Scherübl H, Klöppel G
Klinik für Innere Medizin - Gastroenterologie und GI Onkologie, Vivantes-Klinikum Am Urban, Dieffenbachstrasse 1, 10967 Berlin.
Z Gastroenterol. 2009 Apr;47(4):365-71. doi: 10.1055/s-2008-1027930. Epub 2009 Apr 8.
Rectal carcinoids are becoming more common: in the USA they have increased in frequency by 800 - 1000 % in the past 35 years. This dramatic increase is probably related to the introduction of colonoscopic screening which also results in the "incidentally" detected neuroendocrine rectal tumours/carcinomas being smaller than in the pre-screening era. Endosonography is the method of choice for determining the size and depth of penetration of the tumours and for detecting lymph node metastases. Tumours of < 10 mm in size that have not infiltrated the muscularis propria can usually be removed endoscopically. When invasion of lymph or blood vessels or lymph node metastases are found, surgical resection of the lymph nodes is indicated. Neuroendocrine rectal neoplasms (rectal carcinoids) of 10.1 - 20 mm in diameter have a metastasis risk of 17 - 42 (81) % for neuroendocrine rectal neoplasms > 20 mm in size this risk increases to 60 - 80 %. A carcinoid syndrome is rarely observed, even in cases of distant metastases of neuroendocrine rectal carcinomas. Stable somatostatin analogues and interferon-alpha constitute the drug therapies of choice for carcinoid syndrome. As a result of the increasing early detection of rectal carcinoids/carcinomas the prognosis for the patients has improved considerably in the last 30 years. In addition to the early detection of colorectal adenoma and adenocarcinoma, screening colonoscopy also makes possible the early detection and early therapy for neuroendocrine rectal tumours/carcinomas.
在美国，它们的发病率在过去35年里增长了800%-1000%。这种显著增长可能与结肠镜筛查的引入有关，这也导致“偶然”发现的神经内分泌直肠肿瘤/癌比筛查前时代的更小。内镜超声检查是确定肿瘤大小、浸润深度以及检测淋巴结转移的首选方法。直径小于10mm且未浸润固有肌层的肿瘤通常可通过内镜切除。当发现有淋巴或血管侵犯或淋巴结转移时，则需进行淋巴结的手术切除。直径为10.1-20mm的神经内分泌直肠肿瘤（直肠类癌）转移风险为17%-42%（81%），对于直径大于20mm的神经内分泌直肠肿瘤，此风险增至60%-80%。类癌综合征即使在神经内分泌直肠癌发生远处转移的病例中也很少见。长效生长抑素类似物和干扰素-α是类癌综合征的首选药物治疗。由于直肠类癌/癌的早期发现增加，在过去30年里患者的预后有了显著改善。除了早期发现结直肠腺瘤和腺癌外，筛查结肠镜检查还使神经内分泌直肠肿瘤/癌的早期发现和早期治疗成为可能。
