Treatment of carcinoid

Surgical treatment. The only effective method of treatment of carcinoid is a radical removal of the tumor, as well as regional and distant metastases.
When carcinoid process is the normal appendectomy, providing, as a rule, complete recovery of patients. Some surgeons recommend the removal of the mesentery process (3. Candidate of Douplik, 1967), and in the dissemination of tumor growth on the mesentery of the regional lymph nodes and vessels believe shown hemicolectomy (Latham, and others, 1961). In cases of carcinoid ileum are two kinds of surgical intervention: "turning off" of the affected area or its resection with mesentery and lymph nodes. Most researchers prefer the second method of operation. Mortality in resection of the colon reaches 20% (Thorson, 1958), but at the same time, many patients after discharge from hospital survive and deprived of any symptoms. According to Moertel (1961), the operation must be performed even in the presence of distant metastases. Specified by the author within 5 years have traced the fate of such patients who had a bowel resection. It turned out that 38% of them were still alive, and in 21 % of the marked liver metastases.
When gastric carcinoids utilize the primary tumor, or (more often) Subtotal resection of the stomach (with multiple foci of growth), together with a large gland.
Given the significant traumatic removal of the rectum and a large number of complications, surgeons cautious approach to solving of the question about surgery for rectal carcinoid. For radical surgery, as for rectal cancer, resorted to only in cases when the size of the tumor more than 2 cm, and according to biopsy with subsequent histological examination, it is distributed in the muscle layer and infiltrates the intestine wall. At smaller sizes and absence of invasive growth applies excision of the tumor (B. N. Petrov and A. P. Tedeev, 1968; Sokoloff, 1968; Avulo, 1969). Such patients undergo thorough and long-dispensary observation.
Patients with carcinoid syndrome is also necessary to recommend surgical treatment. In these cases, delete the primary source of tumor growth and excised available part of metastases. These activities facilitated the condition of patients and improve their health. Sometimes temporarily cease attacks "redness". Carcinoid grows slowly, and therefore such palliative surgery seems quite justified. Recently Zeegen and others (1969) successfully applied removal of the lobe of the liver in patients with metastatic the carcinoid ileum and heavy carcinoid syndrome.
One of the indicators of effectiveness of the operation of any kind is the definition of 5-GOOK in the urine. Persistent lowering its release indicates a positive result of intervention, while the stable high content of 5-GOOK refers to poor prognostic features.

Conservative treatment. Taking into account the value of catecholamines in the liberation of kallikrein cells carcinoid with subsequent development of attacks redness, in the literature of the recent years are the materials about the effectiveness of the funds acting on alpha - and beta-receptor blockers these adrenoreaktivnyh functional systems (Mason and Melman 1966; Ludwig and others, 1968). The most efficient among them were beta-blocker - propranolol (30 mg per os pro die), the introduction of which does not warn of attacks redness, but clearly reduces their frequency and severity. Possibly combined application of alpha - and beta-blockers (type of regitine) will be more effective in the treatment of seizures redness. According to Ludwig and others, the appointment α-blockers were not given therapeutic effect in such cases. Sometimes after taking propranolol increased diarrhea that would seriously worsen the condition of patients.
Chlorpromazine has the ability to reduce the vascular responsiveness with increased concentration in the blood of kinins, but this drug is not always have a curative effect for the attacks redness. Morrelli and others argue that chlorpromazine direct and indirect means to weaken the effect of bradykinin, while propranolol reduces the release of this kinna adrenaline.
Corticosteroids in vitro and in patients with bronchial carcinoid can prevent the release of kallikrein, which explains some patients with carcinoid syndrome their successful application. Direct well-known antagonists of kallikrein type trasilol were completely ineffective in such patients.
Radiotherapy is not very effective method of treatment due to low sensitivity carcinoid cells to radiation effects (Sokoloff, 1968).
Vasomotor disorders syndrome redness can be somewhat reduced under the influence of antihistamines in normal doses (Dimedrol, pipolfen, suprastin). In patients with heart failure are used cardiac glycosides, diuretics.
Sometimes patients with functioning carcinoid observed violations of the processes of absorption in the intestine, accompanied by diarrhea. In these cases can be effective antagonist of serotonin, in particular metisergid (Melman and others, 1965).
In General, it should be recognized that there are currently no effective means of conservative treatment for carcinoid syndrome, and used drugs only cause short-term symptoms or decrease the degree of their manifestation.