carcinoid tumor of the large intestine



Overview: A rare type of colorectal tumor.

A rare colorectal tumor, may develop into a malignant tumor, early stage is asymptomatic, late stage may have blood in stool, abdominal pain, constipation, diarrhea and other symptoms are not yet clear, and genetics, rectal-related diseases, lifestyle and other factors related to the choice of surgery, radiotherapy, medication, and other integrated treatment according to the specific staging

Definition

Carcinoid tumor is a kind of slow-growing tumor between benign and malignant, with the possibility of malignant transformation, and capable of recurrence and metastasis, but generally with a lower degree of malignancy.

Carcinoid tumors tend to occur in the lungs, gastrointestinal tract and pancreas, and colorectal carcinoid tumors belong to the gastrointestinal tract carcinoid tumors.

Colorectal carcinoid tumors originate from neuroendocrine cells, which have the function of secreting neurohormones, such as secretion of chromogranin (CgA) and synaptophysin (Syn), and so on, so colorectal carcinoid tumors are also called colorectal neuroendocrine tumors.

Neuroendocrine tumor is a kind of highly differentiated neuroendocrine tumor, i.e., the tumor cells are more similar to normal endocrine cells and the degree of malignancy is relatively low, and the term “neuroendocrine tumor” is gradually replacing “carcinoid tumor”.

The most likely site of metastasis for colorectal carcinoid tumors is the liver. Other common sites of metastasis include the mesentery and peritoneum. In addition, colorectal carcinoid tumors may also metastasize to the retroperitoneal lymph nodes, ovaries, breast and supraclavicular lymph nodes.

Bone metastases from carcinoid tumors have also been found to be increasingly common following the use of growth inhibitor receptor scintigraphy as an imaging method to examine carcinoid tumors.

Classification

Classification according to site

The colon can be divided into the appendix, appendix, colon, rectum and anal canal.

Rectal carcinoid tumors are the most common, appendiceal and colon carcinoid tumors are the second most common, and carcinoid tumors of the cecum and anal canal are very rare.

Classification according to the degree of differentiation

According to the degree of cell differentiation, colorectal carcinoid tumors can be classified as highly differentiated, moderately differentiated, and poorly differentiated.

Classification according to the presence or absence of hormonal syndromes

Colorectal carcinoid tumors can be classified into functional and non-functional carcinoid tumors [1].

Classification according to embryonic origin

Gastrointestinal carcinoid tumors can be classified into three types according to their embryonic origins: foregut, midgut and hindgut, and colorectal carcinoid tumors originate in the midgut and hindgut.

Carcinoid tumors of the appendix, ascending colon and transverse colon belong to midgut carcinoid tumors. Carcinoid tumors in these areas have higher secretion of 5-hydroxytryptamine, and typical carcinoid syndromes may appear.

Carcinoid tumors of the descending colon, sigmoid colon and rectum belong to the hindgut carcinoid tumors. Carcinoid tumors in these areas usually do not secrete 5-hydroxytryptamine, and carcinoid syndrome does not usually occur.

Incidence

The incidence of carcinoid tumors is low, about 3.6 per 100,000 people per year in the general population.

The incidence is slightly higher in men than in women [2].

It can occur in all age groups, but is more common in middle-aged and elderly people. One study showed that the average age of onset of rectal neuroendocrine tumors is around 55 years, and that of colonic neuroendocrine tumors is around 64 years [3].

There are 55% of carcinoid tumors located in the gastrointestinal tract, and among the carcinoid tumors in the gastrointestinal tract, the rectum accounts for about 20%, the appendix accounts for about 16%, the colon accounts for about 11%, the cecum is less common, and carcinoid tumors of the anal canal are relatively rare, and in recent years, the incidence of carcinoid tumors of the rectum is gradually increasing [4-5].

Causes

Causes

The specific etiology and pathogenesis of carcinoid tumors have not been clarified.

The risk factors for high-grade gastrointestinal endocrine tumors are not well defined. Some reports have found an association with smoking, but this association is weaker than that between smoking and small cell lung cancer, and more data are needed to determine the effect of smoking on the risk of development.

Studies suggest that colonic adenomas and ulcerative colitis may increase the risk of colorectal carcinoid tumors.

