Some patients with cancer, which are not going through the best times, there is a special syndrome inherent only in such pathologies. It is characteristic for carcinoids - tumors consisting of neuroendocrine cells.
Because of the slow progression of the disease in some people, complete recovery is possible, but - with an early diagnosis and operation.
Carcinoids and carcinoid syndrome
Carcinoids are so named because of their morphological similarity to carcinomas, but they differ from the latter in a lesser degree of malignancy.
At present, they constitute up to 9% of cancers of the gastrointestinal tract, but can form in any part of the body( approximately 0.2% in the general statistics of cancer).
Tumors are formed from the cells of the nervous system and are hormone dependent, as they themselves produce serotonin and some other biologically active proteins. The age of patients who are diagnosed with such diseases is usually not less than 50-60 years.
Carcinoids grow slowly, many years. Their sizes are often small, so even recently they were considered almost benign tumors. Often they were detected only after autopsy, and the cause of death were not.
But now it is already proved that in 80% of cases without treatment these neoplasms give their metastases - in the intestines, liver, abdominal organs, lymph nodes.
This phenomenon does not occur in every patient, but it can last several years, include different symptoms from the skin, stomach, heart, etc.
Photo of the patient with carcinoid syndrome
The development of carcinoid syndrome is more likely in the presence of a tumor of the small intestine and bronchi, since it is these new growths that produce a significant amount of hormones.
Since other tumors of the gastrointestinal tract and other parts of the body produce less such substances, their symptoms may be absent until the last stage. Only the presence of metastatic processes changes the picture, reflecting the emergence of a clinical picture.
Types of carcinoids
Up to 40% of tumors that cause a characteristic syndrome are found in the small intestine, up to 25% in the appendix, 15% near the anus. Less common are neoplasms of the type described in the stomach, liver, bronchi, genital system, pancreas.
The main characteristics of carcinoids depending on the location are as follows:
- Tumor of the stomach. Develops on the bottom or arch of the body, when gastric juice is released, the release of histamine, the mediator of allergy, is triggered. As a result, hydrochloric acid is produced in increased quantities. Women are sick more often. Symptoms resemble those of ulcers - pain, heartburn, sometimes - bleeding. There are three types of formations - arising from an atrophic gastritis, with Zollinger-Ellison syndrome, without any disease. Swelling of the rectum. Diagnosed more often by accident, because they rarely give symptoms. At large sizes, a clinic of hemorrhoids, as well as constipation, rectal bleeding can be observed. Even with the formation of metastases, carcinoid syndrome is unlikely.
- Tumor of the bronchus. There are infrequent, up to 2% of neoplasms in the lower respiratory tract. Many patients are inveterate smokers, and in the latter usually slowly progressing tumors acquire an aggressive course, often give metastasis to the area of the diaphragm.
- Small intestine tumor. The most common type of localization. Almost always in the late stages gives a complex of characteristic symptoms, and also manifests itself as metastases and obstruction. Can lead to ischemia of the intestine( oxygen starvation due to circulatory disorders), kinks and deformities. These tumors are very difficult to diagnose.
- Tumor of the appendix( appendix).Are observed more often at young men, in overwhelming majority of cases are found out at excision of a cecum against a background of its inflammation. They have a small size, almost do not give metastases, which is why they are often considered benign.
- Tumor of the lung. It constitutes up to 2% of the total number of cancer lesions of the lung parenchyma. The reason is often called smoking. Predominantly, cancer is detected in people over 60 years of age, male. There are several types of such carcinoids - highly differentiated, low-grade, atypical. The prognosis of the last two species is poor, the degree of malignancy is high.
Causes of
The etiology of carcinoids has not yet been clarified. However, predisposing factors are:
- Heredity
- Bad ecology
- Work on harmful production
- Excess consumption of fried foods, smoked products
- Smoking
- Atrophic gastritis and other precancerous diseases
The immediate cause of the development of the entire symptom complex is the production of hormones, hormone-like substances and mediators of allergyarisen tumor.
Usually, such substances are found in the bloodstream of a sick person:
- Histamine
- Prostaglandins
- Serotonin
- Bradykinin
- Enteramin
- Chromogranin
Excess of such components, of which the most irritating is serotonin, and leads to the development of symptoms of carcinoid syndrome. In particular, hormones can constrict vessels, which causes an increase in blood pressure.
