Kartsinoid – rare, potentially malignant new growth from group of neuroendocrine tumors. Settles down in bodies of gastrointestinal and respiratory tract. Allocates large amounts of biologically active agents. Kartsinoid can proceed long asymptomatically. In the subsequent there are inflows which are followed by reddening of the top half of a body, tachycardia and hypotonia. Diarrhea and belly-aches are possible. In the started cases bleedings, intestinal impassability or a lung can develop. The diagnosis of a kartsinoid is established on the basis of symptoms, ultrasonography, KT, laboratory analyses and other researches. Treatment – operation, chemotherapy.
Kartsinoid – the active tumor rare, slow-growing gormonalno coming from APUD system cages. On a clinical current reminds good-quality new growths, however it is inclined to the remote metastasis. Kartsinoid is considered as potentially malignant neoplasia. Affects a stomach and intestines more often, meets in lungs, a pancreas, a gall bladder, a thymus or an urogenital path less often. Usually it is diagnosed at the age of 50-60 years though can come to light also at young patients. Makes 0,05-0,2% of total of oncological diseases and 5-9% of total of neoplaziya of digestive tract. According to one data, men suffer kartsinoidy slightly more often than women, on others the disease equally often affects representatives of both floors. Treatment experts in the field of oncology carry out, gastroenterologies, pulmonology, abdominal surgery, thoracic surgery and endocrinology.
Etiology and patanatomiya of a kartsinoid
The new growths coming from endocrine cages were described in 1888. A bit later, in 1907, Oberndorfer for the first time used the name "kartsinoid" for designation of the neoplaziya reminding intestines cancer, but which are characterized by more good-quality current. Despite more than century history of studying of kartsinoid, the reasons of their development still remain unknown. Researchers note unsharply expressed hereditary predisposition.
In 50-60% of cases of a kartsinoida settle down in the field of an appendix, in 30% - in a small intestine. Damage of a stomach, large intestine, rectum, pancreas, easy and some other bodies is possible. There is a certain correlation between localization of a kartsinoid and level of serotonin in the patient's organism. The greatest number of serotonin is allocated by the kartsinoida located in a podvzdoshny gut, a lean gut and the right half of a large intestine. Lower level of hormonal activity is characteristic of tumors of bronchial tubes, a duodenum, stomach and pancreas.
Because of the slow growth, the small size and a long asymptomatic current of a kartsinoida long time were considered as good-quality new growths. However in the subsequent it became clear that tumors of this group often spread. At kartsinoida of a small intestine the remote metastasises come to light at 30-75% of patients, at damages of a large intestine – at 70%. Secondary oncological processes usually come to light in regionarny lymph nodes and a liver, is more rare – in other bodies.
At defeat of hollow bodies of a kartsinoida are localized in a submucous layer. Tumors grow both in the direction of an external wall of intestines, and towards a cavity of body. Usually diameter of a kartsinoid does not exceed 3 cm. The new growth is dense, yellow or grayish-yellow on a section. Distinguish three main types of a histologic structure of kartsinoid: with formation of trabeculas and solid nests (type A), in the form of narrow tapes (type B) and with a pseudo-ferruterous structure (type C). When carrying out argentafinny and hromafinny reactions in cytoplasm of cages of the studied sample serotoninsoderzhashchy grains are defined.
Symptoms of a kartsinoid
The long asymptomatic current is characteristic of kartsinoidny tumors. The Patognomonichny sign are the pristupoobrazny inflows which are followed by sudden hyperaemia of the person, neck, nape and the top half of a trunk. Prevalence of hyperaemia at a kartsinoida can differ – from local face reddening before widespread change of coloring of all upper body. During inflows there is a feeling of heat, a sleep or burning in hyperaemia zone. Reddening of a conjunctiva, dacryagogue, the strengthened salivation and a face edema are possible.
Along with the listed symptoms in the period of attacks at patients kartsinoidy increase of pulse and decrease HELL are observed. Less often inflows are followed by increase in arterial pressure. Attacks at a kartsinoida develop without the visible reasons or there is against the background of physical activity, an emotional stress, reception of some medicines, alcohol intake, spicy and greasy food. Attack duration usually makes from 1-2 to 10 minutes, is more rare – several hours or days. At initial stages of a kartsinoid inflows are observed 1 time in several weeks or months. In the subsequent the frequency of attacks increases to several times a day.
Taking into account features of a current allocate four types of inflows at kartsinoida. Duration of attacks of the first type (eritematozny) makes several minutes. The zone of hyperaemia is limited to a face and a neck. The second type of inflows lasts 5-10 minutes. The face of the patient kartsinoidy becomes tsianotichny, the nose gets a red-purple shade. Attacks of the third type – the longest, can proceed from several hours to several days. Are shown by the strengthened slezootdeleniye, conjunctiva hyperaemia, arterial hypotonia and diarrhea. At the fourth type of inflows emergence of bright red spots in a neck and the top extremities is observed.