Symptoms

Patients with colorectal carcinoid tumors usually have no obvious symptoms in the early stage, and may have symptoms such as blood in stool, abdominal pain, constipation, diarrhea, etc. In some patients, they may also have no obvious symptoms in the late stage, and may be discovered incidentally during a physical examination or during the treatment of other diseases.

The symptoms of carcinoid tumors occurring in different parts of the colon are different, and we will describe them separately.

Rectal Carcinoid

Rectal carcinoid tumors are the most common colorectal carcinoid tumors and lack characteristic symptoms.

About half of the patients with rectal carcinoid tumors are asymptomatic, and they are often detected during physical examination, endoscopy, or treatment of other rectal diseases, such as rectal adenomas.

Symptomatic patients may experience abdominal discomfort such as abdominal pain, abdominal distension, change of bowel habit such as constipation, diarrhea, blood in stool, and anal swelling sensation after bowel movement.

Patients with rectal carcinoid tumor present carcinoid syndrome less frequently.

Appendix Carcinoid Cancer

Appendiceal carcinoid tumor is also relatively common, which mostly occurs in the root of appendix. Most patients have no symptoms, and many patients are found out because of pathological examination, colon cancer surgery or appendicitis surgery.

Appendiceal Carcinoid Cancer belongs to middle intestinal carcinoid cancer, so some patients with appendiceal carcinoid cancer will show symptoms related to carcinoid syndrome, especially those with liver metastasis.

Colon Carcinoid Cancer

Carcinoid tumor of the colon usually occurs in the sigmoid colon, rectosigmoid junction and ascending colon, and its symptoms are more obvious than those of rectal carcinoid tumor and appendiceal carcinoid tumor, but there is no characteristic symptom.

Patients with colon carcinoid tumor may have symptoms such as blood in stool, abdominal pain, feeling of incomplete stool and anal swelling.

About 2/3 of patients have metastasis at the time of diagnosis, the most common being liver metastasis, so patients with colon carcinoid tumor may have the manifestation of carcinoid syndrome.

Carcinoid syndrome

The typical symptom of carcinoid syndrome is paroxysmal skin flushing. Other symptoms include abdominal pain, diarrhea, wheezing, and symptoms of carcinoid heart disease, such as fatigue, edema, and dyspnea.

Tumor cells of appendiceal carcinoid and some colon carcinoid (e.g., ascending colon and transverse colon carcinoid) can secrete various biologically active substances, including 5-hydroxytryptamine, and typical carcinoid syndrome can occur.

Carcinoid syndrome does not occur in descending colon, sigmoid colon and rectal carcinoid tumors.

Some patients with large tumors and extensive metastases may develop carcinoid syndrome, whose symptoms include persistent skin flushing, bronchial asthma attack, abnormal increase or decrease of blood pressure, cardiac arrhythmia, blurred consciousness or even coma, etc., which may be life-threatening if not treated in time.

Carcinoid crisis is usually induced by handling tumors (e.g. biopsy or surgery) or anesthesia.

Common metastatic symptoms

Liver metastasis

Patients with liver metastases may present with right upper abdominal pain, jaundice or easy feeling of fullness or the carcinoid syndrome described previously.

Mesenteric and peritoneal metastases

Tumors that metastasize to the root of the mesentery may not be resectable, leading to recurrent bowel obstruction or ischemia.

Patients with peritoneal metastatic cancer may also have chronic bowel obstruction, weight loss, and malnutrition.

Incomplete intestinal obstruction is characterized by abdominal pain and distension.

Complete intestinal obstruction, in addition to abdominal pain and distension, also manifests symptoms such as cessation of anal defecation and vomiting.

Bone metastasis

When the metastasis reaches the bone, the patient may have symptoms such as cancerous bone pain and pathologic fracture.

Malignant disease

In the advanced stage of colorectal cancer, due to the rapid growth of cancer cells, there is serious nutritional depletion, causing cachexia.

Anemia, weight loss, loss of appetite and drowsiness are the main manifestations.

Consultation

Department

Department of Proctology

When there are symptoms such as blood in stool, abdominal pain, constipation, diarrhea, etc., or when there are symptoms of narrowing of intestinal lumen, cancerous tumors bursting and bleeding, or even accompanied by related complications, or when there is a suspicion of rectal cancer in physical examination, it is recommended that the patient go to the Department of Anorectal Medicine, or the Department of General Surgery for timely consultation.

Gastroenterology

Patients with symptoms such as paroxysmal skin flushing, abdominal pain, diarrhea, coughing and wheezing can consult the Department of Gastroenterology.

