Every year the number of tumor diseases among the population is steadily growing. Every year, the world loses about eight million human lives.
For example, gastric carcinoid (a pathological formation, often of a benign nature, but capable of metastasizing) is quite rare, but over the past five years, doctors have recorded more and more cases of this disease.
Description
Carcinoid tumor is the formation of a neuroendocrine nature. It consists of mutated cells of the diffuse endocrine system.
A tumor forms on the gastric mucosa and begins the synthesis of biologically active substances (inflammatory mediators - prostaglandins, kinins, kallikrein). These compounds cause unpleasant symptoms. The more actively the tumor synthesizes them, the more pronounced the disease.
How aggressive is this tumor?
It is impossible to answer this question exactly, since gastric carcinoid can be either benign or very high degree of malignant nature.
Types of formations
Carcinoid lesions may varyfrom each other by the level of tissue differentiation. The higher it is, the less malignancy of the process. There are several varieties:
- The first type is characterized by a high level of cell differentiation. Education is a tumor in the stomach of a benign nature. It accounts for 70% of all carcinoid formations. Pathology develops due to a disease in which the synthesis of antibodies that destroy parietal cells occurs. Externally, the tumor is a group of several small tubercles on the gastric mucosa. In rare cases, they can grow into the tissue. Sometimes penetration into neighboring organs (for example, the liver) is possible.
- The second type is characterized by a high level of differentiation and a low degree of malignancy. The second type accounts for about 8% of all gastric carcinoid tumors. It occurs as a result of endocrine neoplasia. Outwardly, it looks like a cluster of small foci of inflammation protruding above the wall of the stomach. You can often notice that at the same time such formations occur in various glands (thyroid, adrenal glands, and so on).
- The third type is characterized by a low level of differentiation and a high degree of malignancy. The second name for this pathology is sporadic gastric carcinoid. The frequency of occurrence among all types of tumors is approximately 20%. At the same time, 80% of them are in the male proportion of patients. Externally, the tumor is a single formation about 3 cm in size. There are no signs of inflammation of the gastric mucosa.
Symptoms
The symptoms of this disease are easily confused with those of gastritis or stomach ulcers. Therefore, the disease may go unnoticed for a long time.
Signs of the disease are as follows:
- Heartburn.
- Pain in the upper abdomen.
- Constant feeling that the stomach is full. This feeling does not go away even if the person is hungry.
- Possible nausea and vomiting.
- Stool disorder: diarrhea alternating with constipation.
- As the disease progresses, there is a chance of developing obstruction of the stomach or intestines, as well as internal bleeding, which are characterized by blackening of the feces and vomiting with blood.
- The hallmark of gastric carcinoid is myocardial damage.
- Sometimes there may be shortness of breath and redness of the skin (due to the use of certain gas-forming products).
- There is a risk of developing carcinoid syndrome, a disease characterized by excessive production of serotonin.
If at least one of the above symptoms is detected, you should immediately seek help from a specialist (physician or gastroenterologist), who will listen to complaints, conduct a proper examination and prescribe the necessary examinations.
Diagnosis
The biggest problem in the successful treatment of the disease is its late diagnosis. The fact is that the pathology is quite rare, and its symptoms are mild. Therefore, approximately 1/4 of the diagnosesplaced postmortem or during histological analysis of tissue during surgery for another reason (for example, when removing appendicitis).
All methods of diagnosing a disease can be divided into three large groups:
- Blood tests for elevated plasma chromagranin A levels.
- Urine serotonin test.
- Instrumental methods of examination.
Chromagranin A blood test
Chromagranin A is a substance of a polypeptide nature, which is a non-specific oncological marker for malignant neoplasms in the gastrointestinal tract and organs of the endocrine system.
The biomaterial is blood from a vein, which is taken from the patient in the morning, on an empty stomach, in the amount of 5-10 ml. The duration of the analysis takes no more than four days.
Normally, the content of this protein should not exceed 10 nmol/liter. If these values are higher, then this allows us to suspect the development of a pathological process in the gastrointestinal tract or endocrine glands.
This method is relevant when making a diagnosis, evaluating the effectiveness of treatment, controlling the occurrence of relapses and the spread of metastases. However, a high test result alone cannot lead to a definitive conclusion that the patient has gastric carcinoid. This diagnostic method can only be used in combination with other options for making an accurate diagnosis.
This method is the simplest among all other diagnostic procedures. Therefore, many are interested in where to take tests fortumor markers? This can be done in any private laboratory.
Urine serotonin test
Serotonin is a hormone, the level of which in the urine or blood directly reflects the state of the body as a whole, especially the organs of the gastrointestinal tract. Its amount in the urine indicates the amount of monoamines that are synthesized by the cells of the gastric mucosa. For this reason, a high level of this substance in biological media makes it possible to suspect an oncological process in the patient's stomach.
The material for analysis is daily urine. The normal value of the results is 3-15 mg / day. The duration of the analysis is from 1 to 5 days.
Hardware examination methods
- Gastroscopy. A method that allows you to determine any pathological formations in the stomach. The first two types of carcinoid look like many small yellowish formations, and type 3 tumors look like single large polyps.
- Endoscopic Ultrasound. This diagnostic method allows you to determine the depth of penetration of the tumor into the tissues of the stomach, as well as to determine whether regional and distant lymph nodes are affected.
