Carcinoid syndrome: cov tsos mob, mob thiab kev kho mob

Medical statistics qhia tias lub xov tooj ntawm cancer tau tshee microscopic. Tuag tau los ntawm kev nce kaw txhua txhua xyoo. Qhov tseeb yog tag nrho cov ntau troubling thiab ua rau cov kws kho mob rau kev tiv thaiv kev ua hauj lwm ntawm cov pejxeem nyob rau hauv thiaj li yuav kom ib tug me ntsis txhoj puab heev expansive txoj kev loj hlob.

Carcinoid syndrome: yog dab tsi?

Carcinoid - qhov no yog feem ntau mob ntawm lub hlwb ntawm lub neuroendocrine system. Cov hlwb tej zaum yuav nyob rau hauv tej khoom hauv nrog cev thiab cov nqaij mos. Lawv lub ntsiab muaj nuj nqi - los tsim heev active proteins. Hais txog yim caum feem pua ntawm tag nrho cov carcinoids nyob rau hauv lub mob huam, nyob rau hauv ob qhov chaw yog hauv lub ntsws. Ntau npaum li cas tsis tshua, tsuas yog tsib feem pua ntawm tus neeg mob, hlav yog pom nyob rau hauv lwm yam kabmob thiab ntaub so ntswg.

Carcinoid syndrome thiab carcinoid mob yuav tsis muab cais los ntawm txhua lwm yam, raws li ib tug syndrome - ib tug txheej ntawm cov tsos mob uas tshwm sim nyob rau hauv lub keeb kwm yav dhau ntawm txoj kev loj hlob thiab kev ua si ntawm malignancy. Tom qab tag nrho, lub cev reacts mus tau rau hauv cov ntshav cov tshuaj hormones secreted los ntawm cov qog. plob tsis so tswj carcinoids tej zaum yuav "ruam", piv txwv li tsis manifest nws tus kheej kom txog thaum tej lub sij hawm kom txog rau thaum muaj metastases thiab tus kab mob no tsis mus rau hauv lub davhlau ya nyob twg theem.

yog vim li cas

Soj ntsuam tseem tsis txaus cov lus qhia kom to taub yog vim li cas tsim carcinoid syndrome thiab carcinoid qog. Zaum muaj peev xwm tsim hypotheses txog tus kab mob etiology, tab sis tag nrho cov pom zoo rau qhov tseeb hais tias lub cev ntawm tej taw tes tsis tu tsis tseg kom paub txog mutated hlwb APUD system (ib qho acronym ntawm cov thawj tsiaj ntawv ntawm lo lus "Amee," "thawj", "assimilation", "decarboxylation" ).

Ib tug tib cancer cell nyob rau hauv thiaj li yuav tawm ntawm nws tsim ib tug ua tiav tshiab txoj kev loj hlob uas yuav tsim cov tshuaj hormones thiab hloov kom haum koj xav tau kev pab tag nrho cov biochemical dab nyob rau hauv tib neeg lub cev.

pathogenesis

Yuav ua li cas muaj peev xwm tsim carcinoid syndrome? Yuav ua li cas yog nws thiab yuav ua li cas los tiv thaiv nws? Muab hais tias neuroendocrine hlwb nyob thoob plaws hauv lub cev, thiab soj ntsuam txog tus mob yuav luag tsis tau kev tso tus txheej txheem, cov kws kho mob tsis tau.

Nyob rau ntawm ib point nyob rau hauv lub cell yog "ua hauj lwm" DNA uas yog zoo tu qab tso yog incorrectly tseem ua hauj lwm nrog ib tug puas fragment. Qhov no ua rau muaj kev cuam tshuam ntawm tes muaj nuj nqi thiab nws uncontrolled division. Yog hais tias lub cev yog noj qab nyob zoo, lub cev yuav hnov mob mus rau lub hloov thiab rhuav tshem ntawm cov tej yam txawv yam khoom. Yog hais tias qhov no tsis tshwm sim, ces tus cell yuav muab, yuav tsim lab ntawm cov ntawv luam thiab pib kis los ntawm lub cev co toxins thiab cov tshuaj hormones.

cov kws kho mob feem ntau tsis qhia hais tias yuav qhov chaw ntawm lub qog, txawm symptomatic carcinoid syndrome.

