The Clinical Diagnosis And Treatment Of 37 Patients With Colorectal Neuroendocrine Tumor

Objective: To investigate the incidence, clinical manifestation, diagnosis and treatment of colorectal neuroendocrine tumor and analyze the factors of prognosis.Methods: Clinical data of 37 patients with colorectal neuroendocrine tumor from Fujian Cancer Hospital between March 1988 and November 2104 was collected and analyzed retrospectively. To get the follow-up data by reading outpatients’ record, sending messages, making telephone calls so that we can understand their overall survival and metastasis situation.Results: In 37 cases of colorectal neuroendocrine tumor, 23 cases were male(62.2%), the other 14 were female(37.8%), the proportion of them was 1.64:1. The age ranged 28 to 66, the average was 45.84±9.89. The rectal neuroendocrine tumor was more than colon’s. In 35 cases of rectal neuroendocrine tumor, most of them happened in middle and low rectal. Both of the 2 colon neuroendocrine tumor happened in ileocecus. Hematochezia(29.73%), changing of bowel habit(24.32%), changing of stool characteristics(10.81%) and abdominal pain(10.81%) were the main manifestation. Some patients didn’t have obviously manifestation; they were discovered by physical examination. Patients may suffer carcinoid syndrome when the metastasis happened. All of them accepted colorectal endoscopy, 27.03% of them accepted ultrasound endoscopy. The mainly image examination were CT, MRI and abdominal ultrasound, one of them accepted the PET-CT because of the metastasis. All of them accepted the pathology test, 64.86% of them had immunohistochemical, including Cg A, Syn, NSE and CK. Syn had the highest positive rate(100.00%), the next were NSE(88.24%) and CK(83.33%), but the Cg A had the lower positive rate(33.33%). 36 cases accepted treatment, including radical treatment and late-stage treatment. In radical treatment, surgical therapy was the mainly method, including endoscopic therapy and operation. In late-stage treatment, chemotherapy and palliative operation toward metastases or primary lesions were used. For prognosis, when tumor diameter ≥2cm, its metastasis rate was significant higher than tumor diameter ≤1cm and tumor diameter 1-2cm(P<0.01 and P=0.032). When tumor invaded into serosal layer, its metastasis rate was significant higher than tumor invading the muscle layer and limiting in mucosal or submucosal layer(P<0.01 and P=0.005).Conclusion: The colorectal neuroendocrine tumor morbidity of male is a little higher than that of female, average episode age is 45.84±9.89. The amount of rectal neuroendocrine tumor is more than colon’s. Most colon neuroendocrine tumor happen in ileocecus and a majority of rectal neuroendocrine tumor are in middle and low rectal. The manifestation of colorectal neuroendocrine tumor doesn’t have enough specificity, like the other colorectal tumor, mainly of them are hematochezia, changing of bowel habit and stool characteristics. Colorectal endoscopy is the prime choice for examination and the ultrasound endoscopy should be taken if there is a suitable condition. Pathology is the golden criterion for diagnosis and it is also helpful for classification. Surgical therapy is the only way to cure it, but the suitable method should be chosen according to the tumor diameter and depth of tumor invasion. When the metastases happen, there are still methods to treat it. Cytotoxic chemotherapy doesn’t have demonstrated response in prognosis and survival. Instead of it, somatostatin analogs like octreotide can be used. Hepatic arterial embolization and surgical cytoreduction can be used to control the metastases in liver. When tumor diameter is bigger than 2cm or the depth of invasion gets to serosal layer, the recurrent and metastasis rate will be higer and the overall survival rate will get down.