Medical Oncology

If you are diagnosed with colorectal carcinoid tumor and need medical treatment, you can consult the Department of Medical Oncology.

Preparation

Consultation Information: Registration, Preparation of Documents, Frequently Asked Questions

Tips for medical treatment

Wear loose-fitting clothes that are easy to put on and take off, so that the doctor can easily do physical examination such as rectal fingerprinting and other laboratory tests.

Do not wear jewelry. Remove dentures if possible to facilitate MRI examination.

It is recommended that a family member accompany you to the appointment.

Preparation Checklist

Symptom list

Pay particular attention to the time of onset of symptoms, specific manifestations, etc.

Are there any symptoms of diarrhea? If diarrhea is present, is there blood in the stool? What is the approximate frequency of diarrhea per day?

Is there any abdominal discomfort, such as bloating or abdominal pain?

Do you have constipation and how often do you have bowel movements?

Has the skin of the face, neck or upper chest suddenly turned red or purple and felt hot? If so, how long did these symptoms last? Was there a trigger, such as eating a large meal or drinking alcohol, before the symptoms appeared? About how often do the attacks occur?

Are there any symptoms of wheezing (breath sounds with a murmur) or difficulty breathing?

Is there any swelling of the legs, breathlessness or tiredness after activity?

Medical History Checklist

Is there a history of gastrointestinal carcinoid or other tumors in the immediate family, such as parents, siblings, or children?

Has alcohol been consumed? How long have you been drinking? How much per day?

Do you smoke? How long have you been smoking? How many cigarettes per day?

Checklist

Examination results of the last six months, which can be brought to the doctor’s appointment

Specialized examination results: previous rectal examination results.

Laboratory test results: fecal occult blood test, tumor marker test, blood routine, blood biochemistry, urine routine, stool routine, etc.

Imaging findings: computed tomography (CT), magnetic resonance imaging (MRI), growth inhibitor receptor scintigraphy, PET-CT, etc.

Endoscopy: colonoscopy.

Diagnosis

Diagnostic basis

The diagnosis of colorectal carcinoid tumor carcinoid requires a combination of medical history, clinical manifestations, laboratory tests, imaging, endoscopy, pathology and immunohistochemical tests (synaptophysin).

Medical history and family history

When the doctor makes a clinical diagnosis, some patients may have the following relevant medical history and family history:

Family history of colorectal cancer.

History of colorectal adenomas.

History of inflammatory bowel disease, such as ulcerative colitis and Crohn’s disease.

History of schistosomiasis.

History of diabetes mellitus.

History of pelvic radiotherapy

History of chronic diarrhea, chronic constipation, chronic appendicitis, chronic cholecystitis, etc.

Clinical manifestations

Symptoms

Blood in the stool, change in bowel habits, frequent bowel movements, abdominal pain and bloating are common.

See “Symptoms” section above.

Physical signs

Rectal palpation may reveal a mass or enlarged lymph nodes in the groin.

See “Symptoms” section above.

Specialized tests

Rectal palpation

It is the most important specialized physical examination for initial diagnosis of adenocarcinoma of the rectum, and 60%~70% of the masses can be palpated during rectal palpation.

It refers to the palpation of the patient’s anus with the doctor’s finger, usually the index finger (pointer finger), under sufficient lubrication.

This test allows for early detection of the mass, understanding the size of the tumor, its texture, the extent to which it occupies the circumference of the intestinal wall, the mobility of the base, the distance from the anal verge, the degree of infiltration of the tumor, and the relationship to the surrounding organs.

If the tumor is located in the anterior wall of the rectum, male patients should focus on whether it involves the prostate, and female patients should pay special attention to whether it involves the vagina, and if necessary, feasible double and triple diagnostic examination.

If the tumor is located in the high rectum, it is necessary to press the abdomen and perform rectal examination at the same time.

Doctors should move gently and touch carefully during rectal palpation, observe whether the finger cuff is stained with blood when withdrawing the finger, and make detailed records after examination.

The patient should try to relax and cooperate with the doctor, and inform the doctor if the pain is intolerable.

Duplex examination

The fingers of one hand are put into the vagina, and the other hand is pressed down on the abdomen to cooperate with the examination.

For women with adenocarcinoma of the rectum, this examination is able to check whether there are any abnormalities in the vaginal wall, cervix and uterus.