The interaction of pathologically large amounts of excreted substances and other normal hormones in the body also causes damage to the heart with the development of valvular insufficiency, pulmonary artery stenosis and other serious disorders.
Symptoms of
The symptoms of of the carcinoid syndrome are diverse and will largely depend on what substances were produced by the neoplasm.
In the vast majority of cases, there is a strong reddening of the skin, which is most noticeable on the front of the head, on the front surface of the neck, on the decollete. Body temperature in many patients also does not remain normal - it increases.
Hyperemia of the skin is not always kept by everyone. Some suffer from sudden tides in the upper body and head only after overload, nervous overexertion, taking alcohol, spicy food. Paroxysmal reddening of the skin and heat can pass spontaneously after a couple of minutes or in 2-5 hours.
If at such a moment to measure the pulse, then it will be raised, and the pressure, on the contrary, is reduced. During periods of attacks, hypertension is rare.
Another symptom that happens in almost 90% of cases is frequent diarrhea. Diarrhea happens without combination with tides, or develops with them. If at the time of the appearance of diarrhea take drugs that depress serotonin, then this unpleasant symptom ends.
Sometimes, instead of diarrhea, intestinal obstruction develops with severe pain in the peritoneum, if the tumor is already so large that it blocks the lumen of the intestine.
Other Possible Symptoms Combined with Carcinoid Syndrome:
- Swelling, pain in the heart, abdominal hydrops, enlargement of the liver, soreness, severe dyspnoea, including lying down, signs of heart failure.
- Bronchospasm, wheezing in the chest, respiratory failure as a result of compression of the bronchus or the influence of tumor hormones.
- Dizziness and fainting as a result of oxygen starvation of the brain tissue.
Over time, the intensity of symptoms increases, as does the frequency of acute manifestations. Complication can become a state of crisis with severe hypotension until shock, with suffocation on the background of bronchospasm. The immediate cause of this effect is the operation of the tumor.
Diagnosis of
Syndrome The main indicator that reflects the onset of carcinoid syndrome is the increase in serotonin in the blood.
In addition, in urine, the patient has a very high level of 5-hydroxyindoleacetic acid.
To be accurate and objective, a few days before they are performed, a person is not allowed to eat food with a high presence of serotonin.
If all the symptoms are too obvious, and the analysis does not give a positive result, a test with provocation( for example, with drinking alcohol) is needed.
After revealing the markers of carcinoid syndrome, it is necessary to urgently make a detailed examination and find a zone of localization of the neoplasm.
To find such methods may be needed:
- radiograph
- CT, MRI and standard
- Endoscopic ultrasound
- Capsule endoscopy intestine
- Fibrogastroduodenoscopy
- Fibrovideokolonoskopiya
- Bronchoscopy
- Laparoscopic examination
- biopsy
Since the syndrome develops in only 15-20% of patients, it should bedistinguish from manifestations of menopause, hypertension, side effects of taking medications.
Treatment of
disease The best option for effective treatment is to remove the tumor at an early stage or as it is detected. Only in this way can completely eliminate the carcinoid syndrome.
But sometimes the operation is impossible, since tumor metastases are already present in the liver or in a number of other organs. Nevertheless, there are always attempts to remove at least some of the new tumors, which will reduce the total volume of pathological tissue that produces hormones.
The use of radiation therapy for this type of cancer does not make sense. Chemotherapy has a weak therapeutic effect, but in the complete absence of the possibility to operate it still appoint. Cytostatic Cyclophosphan, which works in half of the clinical cases, is more often recommended.
With regard to symptomatic treatment of the syndrome, it is advisable to conduct it by taking drugs that depress serotonin( eg, Deseril).
other means to reduce unpleasant sensations are:
- antihypertensives
- Opioid analgesics
- Astringents
- Antidiarrhoeals drugs
- Glucocorticosteroids
- Antidepressants Antihistamines
- Interferons
forecast average term survival syndrome - 5-15 years due to slow tumor growth( 50%people live more than 5 years).With a successful operation, the forecast is favorable.
Very rarely there is a lightning-fast course of the disease with a lethal outcome. The most unfavorable prognosis for bronchial carcinoid.
Video about modern diagnosis and treatment of carcinoid syndrome: