Kaposi Sarcoma Early Detection, Diagnosis, and Staging

For skin lesions, a doctor usually does a punch biopsy, which removes a tiny round piece of tissue. Some lesions might be removed with a scalpel instead. If all of the lesion is removed, this is called an excisional biopsy. If only part is removed, it is called an incisional biopsy.

Skin biopsies can often be done with just local anesthesia (numbing medicine).

Lesions in your lungs, intestines, or other areas can be biopsied during procedures such as bronchoscopy or endoscopy, which are described below. Biopsy of lesions in these areas can sometimes cause serious bleeding, so it isn’t often done in people already known to have KS.

KS can sometimes affect other organs, such as your liver, spleen, heart, or bone marrow. These organs often don’t need to be biopsied if KS has already been confirmed with biopsies of other tissues.

All biopsy samples are sent to a lab, where a specially trained doctor called a pathologist looks at them under a microscope. They may also do other tests to find out if the samples contain KS cells.

You might have a chest x-ray to see if KS is in your lungs.

These tests create more detailed pictures of the inside of your body. A CT scan creates images using x-rays. An MRI does this with strong magnets.

These tests are typically only done if there is a reason to suspect KS might be in the lungs or digestive tract. You might get a CT scan or MRI if:

• A chest x-ray shows something abnormal.
• You have lung symptoms, such as shortness of breath or coughing up blood.
• You have digestive symptoms, such as belly pain or diarrhea.
• A test shows blood in your stool.

Upper endoscopy, also called esophagogastroduodenoscopy or EGD, is used to look at the inner lining of your esophagus, stomach, and the first part of your small intestine.

For this procedure, you are typically given medicine through an intravenous (IV) line to make you feel relaxed. Less often, you might be asleep for the test (under general anesthesia).

The doctor guides the endoscope through your mouth and esophagus and into your stomach and small intestine. This lets them see things like ulcers, infections, and KS lesions.

If the doctor sees an abnormal area, they can use small surgical tools through the endoscope to biopsy it.

Colonoscopy is used to look inside your large intestine (colon and rectum).

Before this test can be done, your colon and rectum must be cleaned out to remove any stool. This often means drinking a large amount of a liquid laxative the night before and the morning of the procedure. A laxative is a medicine that quickly clears the stool out of your body.

Just before the procedure, you will get intravenous (IV) medicine to make you relaxed or even fall asleep (sedation).

The doctor inserts a colonoscope (a type of endoscope) through your rectum and into your colon. If they see any abnormal areas, those can be biopsied.

Double balloon enteroscopy is a way to look inside your small intestine. Most of the small intestine can't be viewed with an upper endoscopy because it is too long (about 20 feet) and has too many curves. This method gets around these problems by using a special endoscope made up of 2 tubes, one inside the other.

For this test, you will get intravenous (IV) medicine to make you relaxed (sedation) or general anesthesia to put you to sleep.

The endoscope is inserted through your mouth or rectum, depending on what part of your small intestine needs to be examined.

Once inside your small intestine, the inner tube and video camera are advanced about a foot as the doctor looks at the lining of your intestine. A balloon is inflated to anchor the inner tube in place. The outer tube is then pushed forward and anchored in place with a second balloon.

This process is repeated over and over, letting the doctor see your intestine one foot at a time. The doctor can take a biopsy if they see something abnormal.

The procedure can take hours. It is more involved than capsule endoscopy (described below), but it has the advantage of letting the doctor biopsy any lesions that are seen.

Capsule endoscopy is another way to look at the small intestine. Despite the name, it’s not truly a type of endoscopy since it doesn’t use an endoscope. Instead, you swallow a capsule about the size of a large vitamin pill that has a light along with a very small camera.

You will probably be told not to eat or drink for about 12 hours before the test.

The capsule goes through your small intestine in about 8 hours. During this time, it takes thousands of pictures and sends them to a device you wear around your waist while going about your normal daily activities. The images are downloaded onto a computer where the doctor looks at them as a video.

The capsule passes out of your body through your stool during a normal bowel movement.

This test can often show abnormal areas in the small intestine, and it is easier to have than a double balloon enteroscopy. But one disadvantage is that the doctor can’t biopsy any abnormal areas during the test.

T0 (good risk): Localized tumor

KS is only in the skin and/or the lymph nodes (bean-sized collections of immune cells throughout the body), and/or there is only a small amount of disease on the palate (roof of the mouth). The KS lesions in the mouth are flat rather than raised.

T1 (poor risk): KS lesions are more widespread. One or more of the following is present:

• Edema (swelling) or ulceration (breaks in the skin) due to the tumor
• Extensive oral KS: Lesions are nodular (round lumps) and/or in areas of the mouth besides the palate (roof of the mouth)
• KS lesions are in other organs (such as the lungs, stomach, intestines, liver, etc.)

The immune status is assessed using a blood test known as the CD4 count, which measures the number of white blood cells called helper T cells.

I0 (good risk): CD4 cell count is 150 or more cells per cubic millimeter (mm³).

I1 (poor risk): CD4 cell count is lower than 150 cells per mm³.

S0 (good risk): No systemic illness present; all of the following are true:

• No history of opportunistic infections (infections that rarely cause problems in healthy people but affect people with suppressed immune systems) or thrush (a fungal infection in the mouth).
• No B symptoms lasting more than 2 weeks. B symptoms include unexplained fever, night sweats severe enough to soak the bed clothes, weight loss of more than 10% without dieting, and diarrhea.
• Karnofsky performance status (KPS) score of 70 or higher. This means you are up and about most of the time and able to take care of yourself.

S1 (poor risk): Systemic illness present; one or more of the following is true:

• History of opportunistic infections or thrush
• One or more B symptoms are present
• KPS score is under 70
• Other HIV-related illness is present, such as neurological (nervous system) disease or lymphoma