Triple Examination

Combined examination of the rectum, vagina and abdomen.

For female rectal cancer patients, if the tumor is suspected to invade the vaginal wall, the triple examination is usually needed to understand the relationship between the mass and the back wall of the vagina.

Laboratory tests

Laboratory tests can provide an important basis for the diagnosis of colorectal carcinoid tumor, and the most meaningful laboratory tests include chromogranin A (CgA) and 5-hydroxyindoleacetic acid (5-HIAA).

In addition to aiding in diagnosis, CgA and 5-HIAA levels can also monitor the effectiveness of treatment and predict patient prognosis [6].

Chromogranin (CgA)

CgA is widely present in neuroendocrine cells, and almost all types of neuroendocrine tumors show elevated levels of CgA, so it can be used as a tumor marker for adjuvant diagnosis of colorectal carcinoid tumors.

Plasma CgA level will be reduced in colorectal carcinoid tumors treated by surgery, which can be used as an indicator for detecting treatment effect and evaluating prognosis.

After treatment, dynamic monitoring of plasma CgA level can be used to monitor tumor development and metastasis. If plasma CgA level increases during dynamic monitoring, it suggests that tumor progression or metastasis may occur.

However, elevated plasma CgA level does not necessarily mean colorectal carcinoid tumor; other diseases may also cause elevated plasma CgA level, such as myocardial infarction, heart failure, prostate cancer and so on.

Plasma CgA levels vary in different methods, so there are some limitations in diagnosing carcinoid tumors with CgA levels [7].

5-Hydroxyindoleacetic acid (5-HIAA)

5-HIAA is the end product of 5-hydroxytryptamine metabolism and is excreted in the urine, so the 24-hour urinary excretion of 5-HIAA is usually examined.

Because midgut carcinoids produce the highest levels of 5-hydroxytryptamine, especially in patients presenting with carcinoid syndrome, the 5-HIAA urinary excretion test is usually most useful in primary midgut carcinoids, such as carcinoids of the appendix, ascending colon, and transverse colon.

Ingestion of certain medications and tryptophan/5-hydroxytryptamine-rich foods may lead to false-positive results, so these medications such as p-acetamidophenol-based or foods such as bananas and kiwis should be avoided for 3 days prior to urine collection.

Fecal occult blood test

Can help diagnose colorectal carcinoid tumors.

A positive result suggests the presence of gastrointestinal bleeding and requires further testing to confirm the diagnosis of colorectal carcinoid tumor.

It is important to note that a positive result does not necessarily indicate the presence of colorectal carcinoid tumor, and a negative result does not rule out colorectal carcinoid tumor.

Tumor markers

Tumor markers can assist in the diagnosis of colorectal carcinoid tumor and are mainly used for evaluating the efficacy of treatment, assessing the prognosis and monitoring recurrence and metastasis.

The main indicators include carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP) and so on.

For patients with elevated CEA in colorectal carcinoid tumors, after treatment, if the CEA level decreases, it means good therapeutic effect; if the CEA level doesn’t decrease or increases instead, it indicates poor therapeutic effect.

The CEA level is high before operation, and the CEA level decreases after treatment, and the CEA level will increase again if the tumor recurs or metastasizes during the follow-up review.

It is of little significance to monitor CEA in patients who do not have elevated CEA before treatment.

Patients with liver metastasis usually have elevated AFP, and it is important to check the AFP level if liver metastasis is suspected in colorectal carcinoid tumor or patients with obvious symptoms of carcinoid syndrome.

Other laboratory tests

Such as blood routine, blood biochemistry, urine routine, stool routine and other examination results.

It is important to understand the basic health condition of the patient, which can help to formulate the subsequent treatment plan.

Imaging examination

In the diagnostic process, in order to determine the site of the disease and assess the stage of the disease, a variety of imaging tests are often combined, such as CT, MRI, growth-suppressor receptor imaging (SRS) and so on.

CT

CT with whole abdominal and pelvic sweep + enhancement is of great diagnostic value for colorectal carcinoid tumors, and CT can clarify the stage of carcinoid tumors, which is helpful for the choice of treatment. Enhanced CT is recommended for all patients with carcinoid tumors.

Colorectal carcinoid tumors do not have characteristic CT manifestations, but can be manifested as localized thickening of the intestinal wall or soft tissue mass.

When colorectal carcinoid tumors are small, they are difficult to detect on CT.