Carcinoma ntawm lub ntsws

Tsuas kaum feem pua ntawm cov neeg mob nyob rau hauv lub pa system yuav tsim o thiab, thiaj li, carcinoid syndrome. Tej yam tshwm sim nyob rau hauv lub ntsws yuav tsis hais, thiab tej zaum kuj tsis nyob rau hauv tag nrho cov. Qhov no yog vim lub kuj me me luaj li cas ntawm cov qog thiab lub tsis tuaj kawm ntawv ntawm metastasis. Cov neeg mob nrhiav kev pab txij li thaum advanced kab mob thiab, raws li ib tug txoj cai, tsis yog ib qho oncologist, thiab cov thawj mus rau lub kws kho mob. Nws yuav muaj unsuccessfully los kho bronchiolitis, mob hawb pob los yog ua pa tsis ua hauj lwm, kom txog thaum lub xav tias muaj mob cancer txheej txheem.

Cov tsos mob nyob rau hauv cov ntaub ntawv no yog atypical:

• palpitations, palpitations;
• dyspepsia;
• lawm lub tshav kub thiab maj ntawm cov ntshav mus rau lub sab sauv ib nrab ntawm lub cev;
• hnoos, txog siav;
• bronchospasm.

Nrog rau qhov no set mob yuav tsis yog yuav xav tias carcinoid. Tsis havzoov tas, kev drastic poob phaus, yuav txo tau ntawm kev tiv thaiv, qaug zog thiab lwm yam kev mob yam ntxwv ntawm cancer txheej txheem.

me me quav mob

Nyob rau hauv cov hnyuv me ntsis ntau tshaj nyob rau hauv lub ntsws, lub qog yog sau tseg thiab nws cov nrog carcinoid syndrome. Tej yam tshwm sim ntawm nws yog heev scarce. Feem ntau muaj cov xwb tsis yog-kev mob plab. Qhov no yog vim lub me me luaj li cas ntawm cov qog. Tej zaum nws tseem tsis tau mus nrhiav tau txawm nyob rau hauv kev ua hauj lwm. Kev kawm ntawv yog feem ntau pom los ntawm lub caij thaum lub sij hawm moj xeem.

Tsuas muaj li kaum feem pua ntawm cov qog ntawm cov hnyuv ntawm lub etiology ntawm qhov ua rau ntawm lub carcinoid syndrome. Rau cov kws kho mob, qhov no txhais tau tias cov txheej txheem tau ua phem thiab kis mus rau lub siab. Cov hlav yuav ua obturation ntawm lub lumen ntawm txoj hnyuv thiab raws li ib tug tshwm sim, plab hnyuv dab tsi thaiv. Tus neeg mob los txog rau lub tsev kho mob nrog cov neeg ua zog zoo li kev mob kev nkeeg, xeev siab, ntuav thiab mob ntawm lub rooj zaum. Thiab qhov ua rau ntawm tus mob no yuav paub xwb nyob rau lub operating rooj.

Zais tej zaum yuav tshwm sim los ntawm ncaj qha mob luaj li cas thiab Torsion hnyuv vim tshwm sim ntawm fibrosis thiab o ntawm lub qog ua kua membrane. Tej zaum cov nti thab ntshav txaus rau lub plob tsis so tswj cheeb tsam, uas ua rau yus necrosis thiab peritonitis. Ib yam ntawm cov tej yam kev mob yog ib lub neej-tuag thiab tej zaum yuav ua rau tuag ntawm tus neeg mob.

