What is Carcinoid Syndrome?

The extensive endocrine or paracrine system surrounding functional tumors produces different amines and peptides, which is consistent with the symptoms and signs including carcinoid syndrome. Carcinoid syndrome usually involves the production of serotonin and the formation of endocrine cells in the ileum Malignant tumors, but it can be found elsewhere in the GI tract, pancreas, gonadal and intratracheal tumors. Rare and more malignant tumors include lung oat cell carcinoma, islet cell tumor, and medullary thyroid cancer. With the above syndromes, metabolites released by small intestinal carcinoids can be quickly degraded by liver and liver enzymes in the portal circulation (such as serotonin is degraded by hepatic monoamine enzymes), so they are usually not produced except for liver metastases. Carcinoid syndrome, metabolites released after liver metastases can pass directly to the systemic circulation through the hepatic veins. Tumor products of the primary lung and ovary can cause carcinoid syndrome through portal bypass, which is less common in small intestine-like cancers such as There is only extra-abdominal metastasis, and its metabolites can go directly to the systemic circulation or lymphatic system.

Carcinoid syndrome

Metabolic intestinal carcinoid tumors secrete a series of serotonin, bradykinin, histamine, prostaglandin and peptide hormones that cause skin flushing, cyanosis, intestinal cramps, diarrhea, etc. due to the excessive secretion of substances that act on blood vessels. Appearing symptoms. The severity of the symptoms is to some extent related to the amount of hormones entering the systemic circulation. This syndrome is characterized by the typical paroxysmal skin vascular symptoms. Primary carcinoids are mostly located in the ileum. Symptoms often occur after liver metastases. Most patients have elevated 5-oxindoleacetic acid in their urine.

Etiology and pathophysiology of carcinoid syndrome

Serotonin can cause diarrhea, colitis and malabsorption in smooth muscle. Histamine and bradykinin can cause skin flushing through vasodilation. The effects of prostaglandins and different peptide hormones produced by pancreatic cells need further study, and Human chorionic gonadotropins occasionally increase in peptide-level carcinoid tumors.

Carcinoid syndrome symptoms and signs

The most common and earliest signs are skin flushing, typically on the head and neck, often after agitation, ingestion of food, hot water, and alcohol. There is a stronger change in skin color, which can change from pale or Erythema to purple, intestinal spasm with recurrent diarrhea is the main complaint of patients, some patients have intestinal malabsorption syndrome, and many patients develop right heart fibrosis, causing pulmonary artery stenosis and tricuspid regurgitation. It is reported that bronchial Patients with cancer have left heart damage, but it is rare because serotonin has been destroyed when it passes through the lungs. A few patients have asthma-like wheezing, and some patients have sexual dysfunction and impotence. Pellagra is rare.

Carcinoid Syndrome Diagnosis

Non-functional carcinoids can be diagnosed by angiography, CT, or magnetic resonance according to different parts, as with other occupying lesions. Small intestinal carcinoids can be examined by barium X-rays to show that the mass fills the intestine or other abnormalities. A histological examination is required to confirm the diagnosis.

Functional carcinoids can be diagnosed initially through symptoms and signs. Confirmation of the diagnosis requires an increase in the excretion of 5-hydroxyindoleacetic acid (5-HIAA), a metabolite of 5-hydroxytryptamine in urine. Colorimetric tests require patients to fast for 3 days without Serotonin foods (such as bananas and tomatoes) to avoid false positive results. Some drugs include guaiacol glyceryl ether, mesobamo, phenothiazine, which can also interfere with test results. Leave urine for 24 hours on day 3. The normal value of 5-HI-AA, 5-HIAA was detected <10mg / d (<52mol / d); patients with carcinoid syndrome were greater than the normal value of 50mg / d (> 260mol / d).

Skin flushing can be induced by calcium gluconate, catecholamine, pentagastrin, and alcohol challenge test. This method can help some patients to make a diagnosis, but caution should be taken. The location of the tumor requires a large number of tests, including laparotomy, which is necessary. Liver scan to check for metastases. With proper examination, the rarer tumors mentioned above can be ruled out.

Carcinoid syndrome treatment and prognosis

Primary lung cancer can be performed with effective lung resection. Surgery for patients with liver metastases is only to diagnose or relieve symptoms. Radiotherapy is not necessary, in part because these patients have poor tolerance to normal liver tissue and have not yet adapted to effective chemotherapy. However, 5-fluorouracil streptozotocin has been widely used, and sometimes doxorubicin is also used. Skin flushing and certain symptoms can be alleviated by somatostatin (which inhibits the release of most hormones), but does not reduce 5- HIAA and gastrin. Some studies have shown that octreotide also has a good effect. It is a long-acting drug of the same class of somatostatin, which can be used to control diarrhea and flushing. Tamoxifen citrate has been reported in some uncontrolled cases. Also works; Interleukin (IFN-) can temporarily relieve symptoms.

Diarrhea can be controlled by some drugs-codeine phosphate 15 mg every 6 hours, opioid 0.6 mg every 6 hours, diphenoxylate hydrochloride 2.5 mg, 1 to 3 times / day. Or peripheral serotonin antagonists For example, cyproheptadine hydrochloride 4-8 mg every 6 hours or ergometrine 4 times a day.

Because tryptophan in food is converted into serotonin by tumors, you need to take in sufficient amounts of niacin and protein to prevent pellagra and prevent serotonin from converting to serotonin enzyme inhibitors such as methyldopa 250 ~ 500mg orally or phenoxybenzamine 10mg / d every 6 hours.

