Carcinoid syndrome, carcinoid - a tumor of the gastrointestinal tract, which develops from cells of APUD-system, and therefore belongs to the apudomam. APUD-cells are part of the humoral regulation of the gastrointestinal tract and produce biologically active peptides, therefore, carcinoid is characterized by excessive production of these substances. Carcinoid tumors usually develop between the ages of 50-60 years from the enterochromaffin cells of the gastrointestinal tract, pancreas, gall bladder, bronchi and occasionally the excretory system. The highest percentage of carcinoid developing in jejunum and ileum (about 2/3 cases), about three quarters of cases of carcinoid associated with gastro-intestinal tract, and about 1/4 - with the organs of respiration. The remaining cases are extremely rare carcinoid.
The most common carcinoid of the gastrointestinal tract are multiple, slow-growing tumors, no larger than 2 cm in almost all carcinoids reveal signs of malignancy, and infiltrating growth, which allows to classify them as malignant tumors. Metastasis to regional lymph nodes occurs quite rapidly, from distant metastases are the most common liver. Other types of metastases (in the brain, lungs, pancreas, etc.) are rare.
Clinic of the disease is determined by the excessive production of biologically active peptides, which are dominated by serotonin. The clinical effect of excessive production is partially offset by the expense of liver enzymes - monoamine oxidase, so even when the size of the tumor symptoms may not be as bright as when apudomah, developing outside of the gastrointestinal tract.
Symptoms of carcinoid:
Redness of the face and upper body. Accompanied by a decrease in blood pressure and increased heart rate. Nachinetsya redness from the face and can spread to the chest, sometimes on the limbs. Redness is paroxysmal in nature. After an attack is often a headache. Seizures triggered by stress, alcohol, food, palpation of the abdomen.
Diarrhea (diarrhea). There is loose stools. Depending on the severity of the disease attacks can be from 1-2 times per week up to 20 times a day. Diarrhea develops as a result of malabsorption and intestinal motility activation. Enlarged liver (hepatomegaly) develops in the metastasis of the tumor in the liver. Pain in the abdomen. Usually, the pain associated with attacks of diarrhea. Sometimes there is pain due to acute myocardial intestinal necrosis of the tumor or its metastases. In that case, develop leukocytosis, fever.
Weight loss. Develops due to digestive disorders.
Some less common symptoms such as endocardial fibrosis, telangiectasia (vascular "stars" that are formed due to capillary expansion), asthma, edema, cyanosis, arthritis, etc. These symptoms develop due to exposure to biologically active substances produced by apudomoy (serotonin, histamine, bradykinin, motilin, etc.) to the relevant organs and tissues. For a long time developing apudoma does not manifest itself as symptoms can expose erroneous diagnoses, such as spastic colitis and irritable bowel syndrome.
Diagnosis of carcinoid syndrome
Diagnosis in the development of the classic symptoms, as well as on the basis of laboratory studies:
Determining the level of serotonin, the level of excretion of its metabolites, determination of other biologically active substances produced by apudomoy.
The sample with calcium (causing redness of the face).
Test with noradrenaline (also causes redness attack)
Methods of medical imaging (X-ray computed tomography, magnotorezonansnaya tomography, ultrasound, scintigraphy, X-ray methods). They can not only detect the presence of a tumor, but also to diagnose the presence and extent of metastasis.
Treatment of tumors of the gastrointestinal tract.
Typically used surgical treatment. Remove the affected area, produce an audit of regional lymph nodes as possible excised liver metastases. After surgery, chemotherapy is usually done
Without treatment, life expectancy is about 4 years. Successful treatment gives a good prognosis and prolongs life by 15 years or more. Timely initiation of treatment at the small size of the tumor gives the 5-year survival of around 95%. Advanced forms of the disease, depending on the location of the primary tumor give a 5-year survival rates ranging from 40 to 85%.