Inflows are a part of a kartsinoidny syndrome and develop at 90% of the patients suffering from kartsinoida. Along with inflows 75% of patients have ponosa caused by strengthening of motor function of intestines under the influence of serotonin. Expressiveness of diarrhea at a kartsinoida can significantly differ, at a repeated liquid chair there can be a gipovolemiya, a gipoproteinemiya, a gipokaltsiyemiya, a gipokaliyemiya and a gipokhloremiya. Also the bronchospasm which is followed by expiratory short wind, the buzzing and whistling dry rattles is possible.
Over time a half of patients with kartsinoidy has a fibrosis of an endokard caused by influence of peak emissions of serotonin. Primary defeat of the right departments of heart with formation of insufficiency of the trikuspidalny valve is noted. Along with the listed symptoms at kartsinoida pellagropodobny changes of skin, a fibroziruyushchy stenosis of an urethra, fibrous changes and narrowing of vessels of a bryzheyka can come to light. Sometimes at patients kartsinoidy formation of solderings in an abdominal cavity with development of intestinal impassability is observed.
When carrying out surgical intervention or the invasive procedure kartsinoidny crises, life-endangering the patient can develop. Crisis is shown by the inflow, sudden falling HELL (is possible a vascular collapse) expressed by increase of heart rate, temperature increase of a body, plentiful sweating and a sharp bronchospasm. In some cases kartsinoidny crises arise spontaneously or against the background of a stress.
At metastasis the liver most often is surprised. At the widespread secondary centers increase in a liver, jaundice and increase in activity is observed. At metastasises of a kartsinoid in a peritoneum ascites is possible. At some patients metastasises in bones, a pancreas, a brain, skin, ovaries or a thorax come to light. At damage of a skeleton patients with kartsinoidy have bone pains, at metastasises in a pancreas – pains in epigastralny area with irradiation in a back, at damage of a brain – neurologic frustration, at metastasises in a thorax – short wind and cough. In some cases the small metastatic centers at a kartsinoida proceed without clinical manifestations and are found only when carrying out tool researches.
Diagnostics of a kartsinoid
Because of a possible asymptomatic current, slow progressing and the small size of primary center diagnostics of a kartsinoid can be accompanied by certain difficulties. The specific laboratory researches allowing to confirm existence of a neuroendocrine tumor are determination of level of serotonin in plasma of blood and level of 5-hydroxyindolacetum acid in urine. For definition of localization of primary neoplasia and the metastatic centers use a stsintigrafiya with oktreotidy.
In some cases it is possible to find when carrying out an endoscopic research. At suspicion appoint gastroscopy to damage of a stomach, a large intestine – a kolonoskopiya, a rectum – a rektoromanoskopiya, bronchial tubes – a bronkhoskopiya etc. During endoscopy carry out a biopsy with the subsequent histologic research of a sample of fabric. Along with a stsintigrafiya in the course of identification of a kartsinoid and the metastatic centers MPT and KT of abdominal organs, a thorax X-ray analysis, a selective angiography, a stsintigrafiya of all skeleton and other researches can be used.
Laboratory methods, in particular – determination of level of a hromatogranin And in blood can be also applied to assessment of prevalence of a kartsinoid. Increase in concentration of a hromatogranin And more than 5000 mg/ml demonstrates existence of multiple metastasises of a kartsinoid. In the presence of a kartsinoidny syndrome performing differential diagnostics with other neuroendocrine tumors, a medullary tumor of a thyroid gland and melkokletochny cancer of a lung can be required. In the absence of inflows an appendix sometimes it is necessary to differentiate with chronic appendicitis, damage of a large intestine – with a colon cancer, metastasises in a liver – with other diseases of a liver which are followed by jaundice and a gepatomegaliya.
Treatment of a kartsinoid
The main method of treatment of a kartsinoid is surgical intervention. At neoplaziya of an appendix carry out an appendektomiya, at tumors of a lean and podvzdoshny gut carry out a defeat zone resection in combination with removal of the site of a bryzheyka and regionarny lymph nodes. At kartsinoida of a large intestine carry out a gemikolektomiya. At single metastasises in a liver the segmentary resection of body is possible. At multiple metastasises sometimes use an embolization of hepatic arteries, cryodestruction or radio-frequency destruction, but efficiency of these methods of treatment, and also probability of development of complications are insufficiently studied because of a small amount of observations.
The chemotherapy at a kartsinoida is ineffective. Some increase in life expectancy is noted at purpose of a ftoruratsil with streptozotsiny, however use of these medicines is limited because of nausea, vomiting, negative impact on kidneys and system of blood formation. Medicamentous therapy of a kartsinoid usually consists in use of analogs of a somatostatin (an oktreotid, a lanreotid), it is possible – in combination with interferon. Use of this combination of medicines allows to eliminate displays of a disease and to reduce the speed of tumoral growth.
The forecast at kartsinoida rather favorable. At early identification of a new growth, lack of the remote metastasises and successful radical surgical intervention recovery is possible. Average life expectancy makes 10-15 years. Usually become a cause of death of patients with common forms of a kartsinoid heart failure owing to defeat of the trikuspidalny valve, intestinal impassability at adhesive process in an abdominal cavity, the cancer kakheksiya or malfunction of various bodies (usually – a liver) caused by the remote metastasis.