Magnetic resonance imaging (MRI)

Compared with abdominal CT examination, abdominal MRI examination is more advantageous in detecting carcinoid tumors with liver metastasis, and when liver metastasis is suspected, liver enhancement MRI examination is recommended.

When liver metastasis is suspected, liver enhancement MRI is recommended. For some lesions that are difficult to be characterized by CT, MRI is helpful for further determination.

Evaluate the location and infiltration depth of the tumor, and accurately distinguish the involvement of lymph nodes and rectal mesenteric fascia.

The examination of lymph nodes and rectal fascia is better than CT.

It is important to remove any metal objects, such as necklaces and earrings, before the MRI examination.

Growth inhibitory receptor scintigraphy (SRS)

It is a highly sensitive and specific method for locating neuroendocrine tumors.

Most carcinoid tumors express high levels of the growth inhibitory receptor (SSTR), so the receptor can be labeled with a radioisotope that allows whole-body imaging and also provides information about SSTR expression. The most commonly used marker is 68 gallium (68-Ga ).

SRS has high sensitivity and specificity for carcinoid tumors, and is important for early detection of carcinoid tumors.

Endoscopy

Colonoscopy: Some patients with colorectal carcinoid tumors may be accompanied by other tumors, such as colorectal cancer, so patients with colorectal carcinoid tumors should undergo colonoscopy [8].

Pathologic and histologic examination

Pathologic examination is the gold standard for the diagnosis of colorectal carcinoid tumor.

Specimens can be obtained through endoscopy and surgery.

After clear diagnosis by pathology, the size, infiltration depth and metastasis of the tumor should be comprehensively evaluated in combination with the above examinations, and the treatment plan should be comprehensively formulated.

Grading

The clinical behavior and prognosis of highly differentiated neuroendocrine tumors are closely related to histological differentiation and grade.

WHO classifies highly differentiated gastroenteropancreatic highly differentiated neuroendocrine tumors into low-grade (G1), intermediate-grade (G2), and high-grade (G3) according to the histological manifestations and the rate of proliferation (as assessed by nuclear fission counts and/or Ki-67 labeling index).

The higher the grade, the more malignant the tumor, and the clinical behavior of highly differentiated G1 or G2 highly differentiated neuroendocrine tumors is generally inert. All poorly differentiated highly differentiated neuroendocrine tumors were G3 NEC with an aggressive clinical course.

<2

<3

G2 medium 2~203~20

G2

Medium

2~20

3~20

G3 high＞20＞20

G3

High

＞20

＞20

Differential diagnosis

Rectal adenocarcinoma should be differentiated from other pathological types of rectal cancer, rectal adenoma, rectal polyps and hemorrhoids.

Other pathological types of rectal cancer

Clinical manifestations and signs are almost the same, and differential diagnosis can only be made by histopathologic examination.

Rectal adenoma

Both may present with symptoms such as change in bowel habit, blood in stool, abdominal distension, and hyperactive bowel sounds.

During rectal palpation, rectal adenoma can be palpated as a spherical mass with smooth surface, with or without tip, good mobility, and generally without blood when retreating from the finger. Rectal adenocarcinoma can be palpated as a hard mass, usually with no tip, and the glove can be stained with blood when retracting the finger.

Pathologic examination can clarify the nature of the lesion.

Rectal polyp

Both of them can present with symptoms such as change of bowel habit, blood and mucus in stool, abdominal pain and so on.

Endoscopy may reveal small polyps, which may be single or multiple. Larger polyps can be detected by barium enema X-ray and rectal palpation.

Pathologic examination can clarify the nature of the lesion.

Hemorrhoids

Both can present with symptoms such as blood in the stool. Internal hemorrhoids, mixed hemorrhoids and rectal adenocarcinoma can be palpated on rectal palpation.

Hemorrhoidal blood in stool usually occurs during defecation, and the blood is not mixed with feces. In addition to blood in stool, it may also show symptoms such as pain or itching in anal region and anal swelling.

Rectal adenocarcinoma can show rectal irritation, abdominal distension, hyperactive bowel sounds and so on.

When it is not easy to distinguish clinically, endoscopy and pathologic examination can be used to clarify the nature of the mass.

Treatment

Treatment principle: individualized comprehensive treatment strategy. According to the patient’s own health condition and the stage of the tumor, appropriate treatment should be taken.