Ib tug mob ntawm lub appendix

Tumor ntawm lub appendix - ib tug tsawg tshwm sim nyob rau hauv nws tus kheej. Cov lawv carcinoids nyob ib honorable thawj qhov chaw, tab sis tsis yog ua rau carcinoid syndrome. Tej yam tshwm sim ntawm lawv tsis tshua muaj neeg scarce. Raws li ib tug txoj cai, nws yog cov uas nrhiav tau ntawm pathologists tom qab appendectomy. O nyob rau hauv loj yog tsawg tshaj li ib centimeter thiab behaves heev "nyob ntsiag to". Muaj feem yuav muaj tias tom qab qhov kev tshem tawm ntawm ib tug mob ntawm lub appendix tshwm nyob rau hauv lwm qhov chaw, tsis tseem ceeb txaus.

Tab sis yog hais tias tus mob twb ntes tau nyob rau hauv ob centimeters nyob rau hauv loj, thiab ntau, koj yuav tsum tau ceev faj ntawm metastasis nyob rau hauv lub zos cov qog ntshav hauv thiab nthuav tawm ntawm lub qog hlwb nyob rau hauv lwm yam kabmob. Ordinary appendectomy nyob rau hauv xws li ib tug cov ntaub ntawv yuav tsis tau tiv nrog tag nrho cov kev tshuaj thiab yuav tau nyiam oncologists rau kev qhia ntawv kho mob.

Ntsuas ntawm lub carcinoid hlav

Lwm localization, nyob rau hauv uas yuav luag tsis qhia carcinoid syndrome. Tsis muaj yam qhia ntawm lub qog thiab ntawd nyob thaum lub sij hawm diagnostic cov txheej txheem xws li mus xoos hnyuv laus los yog sigmoidoscopy.

Qhov ntau yam ntawm malignancy (malignancy), thiab cov tsos ntawm nyob deb metastases nyob ntawm qhov loj ntawm lub qog. Yog hais tias nws yog ntau tshaj lub cheeb ntawm ob centimeters, txoj kev pheej hmoo ntawm cov teeb meem yog hais txog yim caum feem pua. Yog hais tias lub qog tsis tuav mus rau ib tug centimeter nyob rau hauv txoj kab uas hla, koj yuav nco ntsoov rau cuaj caum-yim feem pua, muaj yog tsis muaj metastasis.

Yog li ntawd, qhov mus kom ze rau kev kho mob nyob rau hauv cov ob tus neeg no sib txawv. Ib tug me me qog tshem tawm feem ntau yig resection ntawm cov nyuv, thiab yog hais tias muaj cov cim qhia ntawm malignancy, nws puas yuav tsum tau tshem tawm ntawm tag nrho cov nyuv, raws li zoo raws li cov kws khomob.

pais plab carcinoid

Muaj peb hom carcinoid hlav ntawm lub plab, ua carcinoid syndrome. Cov yam ntxwv ntawm cov thawj hom hlav:

• me me qhov ntev (txog li 1 cm);
• benign kawg.

Tau kis ntawm lub qog nyuaj thaum cov txheej txheem captures rau tag nrho cov plab. Lawv yog txuam nrog rau pertsinoznoy anemia los yog mob gastritis nyob rau hauv ib tug neeg mob. Kev kho mob ntawm xws hlav yog tau txais somatostatin inhibition ntawm zus tau tej cov gastrin los yog gastrectomy.

Qhov thib ob hom mob hlob maj mam, tsis tshua ua ua cancer. Lawv yog cov nais khu nyob rau hauv cov neeg mob uas muaj ib tug kev tshuaj ntsuam genetic teeb meem xws li ntau yam endocrine neoplasia. Marvel tsis tau tsuas yog lub plab, tab sis lub pineal caj pas, cov thyroid caj pas, pancreas.

Qhov thib peb hom mob - ib tug loj hlav loj hlob nyob rau hauv ib tug noj qab nyob zoo lub plab. Lawv yog cov phem, txeem sib sib zog nqus rau hauv lub cev cov phab ntsa thiab muab ntau yam metastases. Tej zaum yuav ua perforation thiab los ntshav.

