Recently a netizen consultation platform consultation, this is a lung cancer postoperative patient, one month after surgery, the pathological stage is IB stage, the patient consults whether postoperative adjuvant treatment is required. From the pathological reports uploaded by patients, the patient is neuroendocrine carcinoma (class G1 carcinoma). Lung carcinoid cancer has undergone radical surgery and does not require any postoperative adjuvant therapy or genetic testing.
What exactly is carcinoid?
Carcinoid is a low-grade malignancy that originates from endocrine cells, mostly occurs in the digestive system, can occur in any part of the esophagus to the rectum, and the more common sites are the distal end of the appendix, other parts of the appendix, the small intestine, the rectum, the stomach, and the duodenum. About 10% of carcinoid carcinoids are seen in the bronchi, lungs, thymus, thyroid, ovaries, cervix, and testicles.
Although the tissue structure is like a carcinoma, carcinoid carcinoid generally grows in local infiltrativeness and rarely metastasizes, so it is called carcinoid. Because carcinoid carcinoid originates from neuroendocrine cells, it has endocrine functions and produces active substances such as serotonin, histamine, kallikrein, bradykinin and prostaglandin, causing carcinoid syndrome. Presents with skin flushing, diarrhea, abdominal pain, asthma, hypertension, tachycardia, and other symptoms. After surgery to remove the lesion of the cancer, these symptoms often disappear.
What is lung carcinoid?
Lung carcinomas are rare tumors, accounting for about 1%-2% of lung tumors. Lung carcinoids originate from the silver-loving cells of the bronchopulmonary mucosa and submucosal glands, known as Kulchitsky cells. These cytoplasms contain neuroendocrine granules that have a secretory function.
According to the biological behavior of carcinoid, lung carcinoids are divided into: typical carcinoid and atypical carcinoid, typical carcinoid carcinoid accounts for the majority, about 90%, its degree of differentiation is high, atypical carcinoid differentiation degree is poor, invasive, accounting for only about 10%.
In terms of age of onset, the median age of onset of lung carcinoid is 45 years old, and the average age of typical carcinoids is 10 years younger than that of atypical carcinoids, which is the most common lung malignancy in childhood.
In terms of the site of onset, lung carcinoid carcinomas can occur both hilar (central carcinoid) and peripheral lung (peripheral carcinoid). Since the closer to the central bronchi, the more K cells in the mucous membrane are distributed, the greater the chance of carcinoid development, so there are more central carcinoid types than peripheral types. In particular, typical carcinoid carcinoids occur mostly around the trachea and main bronchi.
In terms of prognosis, lung carcinomas grow slowly, and the prognosis is better than that of common lung squamous cell carcinoma and lung adenocarcinoma. Prognosis is related to clinical staging and lymph node metastasis, and the survival rate of 5 and 10 can reach 92% and 88% even if there is ipsilateral mediastinal lymph node metastasis in typical carcinoids. The prognosis of aggressive atypical carcinoids is relatively poor, with 5-year and 10-year survival rates of 69% and 24% to 52%, respectively.
In terms of treatment, radical surgery is the preferred treatment method, chemotherapy is generally not considered after typical carcinoid surgery, while aggressive atypical carcinoid, regardless of whether there is lymph node metastasis, postoperative chemotherapy is still recommended, but carcinoid sensitivity to chemotherapy is low.
Chemotherapy in advanced patients is not very effective, and some special drugs can be used according to whether the lesion has secretory function. For advanced carcinoid carcinoid without secretory function, the oral drug everolimus has been shown to have a good therapeutic effect and has been listed in 2016. For typical carcinoids with secretory function, somatostatin drugs such as Shandedine have the effect of controlling tumor growth.