Treatment purpose: early stage patients can achieve the purpose of radical treatment, and middle and late stage patients mainly focus on controlling tumor progression, prolonging survival and improving patients’ quality of life [9].

Surgical treatment

The treatment of colorectal carcinoid tumors in China is still controversial and has not yet formed a unified standard, but surgery is still the main means of treatment, and chemical, biological, radiological, interventional and targeted therapies can also be used as auxiliary treatment.

At present, colorectal carcinoid tumors are not sensitive to radiotherapy, and surgery is the main treatment method for radical treatment of colorectal carcinoid tumors, which can obviously improve the survival time of patients.

It mainly includes local resection and radical surgery, which can be endoscopic surgery, laparoscopic surgery, open surgery, etc. [10-12].

Endoscopic resection

Indications

Maximum diameter of colorectal carcinoid <lc.

No invasion of the muscular layer.

Those without depression or ulceration in the center of the lesion.

Features

Endoscopic resection is less invasive but may be incomplete.

Local excision

In addition to endoscopic treatment, local excision can be used for early stage patients.

It includes transanal rectal carcinoid resection and minimally invasive transanal endoscopic surgery.

Indications

Limited to submucosa.

The diameter does not exceed 2cm.

No signs of lymph node metastasis in imaging examination before treatment.

Characteristics

Traditional transanal local excision is also less traumatic and has a high likelihood of cure, but the operating space is small and the field of view is limited.

Transanal endoscopic minimally invasive surgery has a better field of view than traditional transanal local excision and can resect high rectal lesions.

For rectal carcinoid tumors, especially those in the upper rectum, transanal endoscopic minimally invasive surgery is a safe and minimally invasive method of local excision and can remove residual lesions after colonoscopic resection.

Radical surgery

Colorectal carcinoid tumors with a diameter of >2 cm or those that have involved the muscularis propria have a high chance of metastasis, and therefore need to be treated according to the principles of rectal adenocarcinoma.

Surgical principles

Comprehensive exploration, from distant to proximal. The liver, gastrointestinal tract, uterus and adnexa, pelvic floor peritoneum and associated mesentery, and major paravascular lymph nodes and organs adjacent to the tumor must be explored and recorded.

Routine resection of adequate bowel, clearance of regional lymph nodes, and en bloc resection is recommended, and routine clearance of lymph nodes from two or more sites is recommended.

Sharp dissection techniques are recommended.

Recommend following the principle of tumor-free surgery

For tumors for which the chance of radical surgery has been lost, if the patient has no symptoms of bleeding, obstruction, perforation, or compression of surrounding organs causing relevant symptoms, the need for resection of the primary focus is determined based on the evaluation of multidisciplinary consultation.

Indications

Tumor >2cm.

Invade the muscle layer.

Lymph node metastasis.

Repeated local resection or other intestinal malignant tumors.

Treatment principle

Under the premise of radical treatment of the tumor, the anal sphincter function, urination and sexual function should be preserved as far as possible.

Resect the primary tumor, ensure sufficient margins, and the distal margin should be at least 2 cm from the distal end of the tumor.

Remove the lymphoid adipose tissue within the rectal mesentery as well as suspicious positive lymph nodes.

Preserve the pelvic autonomic nerves as much as possible.

Combined organ resection can be considered if the tumor invades the surrounding tissues and organs.

If the tumor is locally advanced and cannot be resected or cannot tolerate surgery, palliative treatment, such as palliative radiotherapy, is feasible.

Surgical Procedures

They mainly include anterior rectal resection (Dxion operation), combined abdominal perineal resection (Miles operation), transabdominal rectal cancer resection, proximal stoma, distal closure operation (Hartmann operation) and so on.

Chemotherapy

Chemotherapy, short for chemotherapy, is a systemic treatment that uses drugs to kill cancer cells, and the efficacy of chemotherapy on carcinoid tumors is yet to be determined.

Highly proliferative colorectal carcinoid tumors can be combined with cisplatin, etoposide, streptozotocin and 5-FU for chemotherapy, which has certain effect.

Slow-growing colorectal carcinoid tumors can be treated with growth inhibitor analogs and alpha-interferon shots.

Radiation therapy

Abbreviated as radiotherapy, it is the killing of tumor cells in the irradiated field by high-energy rays. It is an important local treatment for rectal cancer.

