Gastrointestinal Cancer Syndrome
Introduction
Introduction to Gastrointestinal Cancer Syndrome Gastrointestinal syndrome with cancer refers to some syndromes associated with certain cancers of the digestive system, such as hypoproteinemia, edema, diarrhea, and dehydration. It does not include the general systemic effects of tumors, such as jaundice, fever, weight loss, etc., nor does it refer to the parenteral manifestations of classical digestive tract endocrine tumors. The treatment is mainly the resection of primary cancer, and it can also be treated with somatostatin analogues such as octreotide, which is effective for controlling diarrhea. basic knowledge The proportion of the disease: the incidence of the disease is about 0.0003% - 0.0009% Susceptible people: no special people Mode of infection: non-infectious Complications: hemorrhoids edema
Cause
Gastrointestinal tract with cancer syndrome
Physiological studies have confirmed that only about 10% of the decomposition products of plasma albumin and globulin are excreted from the intestine, so it is considered that the loss of gastrointestinal protein in normal human physiological conditions is negligible.
There are three main pathogenesis of protein-losing gastrointestinal diseases:
1. Gastrointestinal mucosal erosion or ulceration causes protein to ooze or leak out.
2. Mucosal cells are damaged or missing, and the tight junctions between cells are broadened, resulting in increased mucosal permeability and leakage of plasma proteins into the intestinal lumen.
3. Intestinal lymphatic obstruction, increased intestinal interstitial pressure, so that the protein-rich intestinal stroma can not be kept in the interstitium or absorbed into the blood circulation, but it will overflow and enter the intestinal lumen and be lost. The mechanism by which intestinal inflammation causes protein-losing gastrointestinal disorders is unclear, probably due to exudation of extracellular fluid and inflammatory fluids in the inflammatory zone. Under normal circumstances, the amount of plasma protein leaking into the gastrointestinal tract is not much. It is estimated that these proteins are less than 6% of circulating albumin, which is equivalent to 10% to 20% of the daily decomposition rate of these plasma proteins, of which more than 90% are Re-absorption after digestion, therefore, gastrointestinal catabolism does not play an important role in the total catabolism of plasma proteins. In protein-losing gastrointestinal disorders, plasma protein loss from the gastrointestinal tract far exceeds normal loss. The degradation rate of protein in the gastrointestinal tract can be as high as 40% to 60% of the total circulating plasma protein. Loss of protein from the gastrointestinal tract is not related to the molecular weight of the protein in protein-losing gastrointestinal disorders. A large amount of plasma protein leaks into the gastrointestinal tract, resulting in a shortened half-life of plasma protein and an accelerated turnover rate. Studies have shown that in this disease, the plasma protein is leaked from the gastrointestinal mucosa regardless of its molecular size, so the slower the synthesis rate and/or the longer the half-life, the more obvious the decrease of plasma protein. The half-life of albumin and IgG is long, and even if the body performs compensatory synthesis, its ability is limited, and the rate of synthesis of albumin in the liver can be increased by a factor of at most; and the synthesis of immunoglobulin such as IgG is not stimulated by a decrease in plasma concentration. Therefore, the plasma concentrations of albumin and IgG are the most severe in this disease, making patients with this disease often accompanied by hypoalbuminemia. Plasma proteins with fast turnover and short half-life, such as transferrin, ceruloplasmin, IgM, etc., are not easily affected, and this disease is only slightly reduced. The fibrinogen has the shortest half-life and the fastest synthesis rate, so the plasma concentration is generally normal. The protein lost into the gastrointestinal cavity is decomposed into amino acids and peptides in the intestinal lumen and reabsorbed into the blood circulation. As a nitrogen source of the body, if the amount of protein lost into the gastrointestinal tract is large, the rate of entering the intestine is faster or The intestinal peristalsis is faster, and a large amount of protein is excreted from the intestine. If the protein is lost from the intestine due to obstruction of the intestinal lymphatics, lymphocytes may be lost from the intestine and blood lymphocytes may be reduced. In addition, other plasma components such as copper, calcium, iron, lipids, and the like can also be lost from the gastrointestinal tract.
Prevention
Gastrointestinal cancer with cancer prevention
Prevention: Effective treatment of the etiology of protein-losing gastrointestinal diseases is the key to prevention. The treatment is mainly the resection of primary cancer, and it can also be treated with somatostatin analogues such as octreotide, which is effective for controlling diarrhea.
Complication
Gastrointestinal tract with cancer complications Complications acne edema
1. Mainly for the reduction of plasma albumin and IgG, often early fatigue, weight loss, fatigue, sexual dysfunction, severe lack of visible dry skin, desquamation, pigmentation, sometimes acne, dry hair, easy to fall off, Insufficient mentality, memory loss, excitement and excitement, and even expression of indifference, some patients, especially children may have growth and development disorders, and even death.
2. Due to the decrease of plasma protein, especially albumin, the plasma colloid osmotic pressure is reduced, the water is transferred from the blood vessel to the interstitial space, and the secondary aldosterone secretion is increased, resulting in the retention of sodium and water, and the lower extremity edema occurs during systemic edema. The most common, but also visible facial, upper limb, or periumpanic edema but systemic edema is rare.