Tumor ntawm cov nyuv

Cov hnyuv loj - yog qhov chaw uas cov feem ntau thiaj paub hais tias carcinoid syndrome thiab carcinoid qog. Photo mucosa thaum lub sij hawm qhov kev xeem ntawm lub plob tsis so tswj ya qhia tau hais tias lub xub ntiag ntawm loj (tsib centimeters los yog ntau tshaj) hlav. Lawv metastasize rau regional cov qog ntshav hauv thiab yog yuav luag ib txwm phem.

Oncologists nyob rau hauv xws li mob yuav tsum tau mus radical phais nrog adjuvant thiab neoadjuvant kws khomob mus cuag ib tug zoo dua cov nyhuv. Tab sis ciaj sia taus raug rau cov neeg mob no yog tseem unfavorable.

Carcinoid Syndrome: Cov tsos mob, cov duab

Cov paub txog tus carcinoid syndrome yog nyob ntawm seb yam yog muab rho tawm qog. Qhov no yuav ua tau serotonin, bradykinin, histamine los yog chromogranin A. Qhov tseem raug tej yam tshwm sim ntawm tus kab mob yog:

• Lub qhov koob liab ntawm lub ntsej muag thiab lub cev. Nws tshwm sim nyob rau hauv yuav luag tag nrho cov neeg. Nrog los ntawm ib lub zos nce nyob rau hauv kub. Tawm tsam tshwm sim nthawv, lawv yuav tau triggered thaum uas haus dej haus cawv, kev nyuaj siab los yog qoj ib ce. Nyob rau hauv cov ntaub ntawv no, muaj yog tachycardia, siab poob qis.
• Siab ntawm ib lub rooj zaum. ¾ tam sim no nyob rau hauv cov neeg mob. Feem ntau, qhov no tshwm sim vim voos ntawm cov qog ua kua membrane ntawm cov hnyuv, mob ntawm plob tsis so tswj thaiv.
• Cuam tshuam rau lub plawv yog xam qhovkev rau hauv ib nrab ntawm cov neeg mob. Carcinoid syndrome txhawb tsim ntawm lub plawv valve stenosis thiab ua rau mob tsis ua hauj lwm.
• Hawb pob nyob rau hauv lub ntsws yog vim spasm ntawm lub bronchi.
• Mob plab yog txuam nrog rau cov tshwm sim los ntawm metastases nyob rau hauv lub siab, plab hnyuv rhuav txhua los yog mob ntxeem tau mus rau hauv lwm yam kabmob.

Carcinoid ntsoog - ib tug mob uas yog yus muaj los ntawm ib tug ntse poob nyob rau hauv siab thaum phais. Yog li ntawd, cov neeg mob muab somatostatin rau zoo xws li manipulations.

diagnostics

Yog nws tau mus ntes carcinoid syndrome? Tej yam tshwm sim, cov duab, disparate kev kho mob ntawm cov tsos mob tsis muab ib tug ntshiab soj ntsuam daim duab, tsis pom tau. Feem ntau cov feem ntau lub qog - ib tug txhob txwm nrhiav ib tug kws phais neeg los yog radiologist. Nyob rau hauv thiaj li yuav paub meej tias muaj cov qog, nws yog tsim nyog los ua ib tug me ntawm lub cheeb tsam cov thiab xyuas cov ntaub so ntswg.