The therapeutic effect of radiotherapy on colorectal carcinoid tumor is also inexact, and it is generally helpful for bone metastasis and brain metastasis caused by colorectal carcinoid tumor.

In recent years, growth inhibitor analogues labeled with radioisotopes have been put into use, which have good tumor-targeting effects, including 111Ln, 30Y, 177Lu and 186Re-labeled octreotide, etc., and 177 Lu-labeled octreotide has higher tumor uptake.

Treatment of carcinoid syndrome

Treatment of carcinoid syndrome includes treatment with growth inhibitor analogs, treatment of liver metastases, treatment of refractory carcinoid syndrome, treatment of carcinoid heart disease, and treatment of carcinoid crisis.

Growth inhibitor analog therapy

Growth inhibitor analogs bind to growth inhibitor receptors on the surface of most carcinoid tumors and inhibit the secretion of various substances, such as 5-hydroxytryptophan, resulting in significant improvement of skin flushing and diarrhea in more than 80% of patients with carcinoid syndrome.

Growth inhibitor analogs include octreotide and lanreotide.

In addition to inhibiting the secretion of various substances and controlling carcinoid syndrome, these two drugs can also inhibit tumor growth and play a role in treating primary carcinoid tumors.

Treatment of liver metastasis

Hepatic resection: the preferred treatment for liver metastasis.

Hepatic artery embolization: commonly used in patients with liver-dominated metastatic lesions that cannot be surgically resected, it can effectively improve skin flushing and diarrhea.

Treatment of refractory carcinoid syndrome

Mainly includes trostan, interferon, antidiarrheal drugs and systemic therapy.

Treatment of carcinoid heart disease

Includes growth inhibitor analogs, surgical treatment of valves, diuretics, and trolox.

Treatment of carcinoid crisis

Carcinoid crisis is mainly treated with octreotide, vasopressors and intravenous rehydration.

Prognosis

Cure

Colorectal carcinoid tumor belongs to low grade malignant tumors, and the overall prognosis is good.

Some reports show that the 3-year survival rate is 80.8% and 5-year survival rate is 49.2%.

The distant metastasis rate of rectal carcinoid tumor is 1.7%, and the 5-year survival rate after distant metastasis is 32.3%.

If rectal adenocarcinoma can be detected as early as possible and treated in time, the prognosis is better.

Prognostic factors

Prognostic factors refer to a series of factors that may affect patients’ survival time and quality of life.

Among them, the indicator that has the greatest influence on the prognosis of colorectal adenocarcinoma is distant metastasis. Once distant metastasis occurs, the treatment effect is poor and recurrence is easy to occur, which shortens the survival time of patients.

Clinical factors

Sex, age, physical as well as psychological quality of patients.

Duration of the disease, clinical symptoms and complications.

Tumor location, size, trait and growth pattern.

Early diagnosis and treatment, through surgery and radiotherapy, can often achieve a better prognosis.

Pathological factors

The degree of differentiation of the tumor.

Depth of tumor infiltration, lymph node metastasis and number of metastasis, distant metastasis.

Daily

Daily management

Dietary management

Diet should be light and easy to digest, and egg custard, noodle soup, etc. can be consumed appropriately.

Increase the intake of protein, such as milk and lean meat.

Consume fresh fruits and vegetables with soft texture and rich in vitamins such as kiwi and strawberries as appropriate to ensure balanced nutrition.

Eat low-fat, fiber-rich foods (bitter gourd, celery, mango, oats) as appropriate to avoid excessively dry or loose stools and to maintain smooth bowel movements.

Avoid foods such as eggs, garlic, onions and shrimps.

Lifestyle Habits

Live a regular life, pay attention to rest and avoid exertion.

Keep in a good mood.

Home care

Oral care, assist patients to gargle, brush teeth, etc. to ensure oral hygiene and improve appetite.

Maintain a suitable environment, clean and disinfect the room every day, ventilate the room regularly, and keep the temperature and humidity suitable (room temperature 18～22℃, humidity 50%～70%).

Nursing care of artificial anus, artificial anus after surgery, initial family members should assist the finger expansion, keep the skin around the anus dry.

Perineum care, patients without surgical conditions, frequent bowel movements, easy to cause eczema and inflammation in the perineum, it is recommended to keep the perineum clean, you can use anal sitz bath to clean.

Follow-up

The importance of regular follow-up examination helps to detect recurrence and metastasis in time, and adjust the treatment plan in time.