Symptom
Symptoms of gastrointestinal syndrome with cancer Common symptoms diarrhea hypoproteinemia tissue necrosis gastrointestinal mucosal permeability increased secretory diarrhea intestinal villus atrophy shock edema gastrointestinal lymphatic drainage blocked lymphatic deposition
First, protein loss gastrointestinal disease
More common in gastric cancer and colon cancer, due to the necrosis of cancer tissue, the permeability of the corresponding gastrointestinal mucosa is increased, a large amount of plasma protein leaks from the gastrointestinal tract, cancerous tumors and occlusion of lymphatic vessels, causing obstruction of gastrointestinal lymphatic drainage, lymph The tube is silted, ruptured, and a large amount of protein is lost. Clinically, hypoproteinemia and edema are the main manifestations.
Second, small intestine villi atrophy
Can be seen in colon cancer, rectal cancer, mainly manifested as diarrhea.
Third, diarrhea, loss of water and shock
Mainly found in colonic villus adenoma, occasionally in the digestive tract APUD system tumors, such as VIP tumors, gastrinoma and pancreatic polypeptide tumors, etc., manifested as secretory diarrhea, can lead to water loss, electrolyte imbalance, and even shock.
Examine
Examination of gastrointestinal tract with cancer syndrome
X-ray inspection
X-ray examination of the gastrointestinal tract is important for differential diagnosis, especially the following X-ray signs: large hypertrophy of gastrointestinal mucosa (see hypertrophic secretory stomach disease); X-ray sign of malabsorption (intestinal dilatation, snowflake or feather) The sputum sputum is deposited, the sputum is distributed in a segmental manner, and is found in various protein-loss gastrointestinal diseases with malabsorption; the intestinal mucosa is generally thickened (lymphoma, Crohn's disease, primary intestinal lymphatics) Dilatation or secondary intestinal lymphatic obstruction; small intestinal mucosa with nodular changes after finger pressure (lymphoma, Crohn's disease), abdominal CT scan helps to find mesenteric lymphadenopathy.
2. Jejunal mucosa biopsy
Multiple jejunal mucosal biopsy is useful for the diagnosis of lymphoma, celiac disease, eosinophilic gastroenteritis, collagen gastroenteritis, intestinal lymphatic dilatation, and Whipple disease.
3. Lymphangiography
Transpedicular lymphangiography is helpful in identifying congenital or secondary intestinal lymphatic dilatation. The former can be seen in peripheral lymphatic dysplasia and thoracic duct lesions. The contrast agent stays in the retroperitoneal lymph nodes, but the mesenteric lymphatic system does not fill. The contrast agent can be refluxed to the dilated mesenteric lymphatics and spilled into the intestinal or peritoneal cavity.
4. Ascites examination
Those with ascites can be used for diagnostic puncture, ascites cells, proteins, chylomicrons, enzymes, malignant cells, etc.
Diagnosis
Diagnosis and diagnosis of gastrointestinal syndrome with cancer
diagnosis
A protein-deprived gastrointestinal disorder can be confirmed by a radionuclide-labeled macromolecular substance digestive tract excretion test, or an 1-antitrypsin test.
Differential diagnosis
Decompensated cirrhosis
The clinical manifestations of portal hypertension, liver shrinkage, splenomegaly, and abnormal liver function, etc., are characteristic of these cirrhosis.
2. Nephrotic syndrome
Nephrotic syndrome has a large amount of plasma protein (especially albumin) lost from the urine, urinary protein excretion rate> 3.5g / d, mainly albumin, increased plasma cholesterol, with increased concentration of triacylglycerol and low-density lipoprotein The urine test has red blood cells, granular casts, and can also have renal dysfunction and high blood pressure.
3. Plasma protein hyperremediation disease
Long-term fever, hyperthyroidism, malignant tumors, diabetes, etc., can cause excessive consumption of hypoproteinemia, but each has its own disease history and clinical features, specific laboratory and other auxiliary examination abnormalities, can not find plasma Evidence of excessive protein loss from the gastrointestinal tract.
4. Protein digestion and malabsorption
Mainly seen in most of the gastric resection, chronic pancreatitis and some intestinal malabsorption diseases, increased protein and its incomplete decomposition products in the feces, often accompanied by increased fecal fat content, pancreatic exocrine function test and corresponding small intestinal absorption function test abnormalities There is no evidence that plasma protein is excessively lost from the gastrointestinal mucosa, but it should be noted that some diseases that cause protein malabsorption can also cause protein-losing gastrointestinal diseases, so the possibility that the two can exist simultaneously or sequentially is not excluded. .
5. Congenital hypoalbuminemia
In childhood, there is obvious hypoalbuminemia, serum albumin is often <10g / L, erythrocyte sedimentation rate is high, serum cholesterol is high, globulin is normal or increased, sometimes it needs to be dialysis with long-term, and a large number of chest pumps are taken. Ascites, insufficient protein intake, major bleeding, large area burns, etc. lead to the identification of hypoproteinemia, according to the unique medical history, clinical manifestations and the lack of identification of plasma proteins from the gastrointestinal tract.
