Scherübl H
Klinik für Innere Medizin, Gastroenterologie und Gastrointestinale Onkologie, Klinikum Am Urban, Vivantes Netzwerk für Gesundheit, Berlin, Germany.
Endoscopy. 2009 Feb;41(2):162-5. doi: 10.1055/s-0028-1119456. Epub 2009 Feb 12.
Rectal carcinoids are on the rise; in the United States the age-adjusted incidence has increased by 800% -1000% in the last 35 years. The incidence of carcinoids of the stomach, pancreas, or small bowels has also multiplied. The reasons for these epidemiological changes are not yet understood. Both screening sigmoidoscopy and screening colonoscopy lead to a shift to smaller-sized (< or =13 mm) rectal carcinoids and earlier tumor stages at diagnosis. During the last 35 years the overall 5-year survival of patients with rectal carcinoid disease has increased by almost 20% (in the US). Thus, endoscopic screening of the colorectum is effective in the early diagnosis not only of colorectal adenomas and adenocarcinomas but also of carcinoids. Rectal carcinoids that are 10.0 mm or less and do not infiltrate the muscularis propria can be removed endoscopically. If histological angioinvasion or lymph node metastases are found, surgical lymph node dissection has to be considered. Before deciding on definitive therapy, rectal carcinoids should be staged by means of endoscopic ultrasonography, CT, or MRI and somatostatin receptor scintigraphy.
直肠类癌的发病率正在上升；在美国，过去35年中年龄调整后的发病率增加了800% - 1000%。胃、胰腺或小肠类癌的发病率也成倍增加。这些流行病学变化的原因尚不清楚。乙状结肠镜筛查和结肠镜筛查均导致直肠类癌向更小尺寸（≤13 mm）转变，且诊断时肿瘤分期更早。在过去35年中，美国直肠类癌患者的总体5年生存率提高了近20%。因此，结直肠内镜筛查不仅对结直肠腺瘤和腺癌的早期诊断有效，对类癌也有效。直径10.0 mm及以下且未浸润固有肌层的直肠类癌可通过内镜切除。如果发现组织学血管侵犯或淋巴结转移，则必须考虑进行手术淋巴结清扫。在决定最终治疗方案之前，应通过内镜超声、CT、MRI和生长抑素受体闪烁显像对直肠类癌进行分期。