Skin flushing can be treated with phenothiazine (e.g. 5-10 mg of prochlorperazine or 25-50 mg of chlorpromazine taken orally every 6 hours) or H2 blockers such as imipridine or cimetidine. Can prevent skin flushing induced in experiments, corticosteroids (such as prednisone 5mg every 6 hours) can be used to treat severe skin flushing caused by bronchial cancer.

Despite metastatic disease, patients often have a 10-15 year survival period.

Carcinoid Syndrome

Lung cancer is a common disease in oncology. Surgical resection is preferred for early treatment. However, due to various reasons, most patients have reached the middle and advanced stages when they seek medical treatment, and they have lost the opportunity for surgical treatment. In recent years, traditional Chinese medicine and traditional Chinese medicine have achieved remarkable results in the treatment of lung cancer, and have played a role in alleviating symptoms and extending survival. The etiology and pathogenesis of TCM treatment of lung cancer, the relevant literature records and clinical experience of syndrome differentiation treatment are summarized as follows.

Sputum knot is the pathological basis of traditional Chinese medicine and traditional Chinese medicine for lung cancer.

"Difficult classics" cloud: "The product of the lungs, the name of which is breathlessness ... It is breathtaking cold, cough, and lungs." "Su Wen · Zhuang Yi Lun" said: "Under the threat of illness, full of energy and insufficiency, two or three years old ... the disease name is called the product of interest." "Su Wen · Yu Ji Zhen Zang Luan" detailed records of the symptoms of fever, chest pain, shoulders, and cachexia in advanced lung cancer, stating "the bones are withered, the meat is swollen, the chest is full of gas, the breathing is inconvenient, and the internal pain leads to the shoulders Item, body heat and flesh? ". It can be seen that "Xi Xie", "Xiang Xie", "Xi Ji", and "Xi Ji" can all be classified into the category of TCM disease names of bronchial lung cancer.

The etiology and pathogenesis of lung cancer, "Zixi, the source of miscellaneous diseases" is more relevant, saying: "In the evil chest, the Qi is blocked, the Qi cannot pass, and it is sputum ... for blood, all fight against evil, and evil wins. If it is not possible to make it, then it will take shape and become a block. " This article deeply understands the pathogenesis of sputum knots and visible clumps in the chest. Regardless of whether the internal qi is deficient, the internal organs are imbalanced, or external evils invade the lungs, or the heat is too cold, all pass through the pathological process of qi depression and accumulation into sputum. Without sputum, there is no lung volume, so sputum in the lungs is the pathological basis of lung cancer. The spleen is the source of sputum, and the lung is the device for storing sputum. The lungs and spleen are deficient in qi and spleen, and the yin and yang are out of harmony. Due to the evil of wind or heat, they fail to accumulate at first. , Is into a lung product. Phlegm stasis and heat, burning blood veins, cough and sputum. The sputum is condensed under the skin, and pelvic tuberculosis is seen. When it flows to the bone, it becomes osteoporotic. When it flows to the brain, it causes headache. The pathogenesis of lung cancer is closely related to the lungs and spleen. The sputum node runs through the entire course of lung cancer from primary to metastatic.

According to the pathological mechanism of lung cancer, and according to the characteristics of syndrome differentiation of traditional Chinese medicine, traditional Chinese medicine can be divided into four common clinical syndromes of lung stagnation and fever, qi deficiency and phlegm dampness, yin deficiency and phlegm fever, and qi and yin deficiency. The dialectical points and treatment methods are described below.

Carcinoid syndrome

Poor coughing, blood in sputum, chest pain or tightness, shortness of breath, dry lips, constipation, red or dark red tongue, yellow fur, and thin pulse strings. The card is stagnation of lung qi, blood stasis and phlegm. Expelling Xiefei, qi and phlegm.

Carcinoid syndrome

Cough and sputum, chest tightness, shortness of breath, less gas, lazy words, appetite and weight loss, abdominal distension will be diarrhea. The tongue is pale or red, with tooth marks on the sides, greasy fur, and pulses or slippery. The syndrome is of weak lung qi, child disease and mother, loss of spleen, and internal resistance of damp phlegm. Expelling Qi and strengthening the spleen, removing phlegm and dissolving.

Carcinoid syndrome

Cough with little phlegm, or dry cough, dry throat discomfort, or bloody expectoration, chest fullness, shortness of breath, hot flashes, night sweats, dizziness, tinnitus, upset, dry mouth, yellow urine, dry stool. The tongue is red, the moss is peeling or the tongue is moss-free, and the pulse strings are weak. This card is lung and kidney yin deficiency, phlegm and heat stagnation, remedy nourishing kidney and clearing lungs, removing phlegm and clearing heat.

Carcinoid syndrome

Dry cough, low sputum, or low bloody sputum, weight loss, tiredness, dry mouth, shortness of breath, loss of eyesight, irritability and palpitations, lack of appetite, red or tender tongue, dry or no moss, pulse sinking fine. The syndrome is a deficiency of the lungs and spleen, and the kidney is depleted. Expelling qi and nourishing yin, righting and removing product.

However, due to the complexity of the theory of traditional Chinese medicine and traditional Chinese medicine for treating lung cancer, it is necessary to make a comprehensive treatment of patients' physical conditions and conditions before making appropriate treatment rules.