Koj tseem yuav siv qhov kev xeem ntes kom theem ntawm cov tshuaj hormones, tab sis cov ntaub ntawv no tej zaum yuav qhia ntawm ib co kab mob, thiab tus kws kho mob muaj kom paub tseeb uas lawv nws muaj ua li cas. Qhov tseem kev kuaj ntawd yog lub xov tooj ntawm 5-hydroxyindoleacetic acid. Yog hais tias cov theem yog nce, qhov tshwm sim rau carcinoid - yuav luag 90%.

cov kws khomob

Nws puas ua kev zoo siab los kho cov kws khomob-carcinoid syndrome? Tej yam tshwm sim, yees duab mucosa ntawm EGD me regional cov qog ntshav hauv thiab hormonal hloov yuav muab tus kws kho mob ib lub tswv yim ntawm qhov teeb meem uas yog tshwm sim los nyob rau hauv tus neeg mob lub xub ntiag ntawm lub qog. Yog hais tias lub forecast yog unfavorable rau tus neeg mob txawm tias qhov kev tshem tawm ntawm lub qog, cov kws txawj qhia mus rau chaw uasi rau cov kws khomob.

Feem ntau cov feem ntau, cov kws kho mob siv cytotoxic agents rau inhibit qhov kev loj hlob thiab kev loj hlob ntawm cov qog. Tab sis vim hais tias ntawm lub loj tus naj npawb ntawm tshwm sim los ntawm cov qauv no yog pom zoo xwb nyob rau hauv cov ntaub ntawv ntawm thaum muaj xwm ceev. Dhau li nws cov hauj lwm zoo - tsuas yog 40%.

symptomatic kev kho mob

Muaj seeb txoj kev xav hais tias yog pom nyob rau hauv lub keeb kwm yav dhau ntawm pathologies xws li carcinoid syndrome, carcinoid qog. Cov tsos mob yuav tsum zoo yam rau cov hom tshuaj uas tawm qog. Yog hais tias qhov no yog serotonin, tus neeg mob yog kws antidepressants. Yog hais tias lub ntsiab "tus tsim txom" yog histamine, ces tuaj mus rau lub fore blockers histamine receptors nyob rau hauv txoj kev kho.

hluavtaws analogues ntawm somatostatin tau pom, kom txhob muaj cov tsos mob los ntawm yuav luag 90%. Lawv inhibit zus tau tej cov ob peb cov tshuaj hormones hais tias yog lub luag hauj lwm rau lawv ruaj qhov chaw nyob rau hauv cov kev kho mob ntawm tus kab mob no.

operative txoj kev kho

Ib qho tseem ceeb kauj ruam nyob rau hauv cov kev kho mob yog los tshem tawm cov qog ntawm lub cev, thiab nrhiav resected metastases, siab leeg nyuam.

Nyob rau hauv lub ntim ntawm kev phais muaj feem xyuam rau qhov chaw nyob thiab loj ntawm lub qog, lub muaj los yog tsis tuaj kawm ntawv ntawm metastases. Feem ntau cov feem ntau, cov neeg phais tshem tawm cov mob yog ib feem ntawm lub cev, thiab tej pob khoom ntawm lub regional lymph node. Raws li ib tug txoj cai, nws yog txaus mus cawm cov neeg los ntawm carcinoid mus ib txhis. Nyob rau hauv heev zaus, thaum curative kev kho mob yog tsis tau, tus neeg mob yog raug caw mus rau siv embolization ntawm lub hepatic leeg kom tshem tawm cov tsos mob ntawm tus kab mob.

outlook

Yuav ua li cas mus cia siab tias cov neeg mob mob carcinoid syndrome thiab carcinoid mob? Flushing, palpitations thiab bouts ntawm breathlessness, yog yuav nyob twj ywm nrog lawv txog rau thaum xaus ntawm lub neej, tab sis yuav ua tsawg pronounced tom qab kev kho mob.

Tshuaj, muaj mob qhov twg tus neeg mob nyob ntau tshaj kaum xyoo tom qab phais, thiab symptomatic txoj kev kho. Tab sis lawv nruab nrab txoj sia luv yog hais txog 5-10 xyoo. Qhov phem tshaj raug yog mob nyob rau hauv lub ntsws, thiab qhov zoo tshaj plaws - nyob rau hauv lub appendix.