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- Wed Sep 03, 2008 5:40 am
Recently I had an EGD due to many years of GERD and the Carcinoid Tumor was found in my Gastric Body (stomach) and was removed during the EGD. I was confirmed as a Carcinoid Tumor (Neuroendocrine Tumor). I went in 10 days later an had another EGD and this time he removed a large stomach polyp and piopsy of other stomach locations.
I'm scheduled to meet with an Oncologist next week.
My question is:
What is the recommendation for treatment when there are 20 to 30 stomach polyps in which there was a cancerous tumor? Should I be concerned about having so many stomach polyps?
Any advice would be appreciated.
| Dr. Safaa Mahmoud
- Fri Oct 10, 2008 12:52 pm
Carcinoid tumors arise from cells known as Argentaffin cells in the gut and the respiratory tract. The appendix is the commonest site to be involved (although accidentally discovered in most of cases) followed by the small intestine.
Various hormones are secreted from these cells like serotonin, histamine, somatostatin and gastrin. They cause symptoms of flushing, abdominal cramps and diarrhea the so called Carcinoid Syndrome only if they reach the systemic circulation. Since most of these hormones are metabolized in the liver before bypassing the portal (hepatic) circulation into the systemic circulation, they seldom cause symptoms.
Symptoms occur when there is liver metastasis (commonest cause in case of small intestinal disease) or when the tumor can directly reach the systemic circulation (e.g. respiratory tract disease). Involvement of the transverse, descending colon or the rectum seldom cause symptoms.
Initial work up include Octreoscan, a scan that can identify all cells producing somatostatin thus map tumor cells in different parts in the body. Upper Endoscopy, lower Endoscopy or bronchoscopy is used to identify the primary site accordingly. Gastrin hormone should also be evaluated in cases of gastric Carcinoid and if found to be high, B12 level should be determined.
Treatment of non metastatic gastric Carcinoid include resection (endoscopic if <2cm and surgical if >2cm) and biopsy from adjacent gastric mucosa, observation or Octreotide for patients with high gastrin secreting tumors.
Those who have normal gastrin level are treated with radical tumor resection and lymph node resection.
Patients are then followed up with gastroscopy every 6 month for three years then annually.
Regarding the multiple polyps that were found in the stomach, pathological results are important to define the possible underlying causes and the best approach.
In some cases, gastric carcinoid presents in the form of multiple polyps and in association with atrophic gastritis and/or sustained hypergastrinemia.
Carcinoid tumors associated with multiple endocrine neoplasms (MEN1) involve mainly the stomach and the upper small intestine. Lesions can also be in the form of multiple polyps. MEN1 is an autosomal dominant disease that affects mainly the pituitary gland, the pancreas and the parathyroid glands. Based on your family history this should be kept in mind although you did not specify the specific type of tumor they had.
The most common type of gastric polyps is hyperplastic polyps located mainly in the antrum and are multiple. Chronic inflammation (e.g. GERD) and Helicobacter pylori infection are thought to be involved in the pathogenesis of this condition. Most physicians consider resection of all polyps of the stomach, and surveillance is the standard of care. Risk of cancer development in the adjacent mucosa is<2%.
Other types of polyps that develop in the stomach are the adenomatous polyps and those associated with familial adenomatous polyposis and are less likely to be the cause. Both need life time surveillance as they carry greater risk for malignant changes.
Hope you find this information useful.
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