What are neuroendocrine tumors
Cells of the diffuse neuroendocrine system are scattered throughout the mucous membranes of the digestive and respiratory organs and normally regulate their work, releasing hormones and mediators. Tumors from these cells are very diverse in behavior: some grow extremely slowly and remain local for decades, others behave aggressively. Therefore, assessing the degree of malignancy based on the indicator of proliferative activity, which is determined by histological examination, is of key importance. Tumors are divided into functioning ones, which secrete active substances and give vivid symptoms, and non-functioning ones, which remain silent for a long time.
- Source - cells of the diffuse neuroendocrine system
- The most common locations are the small intestine, appendix, pancreas, lungs
- Behavior depends on the degree of malignancy
- Functioning tumors give hormonal symptoms
- Non-functioning ones proceed hidden for a long time
Carcinoid syndrome
The syndrome develops when substances secreted by the tumor enter the general bloodstream. With intestinal tumors, this usually means that the liver can no longer cope with their neutralization, that is, most often there are lesions in it. Classic manifestations are sudden hot flashes: the face and neck turn red, a feeling of heat occurs, sometimes blood pressure drops and the heartbeat quickens. The second sign is profuse watery diarrhea, independent of nutrition and debilitating to the patient. Less common are bronchospasms with shortness of breath. Over time, the substances damage the valves in the right side of the heart.
- Hot flashes and redness of the face and neck
- Watery diarrhea not affected by food
- Abdominal cramps and bloating
- Difficulty breathing and wheezing
- Blood pressure fluctuations and heartbeat
- Damage to the valves of the right heart
- Provocateurs: stress, alcohol, spicy food
Diagnostics
Laboratory diagnostics include determination of chromogranin A in the blood as a general marker of neuroendocrine tumors and 5-hydroxyindoleacetic acid in 24-hour urine if carcinoid syndrome is suspected; Before collecting urine, a special diet is required, excluding foods that affect the result. To search for the tumor itself, CT and MRI with contrast are used, endoscopic methods when located in the stomach and intestines, as well as special radioisotope studies that use the ability of these tumors to bind somatostatin. Echocardiography is mandatory to evaluate the heart valves.
- Chromogranin A in the blood
- 5-HIAA in 24-hour urine with preparation
- CT and MRI with contrast
- Endoscopy of the stomach and intestines
- Radioisotope methods with somatostatin analogues
- Echocardiography
- Biopsy with determination of proliferative activity
Why is the diagnosis made late?
Tumors grow slowly, and their manifestations are nonspecific and individually occur in a variety of common conditions. Hot flashes in a middle-aged woman are explained by menopause, diarrhea by irritable bowel syndrome, spasms by dietary errors, and shortness of breath by asthma. It often takes years from the first complaint to diagnosis. A combination of symptoms, their independence from nutrition and conventional treatment, as well as hot flashes that occur without sweating, which distinguishes them from menopause, helps to suspect a tumor. For persistent complaints, it makes sense to discuss a targeted examination with your doctor.
- Slow growth and nonspecific symptoms
- Hot flashes are mistaken for menopause
- Diarrhea - for irritable bowel syndrome
- Shortness of breath - for bronchial asthma
- The combination of symptoms and their persistence is alarming
- Targeted analyzes solve the problem
Treatment
For localized tumors, the main method remains surgical removal, which often leads to cure; Small tumors of the rectum and stomach are often removed endoscopically. In common forms, somatostatin analogs become the main means of control: they reduce the production of active substances, relieve hot flashes and diarrhea, and slow tumor growth. Additionally, targeted drugs, radionuclide therapy, methods of influencing lesions in the liver are used, and in aggressive forms, chemotherapy. Patients are advised to avoid triggers of hot flashes: alcohol, spicy foods and stress.
- Surgical removal of the tumor
- Endoscopic removal of small tumors
- Somatostatin analogues for common forms
- Targeted and radionuclide therapy
- Effect on lesions in the liver
- Chemotherapy for aggressive forms
- Avoid alcohol, spicy foods and stress