- CT (computed tomography). This is a special type of radiographic examination that gives a clearer picture of the pathological formation. The doctor receives information about the size of the tumor and its boundaries. Before the procedure, the patient should drink 200-400 ml of contrastsubstances. Sometimes it is given intravenously. This will help outline the stomach so that some parts of the internal organs are not mistaken for foreign formations. The duration of the examination is no more than half an hour. Please note that some people may develop an allergic reaction to the contrast material. This usually manifests itself in the form of a rash and itching on the skin, in more severe cases it may be difficult to breathe. Another side effect is a feeling of heat on the skin, especially in the face. This usually resolves within 1-2 days after the CT scan.
- MRI. At the moment, magnetic resonance imaging is the most effective method for diagnosing many tumor diseases, as it provides the most detailed information about the pathological formation. Thanks to MRI, the doctor receives information not only about the size and boundaries of the tumor, but also about its structural nature. In some cases, intravenous contrast may be required, but often the procedure is performed without it. In terms of duration, it can take about 1 hour, and all this time the patient is forced to lie in a narrow pipe, under the sound of the apparatus. For some people, this is mentally difficult. Especially for those who are afraid of confined spaces.
- CT, MRI and bone scintigraphy can be performed to detect the possible spread of metastases. Skeletal bone scintigraphy is a diagnostic method in which bones are repeatedly taken and images are transferred to a computer monitor. Previously, the patient receives an intravenous dose of a radioactive pharmaceutical preparation, whichwill stain the bone in the resulting images.
Treatment: surgical method
The treatment method directly depends on the type of the tumor itself, as well as on the neglect of the process. Therefore, before starting therapy for the disease, doctors must study the education in detail and make an accurate diagnosis.
In any case, surgery to remove the affected area (hemicolectomy) is the only treatment for carcinoid tumors. Only by removing part of the stomach can the patient have the highest chance of recovery.
Carcinoid treatment
In type 1, treatment tactics depend on the stage of the process:
- If there are only a few small solitary tumors, then laparoscopy is indicated, in which the tumor and a small area of the mucous membrane are excised.
- If 3-6 polyps are found, then endoscopic removal of neoplasms is prescribed.
- If there are more than six of them, then, as a rule, a stomach resection is performed. Feedback from oncologists and patients suggests that this is the only right way out of this situation.
It happens that the disease is diagnosed too late, and it is impossible to completely remove pathological tumors. Then the maximum possible excision of the affected areas and chemotherapy are shown. About her in more detail below.
Treatment of carcinoid tumors of the stomach of the 2nd and 3rd types is carried out, as a rule, only by surgery. Such formations are almost completely resistant tochemotherapy.
Gastric carcinoid: Chemo drugs
In addition, it should be noted that in the treatment of this type 1 pathology, the use of chemotherapeutic drugs is possible. Such as:
- "Irinotecan";
- "Oxaliplatin";
- "Cisplatin";
- "Leucovorin".
- "5-fluorouracil".
All of the listed funds have a powerful antitumor effect due to their mechanism of action. The instructions for use of "Cisplatin", for example, indicate that it is introduced into the DNA of a cancer cell, disrupting the processes of division. As a result, the tumor stops spreading and dies.
"5-fluorouracil" is converted in the body tissues into an active metabolite that replaces the enzyme necessary for the proper division of cancer cells.
This method of treatment cannot be the main one, but should be used as an adjunct in the treatment of gastric carcinoid. To increase the chances of recovery, oncologists usually prescribe a combination of two or more drugs.
According to the instructions for use of Cisplatin, this drug is most effectively combined with Leucovorin. Other combinations are allowed. So, it has an extremely effective effect in combination with Fluorouracil.
Symptomatic treatment
In addition, in order to stop the unpleasant symptoms of the disease are often usedadditional drugs. These include:
- Antacids such as Almagel, Ranny, Gaviscon. Used to relieve heartburn.
- Antiemetics ("Metoclopramide", "Onandesterone-Teva") - ease the feeling of nausea.
- Means against spasms of the gastrointestinal tract ("Duspatalin", "No-shpa", "Ganaton").
All of the listed medicines only alleviate the patient's condition, but do not eliminate the cause of the disease.
Forecast
Gastric carcinoid is a dangerous disease. However, the survival rate in such patients is much higher than in other tumor diseases.
The prognosis of the success of treatment directly depends on the stage of the pathological process, and, most importantly, on the type of disease.
- For the first type of tumor, the prognosis is the most favorable. The survival rate is 95%. This gives great hope to patients suffering from this type of gastric carcinoid.
- With the second type of tumor, the survival rate over the past five years drops to 80%. However, even such indicators indicate a very positive outcome.
- The third type of tumor is the most aggressive, so patients suffering from this pathology have the lowest life expectancy. The vast majority (60%) die within the first five years.
Conclusion
Carcinoid tumor of the stomach is a serious disease of the gastrointestinal tract. Some of its types are quite easy to treat. However, in the absence of timely treatment, it can lead to the development of carcinoid syndrome or death. To avoid this, it is extremely important to diagnose the disease in time and carry out the removal of pathological formations. Therefore, each person needs to regularly undergo mandatory medical examinations, medical examinations and, at the first unpleasant symptoms, seek help from specialists.
