symptom can significantly impact mobility and quality of life.

When Kaposi sarcoma lesions block lymphatic vessels or when the cancer involves lymph nodes, the normal drainage of lymphatic fluid is impaired. This blockage causes fluid to accumulate in the tissues, most commonly affecting the lower extremities. The swelling typically:

• Develops gradually over time
• Affects one or both legs
• May extend from the feet up to the thighs
• Causes the affected limb to feel heavy or tight
• Results in skin that appears stretched and shiny

The swollen areas may feel firm or spongy when pressed, and the skin may not immediately bounce back after pressure is applied (pitting edema). In severe cases, the swelling can become so pronounced that it limits mobility and makes wearing shoes or clothing difficult. The affected skin may also become more susceptible to infections such as cellulitis.

Lymphedema can also occur in the arms, face, or genital area, depending on which lymphatic vessels or nodes are affected by the cancer. Facial lymphedema, though less common, can cause significant disfigurement and emotional distress.

5. Respiratory Symptoms

When Kaposi sarcoma affects the lungs or respiratory tract, it can cause a range of breathing-related symptoms. Pulmonary involvement is particularly concerning as it can be life-threatening if not properly managed.

Common respiratory symptoms associated with Kaposi sarcoma include:

• Persistent cough that doesn’t improve with typical treatments
• Shortness of breath (dyspnea), particularly during physical activity or when lying down
• Chest pain or discomfort
• Wheezing or difficulty breathing
• Coughing up blood (hemoptysis)

Pulmonary Kaposi sarcoma occurs when lesions develop in the airways, lung tissue, or the pleura (the lining around the lungs). These lesions can obstruct airways, reduce lung capacity, and interfere with normal gas exchange. The severity of respiratory symptoms often correlates with the extent of lung involvement.

In some cases, pulmonary Kaposi sarcoma can lead to pleural effusion, which is the accumulation of fluid between the layers of tissue lining the lungs. This can cause increased shortness of breath and chest discomfort. Respiratory symptoms may develop gradually or appear suddenly, and they tend to worsen over time if the condition progresses. Any persistent respiratory symptoms, especially in individuals at risk for Kaposi sarcoma, should be evaluated promptly by a healthcare provider.

6. Gastrointestinal Symptoms

Kaposi sarcoma can affect the gastrointestinal (GI) tract, leading to various digestive symptoms. GI involvement is relatively common but often remains asymptomatic in the early stages, making it challenging to detect without specific diagnostic procedures.

When symptoms do occur, they may include:

• Abdominal pain or cramping
• Nausea and vomiting
• Diarrhea or changes in bowel habits
• Blood in the stool (which may appear bright red or black and tarry)
• Unexplained weight loss
• Loss of appetite
• Feeling of fullness after eating small amounts

Gastrointestinal Kaposi sarcoma can occur anywhere along the digestive tract, from the esophagus to the colon, though it most commonly affects the stomach and small intestine. The lesions in the GI tract can cause bleeding, which may be acute and severe or chronic and subtle. Chronic bleeding can lead to anemia, causing additional symptoms such as fatigue, weakness, and pale skin.

In some cases, larger lesions or multiple lesions can cause obstruction of the intestines, leading to severe abdominal pain, constipation, and vomiting. Intestinal obstruction is a medical emergency requiring immediate attention. Lesions in the esophagus may cause difficulty swallowing (dysphagia) or pain when swallowing (odynophagia), making it challenging to maintain adequate nutrition.

7. General Systemic Symptoms

Beyond the localized symptoms, Kaposi sarcoma can cause a range of systemic symptoms that affect overall health and well-being. These symptoms often indicate more widespread disease or reflect the body’s response to the cancer.

Common systemic symptoms include:

• Unexplained fever: Persistent or recurring fever without an obvious infection source can indicate active Kaposi sarcoma, particularly when there is extensive disease or internal organ involvement.
• Night sweats: Profuse sweating during sleep that may require changing bedclothes or sheets is a common symptom associated with many cancers, including Kaposi sarcoma.
• Fatigue and weakness: Overwhelming tiredness that doesn’t improve with rest is frequently reported. This can result from the cancer itself, anemia from bleeding lesions, or the body’s immune response to the disease.
• Unintentional weight loss: Losing 10% or more of body weight without trying over a period of six months or less can indicate advanced Kaposi sarcoma, especially when combined with other symptoms.
• General malaise: A pervasive feeling of being unwell, uncomfortable, or lacking energy that affects daily activities and quality of life.

These systemic symptoms are sometimes referred to as “B symptoms” in cancer terminology and often indicate more aggressive or advanced disease. They result from various factors including the body’s inflammatory response to cancer, the metabolic demands of rapidly growing tumors, and the impact of cancer on normal organ function.

The presence of multiple systemic symptoms, particularly when combined with localized symptoms like skin lesions or swollen lymph nodes, warrants thorough medical evaluation. These symptoms can significantly impact quality of life and may require supportive care in addition to treatment of the underlying Kaposi sarcoma.

Main Causes of Kaposi Sarcoma

Kaposi sarcoma is caused by infection with human herpesvirus 8 (HHV-8), also known as Kaposi sarcoma-associated herpesvirus (KSHV). However, HHV-8 infection alone is not sufficient to cause the disease; additional factors, particularly immune system compromise, play a critical role in disease development.

The main risk factors and causes include:

HIV/AIDS and Immune Suppression: The most common form of Kaposi sarcoma occurs in people with HIV/AIDS, particularly those with severely weakened immune systems. When the immune system cannot effectively control HHV-8, the virus can cause cells to grow abnormally, leading to Kaposi sarcoma. This form is known as epidemic or AIDS-related Kaposi sarcoma.

