Gastric carcinoid is a neoplastic disease that develops from neuroepithelial cells located in the mucous membrane of an organ. This malignant tumor is quite rare. Among all neuroendocrine tumors of the digestive system, it accounts for about 5%. The peak incidence occurs at the age of 50-60 years. Most often, the carcinoid is localized on the mucous membrane of the body or the fundus of the stomach.
In most cases, the neoplasm develops sporadically. However, in some cases, gastric carcinoid is hereditary. There are genetic diseases in which this tumor develops. The most common of these is MEN1 syndrome. In this case, several carcinomas in different organs develop in the human body at once. The tumor process can affect the stomach, pancreas, liver, large and small intestines, etc. MEN1 syndrome has a dominant mode of inheritance, therefore, with a 50% probability, the disease can be transmitted from parents to children.
Symptoms for carcinoid are divided into local and general. In the first case, the clinical picture is due to a malfunction of the stomach and includes pain, heaviness after eating, decreased appetite, fast satiety, belching, and stool disorder. The general symptomatology is associated with the production of various hormones by the carcinoid, which affect the organs and tissues of the body. This manifestation of a tumor is called paraneoplastic syndrome.
With carcinoid of the stomach, as a rule, serotonin, somatostatin, histamine are formed. In this case, a person experiences a periodic increase in blood pressure, which is accompanied by reddening of the skin. After its reduction, the skin becomes cyanotic, that is, it acquires a bluish tint. Also, neuroepithelial tumors of the stomach are characterized by shortness of breath, cramping pain in the abdomen, diarrhea, and increased sweating. In rare cases, headaches are observed. With the long-term existence of carcinoid, the development of chronic heart failure is possible.
There are several approaches to the classification of gastric carcinoid. Depending on the histological picture, there are three variants of the tumor:
- Highly differentiated endocrine tumor. It is characterized by a weak atypia of cells and a benign course.
- Highly differentiated endocrine carcinoma. Has a moderate degree of cellular atypia, deep invasion of the stomach wall, or secondary foci in the liver and lymph nodes.
- Poorly differentiated endocrine carcinoma. Contains atypical cells of small to medium size. Tumor tissues often necrotize (die off), and the neoplasm itself has a high tendency to metastasize.
Also, gastric carcinoids are divided into three types:
- First type. The most common variant is found in 80% of cases. It is characterized by multiple small carcinoids (less than 1 cm) in the organ wall. The first type rarely metastasizes. An increased level of gastrin and low acidity of gastric juice are detected in the laboratory. Usually associated with atrophic gastritis and pernicious anemia.
- Second type. Also represented by multiple small carcinoids. In the blood serum, an increased level of gastrin is found, gastric juice has an increased acidity. This type is associated with MEN1 and Zollinger-Ellison syndrome.
- Third type. As a rule, this is a single tumor 2-5 cm in size, which has normal indicators of gastrin and gastric acidity and is not associated with any other diseases.
There is an international TNM staging system for carcinoids, which distinguishes four stages of the tumor process, depending on the size of the primary focus and the presence of metastases in the lymph nodes and organs. An additional classification distinguishes between multiple and single, hormonally active and inactive gastric carcinoids.
Treatment for gastric carcinoid depends on the type and size of the tumor. It is also important to determine the stage of the neoplasm. Tumors of the stomach of the first or second type, up to 1 cm in size, the number of which does not exceed five, can be resected endoscopically, usually using electrocoagulation. In this case, a special instrument is inserted into the stomach, which destroys the tumor as a result of exposure to an electric current. In other situations, a partial or complete gastrectomy is performed, that is, the removal of the stomach. After resection, the stumps of the gastrointestinal tract are sutured end-to-end. For example, in the case of complete removal of an organ, the small intestine and esophagus are connected. The operation for carcinoid is accompanied by the removal of regional lymph nodes – lymph node dissection.
Medical follow-up after treatment
After treatment, medical monitoring of the patient’s condition is necessary in order to early detect recurrence of gastric carcinoid and metastases. To do this, you must regularly consult a doctor and undergo an examination, which includes:
- Physical examination.
- General analysis of blood, urine, biochemical analysis.
- X-ray diagnostics or computed tomography of the chest.
- Ultrasound examination of the abdominal organs, retroperitoneal space and small pelvis.
- Study of blood serum for the presence of tumor markers specific for gastric carcinoid (neurospecific enolase, embryonic cancer antigen).
The first two years of research are carried out at a frequency of once every three months. From the third to the fifth year – every six months and then annually.