Carcinoid - a family of neuroendocrine tumors composed of cells of the diffuse endocrine system. Such
cells found in all organs and tissues, but their main clusters identified in the gastrointestinal tract, bronchitis, urinary tract
. A feature of the diffuse endocrine system is the ability to produce a number of biologically active compounds (hormones)
. Although the incidence in recent years, growing steadily, carcinoid remains relatively rare disease
. Carcinoids vary according to the embryonic origin of the secretory profile and grade
. By origin are divided into carcinoid tumor of the cells of the anterior, middle and posterior intestine
. The former include carcinoids respiratory tract, pancreas, primary card duodenum and stomach
. The second - from the posterior intestinal carcinoid department duodenum to the appendix, and to the third - from the surrounding stromal tumors and blood vessels
. The potential for malignancy carcinoids varies widely from benign neoplasms nature to a high degree of malignancy
Carcinoids can produce bioactive compounds, including prostaglandins, kinin, serotonin, kallikrein. The more active substances produces the tumor, the more pronounced the clinical picture of the disease.
A typical manifestation of the disease is the carcinoid syndrome. Characterized by the following symptoms: hot flashes, cramping abdominal pain, diarrhea, valvular damage, dyspnea, cyanosis of the skin, telangiectasia. In severe cases can develop carcinoid crisis. This life-threatening condition in which the blood circulation, respiration, the nervous system. The clinical picture depends on the location of the tumor.
Carcinoid lung presents typical and atypical tumors, neuroendocrine large cell carcinoma and small cell lung cancer. Typical tumor has a low degree of malignancy, atypical - average degree. Large-neuroendocrine cancer and small cell lung cancer - a disease with high malignant potential. Mostly common in men older than 60 years. In most cases, small cell lung cancer develops. The forecast is very unfavorable. Five-year survival is less than 8%. The reason for the overwhelming majority of lung carcinoids is smoking.
Gastric carcinoids are of three types. Type A is combined with chronic atrophic gastritis type B - with Zollinger-Ellison syndrome, type C occurs independently. When carcinoid type A hydrochloric acid secretion in the stomach is reduced, increased gastrin levels also often shows anemia. Gastric carcinoid this type are often multiple and their dimensions do not exceed 1 cm. The age of patients usually over 60 years. The disease is considered to be favorable: distant metastases occur in 3-5% of cases, mortality
minimal, virtually no clinical manifestations. Carcinoid type B is most common within the syndrome of Vermeer, when there are other tumors of the endocrine glands. Carcinoid syndrome is not formed, the prognosis quite favorable. With this type carcinoid tumors greater than 1 cm in diameter. These tumors metastasize early, is characterized by high mortality rates of patients.
Treatment of carcinoid
In the treatment of carcinoid preferred radical way
. Even with distant metastases should be considered surgery
. Methods of intervention depends on the location of the tumor and its origin
. Even when complete removal of tumors and metastases impossible sometimes used surgical technique to relieve symptoms of the disease
. Conservative treatment drugs include primarily somatostatin analogues and interferons
. These drugs reduce the secretion of hormones that contribute to the cessation of the growth of tumors and metastases
. Also used chemotherapeutic methods, including treatment temzirolimusom, temozolomide
. Currently, development of new approaches to the treatment carcinoids
. Established drug directional (Targeted)
. These include, for example, angiogenesis inhibitors, stops the growth of tumor vessels