Immunosuppressive Medications: People who take immunosuppressive drugs, such as those used after organ transplantation to prevent rejection, have an increased risk of developing Kaposi sarcoma. This form is called iatrogenic or transplant-related Kaposi sarcoma. The risk increases with the duration and intensity of immunosuppression.

Geographic and Genetic Factors: Classic Kaposi sarcoma occurs more frequently in older men of Mediterranean, Eastern European, or Middle Eastern descent. This form typically develops slowly and is less aggressive than other types. Endemic African Kaposi sarcoma occurs in people living in equatorial Africa, where HHV-8 infection rates are higher in the general population.

Age and Gender: Kaposi sarcoma is more common in men than in women, with ratios varying depending on the type. Age is also a factor, with classic Kaposi sarcoma typically affecting older adults, while AIDS-related Kaposi sarcoma can occur at any age.

Mode of HHV-8 Transmission: The virus can be transmitted through saliva, sexual contact, blood transfusions, or from mother to child during birth. In areas where HHV-8 is common, transmission often occurs through non-sexual routes, particularly during childhood.

Prevention Strategies

While Kaposi sarcoma cannot always be prevented, especially in cases where HHV-8 infection has already occurred, several strategies can reduce the risk of developing the condition or minimize its severity.

HIV Prevention and Management: The most effective prevention strategy for AIDS-related Kaposi sarcoma is preventing HIV infection through safe sex practices, using condoms consistently, avoiding sharing needles, and taking pre-exposure prophylaxis (PrEP) if at high risk. For those already living with HIV, maintaining viral suppression through consistent antiretroviral therapy (ART) is crucial. Good adherence to HIV treatment helps preserve immune function and significantly reduces the risk of developing Kaposi sarcoma.

Regular Medical Monitoring: People at higher risk for Kaposi sarcoma, including those with HIV/AIDS or organ transplant recipients, should have regular medical check-ups. Routine monitoring can help detect early signs of the disease, allowing for prompt intervention. This includes regular skin examinations and reporting any new or changing lesions to healthcare providers.

Immune System Support: Maintaining overall health and immune function through proper nutrition, adequate sleep, stress management, and avoiding smoking and excessive alcohol consumption can help support the body’s natural defenses. For transplant recipients, working closely with healthcare providers to balance the need for immunosuppression with the risk of complications like Kaposi sarcoma is important.

Avoiding HHV-8 Transmission: While challenging, reducing exposure to HHV-8 can help prevent infection. This may include practicing safe sex, as the virus can be transmitted sexually, and being cautious about exposure to saliva in endemic areas where HHV-8 is common.

Awareness and Education: Being informed about the signs and symptoms of Kaposi sarcoma, particularly for those in high-risk groups, enables earlier detection and treatment. Education about risk factors and prevention strategies empowers individuals to take proactive steps to protect their health.

Frequently Asked Questions

Is Kaposi sarcoma contagious?

Kaposi sarcoma itself is not contagious, but the virus that causes it (HHV-8) can be transmitted from person to person through saliva, sexual contact, or blood. However, most people infected with HHV-8 do not develop Kaposi sarcoma unless they also have a weakened immune system.

Can Kaposi sarcoma occur in people without HIV?

Yes, Kaposi sarcoma can occur in people without HIV. There are several types, including classic Kaposi sarcoma (typically in older men of Mediterranean or Eastern European descent), endemic Kaposi sarcoma (in parts of Africa), and iatrogenic Kaposi sarcoma (in organ transplant recipients taking immunosuppressive medications).

Are the skin lesions of Kaposi sarcoma painful?

In most cases, Kaposi sarcoma skin lesions are painless, especially in the early stages. However, they can become painful if they grow large, become ulcerated, or develop secondary infections. Lesions in certain locations, such as the soles of the feet, may also cause discomfort.

How quickly does Kaposi sarcoma progress?

The progression rate varies significantly depending on the type of Kaposi sarcoma and the person’s immune status. Classic Kaposi sarcoma typically progresses slowly over years, while AIDS-related Kaposi sarcoma can progress rapidly, especially in people with very low CD4 counts who are not receiving HIV treatment.

Can Kaposi sarcoma spread to internal organs?

Yes, Kaposi sarcoma can affect internal organs, particularly the lungs, gastrointestinal tract, and lymph nodes. Internal organ involvement is more common in people with severely weakened immune systems and can cause serious complications requiring medical attention.

What is the difference between Kaposi sarcoma and regular skin cancer?

Kaposi sarcoma develops from cells lining blood or lymph vessels and is caused by HHV-8 infection in the setting of immune suppression. Regular skin cancers (such as melanoma, basal cell carcinoma, or squamous cell carcinoma) develop from different skin cell types and have different causes, typically related to UV radiation exposure and other factors.

Should I see a doctor if I notice purple spots on my skin?

Yes, any new, unexplained skin lesions, particularly purple, red, or brown spots that don’t fade like bruises, should be evaluated by a healthcare provider. While these spots may have various causes, early evaluation is important for proper diagnosis and treatment if needed, especially if you have risk factors for Kaposi sarcoma.

Can Kaposi sarcoma go away on its own?

Kaposi sarcoma rarely resolves without treatment. However, in some cases, particularly in people with HIV who start effective antiretroviral therapy, lesions may stabilize or even regress as the immune system recovers. Medical evaluation and appropriate management are important for the best outcomes.

References:

• National Cancer Institute – Kaposi Sarcoma Treatment
• Mayo Clinic – Kaposi Sarcoma
• American Cancer Society – Signs and Symptoms of Kaposi Sarcoma
• NHS – Kaposi’s Sarcoma
• Centers for Disease Control and Prevention – Kaposi Sarcoma